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Nomair AM, Abdelati A, Dwedar FI, Elnemr R, Kamel YN, Nomeir HM. The impact of folate pathway variants on the outcome of methotrexate therapy in rheumatoid arthritis patients. Clin Rheumatol 2024; 43:971-983. [PMID: 38311638 PMCID: PMC10876746 DOI: 10.1007/s10067-024-06892-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/21/2024] [Accepted: 01/27/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND There are currently no validated criteria that entirely explain or predict response to methotrexate (MTX) treatment in rheumatoid arthritis (RA). We tried to identify the connection between three variants (RFC1 G80A (rs1051266), TYMS 2R/3R (rs34743033), and ATIC C347G (rs2372536)) in the folate pathway of MTX metabolism and the response to MTX monotherapy in a cohort of RA cases. METHODS A prospective study on 100 RA patients on MTX monotherapy was performed. Disease activity was measured at the start of treatment and 6 months after treatment with MTX. The patients were then split into two groups: those who responded to the treatment and those who did not. The molecular genetic study for the RFC1 (G80A) variant was employed via the PCR-restriction fragment length polymorphism (PCR-RFLP) technique, the ATIC (C347G) variant was performed using TaqMan allelic discrimination real-time PCR, and the tandem repeat sequences of TYMS (2R/3R) were amplified by conventional PCR and detected by agarose gel electrophoresis. RESULTS The genotype distribution of RFC-1 (G80A) showed significant variations among non-responders and responders in the recessive genetic model. A significant difference was found in TYMS (2R/3R) in the dominant and heterozygous genetic models. However, ATIC (C347G) genotype frequency did not exhibit substantial link with drug response in all genetic models. Furthermore, the genotype and allele rates of the analyzed variants did not show any significant association with adverse events in all genetic models. CONCLUSION The 80AA genotype of RFC-1 G80A and the 2R/3R or 3R/3R genotypes of TYMS 2R/3R are more vulnerable to the good consequences of MTX therapy. Key Points • Current recommendations support the gold standard role of MTX as a first-line monotherapy for RA patients. However, up to 40% of RA patients do not respond or exhibit partial response to MTX. • Persistent disease activity due to treatment unresponsiveness will affect the long-term outcomes in RA patients. • We aimed, through molecular genetic study, to identify the connection between three variants in the folate pathway of MTX metabolism and the response to methotrexate monotherapy in a cohort of RA patients.
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Affiliation(s)
- Azhar M Nomair
- Department of Chemical Pathology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Abeer Abdelati
- Department of Internal Medicine, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Fatma I Dwedar
- Department of Medical Biochemistry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rehab Elnemr
- Department of Physical Medicine Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasmine N Kamel
- Department of Medical Biochemistry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hanan M Nomeir
- Department of Medical Biochemistry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Ghaffari S, Fateh S, Faramarzi F, Rafiei A, Razavipour M, Zafari P. The effect of tranexamic acid on synovium of patients undergoing arthroplasty and anterior cruciate ligament reconstruction surgery. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:3733-3742. [PMID: 37318523 DOI: 10.1007/s00210-023-02555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Abstract
Preoperative hemorrhage can be reduced using anti-fibrinolytic medicine tranexamic acid (TXA). During surgical procedures, local administration is being used more and more frequently, either as an intra-articular infusion or as a perioperative rinse. Serious harm to adult soft tissues can be detrimental to the individual since they possess a weak ability for regeneration. Synovial tissues and primary fibroblast-like synoviocytes (FLS) isolated from patients were examined using TXA treatment in this investigation. FLS is obtained from rheumatoid arthritis (RA), osteoarthritis (OA), and anterior cruciate ligament (ACL)-ruptured patients. The in vitro effect of TXA on primary FLS was investigated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cell viability assays for cell death, annexin V/propidium iodide (PI) staining for apoptotic rate, real-time PCR for p65 and MMP-3 expression, and enzyme-linked immunosorbent assay (ELISA) for IL-6 measurement. MTT assays revealed a significant decrease in cell viability in FLS of all groups of patients following treatment with 0.8-60 mg/ml of TXA within 24 h. There was a significant increase in cell apoptosis after 24 h of exposure to TXA (15 mg/ml) in all groups, especially in RA-FLS. TXA increases the expression of MMP-3 and p65 expression. There was no significant change in IL-6 production after TXA treatment. An increase in receptor activator of nuclear factor kappa-Β ligand (RANK-L) production was seen only in RA-FLS. This study demonstrates that TXA caused significant synovial tissue toxicity via the increase in cell death and elevation of inflammatory and invasive gene expression in FLS cells.
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Affiliation(s)
- Salman Ghaffari
- Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soroosh Fateh
- Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Faramarzi
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Rafiei
- Department of Immunology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehran Razavipour
- Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Parisa Zafari
- Ramsar Campus, Mazandaran University of Medical Sciences, Ramsar, Iran.
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Ramzy M, Gharbia OM, Seleem AK, Mohamed K, Marzouk RE. Methylation of receptor activator of nuclear factor kappa ligand (RANKL) gene in rheumatoid arthritis patients. THE EGYPTIAN RHEUMATOLOGIST 2023. [DOI: 10.1016/j.ejr.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Nishino T, Hashimoto A, Tohma S, Matsui T. Comprehensive evaluation of the influence of sex differences on composite disease activity indices for rheumatoid arthritis: results from a nationwide observational cohort study. BMC Rheumatol 2023; 7:4. [PMID: 36945056 PMCID: PMC10029312 DOI: 10.1186/s41927-023-00328-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 02/24/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The effects and their magnitudes of sex on disease activity indices for rheumatoid arthritis are not clear. We aimed to comprehensively evaluate the influence of sex on disease activity indices in the real-world setting using a large observational database. METHODS We analyzed 14,958 patients registered in the National Database of Rheumatic Diseases in Japan (NinJa) in 2017. We evaluated the sex differences in the 28-joint disease activity score (DAS28) using erythrocyte sedimentation rate (ESR), DAS28 using C-reactive protein (DAS28-CRP), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index by disease activity category using Cliff's delta and regression analysis. Differences in the share of components of indices were evaluated using permutational multivariate analysis of variance. Correction equations were constructed to estimate the number of misclassification in male patients who achieve DAS28-ESR remission. RESULTS DAS28-ESR showed higher values in female patients than male patients in remission despite no obvious difference in other indices or disease activity categories. Among the components of DAS28-ESR, only ESR was higher in female patients than male patients in remission. In DAS28-CRP and SDAI, 28-tender joint count was higher and CRP was lower in female patients than male patients. In addition, the profiles in the components were different between female and male patients, especially among those with high disease activity. Using correction equations, almost 12% of male patients with DAS28-ESR remission were estimated to be misclassified, mainly due to differences in ESR. CONCLUSION Among the disease activity indices, significant sex difference was observed only in DAS28-ESR remission. The degree of misclassification in DAS28-ESR remission would be unignorable.
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Affiliation(s)
- Takahiro Nishino
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan
| | - Atsushi Hashimoto
- Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Shigeto Tohma
- Department of Rheumatology, National Hospital Organization Tokyo National Hospital, Kiyose, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Rheumatology Research, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, 18-1, Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan.
- Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan.
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5
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Wang J, Wu Z, Wang M, Qi Q, Song Q, Sun B, Li C, Dong Y. Evaluation of tenosynovitis in patients with seronegative rheumatoid arthritis using microvascular flow imaging. Med Eng Phys 2022; 110:103839. [PMID: 35773135 DOI: 10.1016/j.medengphy.2022.103839] [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: 04/12/2022] [Revised: 06/06/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The purpose of this research was investigate the potential use of MVFI (microvascular flow imaging) in the assessment of tenosynovitis in cases with SNRA (seronegative rheumatoid arthritis). METHODS Fifty-six SNRA cases and 20 HCs (healthy controls) were enrolled, and all of them were subjected to ultrasonographic examination of the compartments I-VI of the extensor tendons of the wrist, flexor carpi radialis and flexor tendons of the five digits. Each tendon synovial sheath was semi-quantitatively scored by GS (gray-scale) ultrasound, PD (power Doppler) ultrasound, and MVFI. The PD and MVFI scores for each tendon synovial sheath were added up for each patient to get the total scores. GS scores, PD scores, and MVFI scores of tendon synovial sheaths were compared between the two groups. The correlations of total PD scores and total MVFI scores with DAS28 (disease activity scores in 28 joints), ESR (erythrocyte sedimentation rate), and CRP (C-reactive protein) were analyzed. RESULTS (1) In the HC group (480 tendons), GS revealed abnormalities in 29 (6.04%) tendon synovial sheaths. The GS score was 1.03 ± 0.18 with the predominance of GS grade 1 (96.55%). In the SNRA group (1,344 tendons), GS detected abnormalities in 418 tendon synovial sheaths (31.10%). The GS score was 1.97 ± 0.53 with the predominance of GS grade 2 (71.77%). There were significant differences in the GS examination rate and grade for tenosynovitis between the two groups (P < 0.05). (2) In the SNRA group, involvement of the extensor carpi ulnaris in the 6th dorsal compartment was the most common among all extensor tendons; the flexor tendon of the third digit was the most commonly affected among all flexor tendons. (3) In the HC group, the MVFI and PD scores were 0 for tendon synovial sheaths upon GS examination. In the SNRA group, the blood flow display rate of abnormal tendon synovial sheaths indicated by GS was 83.49% and 64.59% upon MVFI and PD, respectively. The results of the two imaging techniques were significantly different (P < 0.05). The blood flow grade of abnormal tendon synovial sheaths indicated by GS was significantly different between MVFI and PD (P < 0.05), which was higher upon MVFI than PD. (4) The total MVFI score and the total PD score in the SNRA group were correlated positively with CRP, ESR and DAS28 (P < 0.05). CONCLUSION MVFI is a more sensitive way in detection of blood flow in the tendon synovial sheaths of SNRA cases, which may be used in clinic to evaluate disease activity and tenosynovitis in SNRA cases.
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Affiliation(s)
- Junkui Wang
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Zhibin Wu
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Miao Wang
- Department of Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Qinghua Qi
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China.
| | - Qingshan Song
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Bingfang Sun
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Caiyun Li
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Yu Dong
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
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Hsieh PH, Geue C, Wu O, McIntosh E, Siebert S. How do multiple long-term conditions impact on the cost-of-illness in early rheumatoid arthritis? RMD Open 2022; 8:rmdopen-2022-002454. [PMID: 36104116 PMCID: PMC9476122 DOI: 10.1136/rmdopen-2022-002454] [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: 05/05/2022] [Accepted: 08/20/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Multiple long-term conditions (MLTCs) are prevalent in rheumatoid arthritis (RA) and associated with worse outcomes and greater economic burden. However, little is known about the impact of MLTCs on the cost-of-illness (COI) in early RA, including direct and indirect costs. The objective of this study was to quantify this impact on COI. METHODS The Scottish Early Rheumatoid Arthritis study is a national cohort of adults with new-onset RA. Direct costs were estimated applying relevant unit costs to health resource utilisation; indirect costs were measured by productivity loss due to health conditions. Two-part models were used, adjusting for age, gender, baseline functional disability and health-related quality of life. The Charlson Comorbidity Index score was calculated using ICD-10 diagnoses. Individuals were defined as 'RA alone', 'RA plus LTC' and 'RA plus MLTCs' according to the number of coexisting LTCs. RESULTS Data were available for 818 participants. Average annualised direct costs incurred by people with early RA plus MLTCs (£4444; 95% CI £3100 to £6371) were twice as, and almost five times higher than, those with a single LTC (£2184; 95% CI £1596 to £2997) and those without LTC (£919; 95% CI £694 to £1218), respectively. Indirect costs incurred by RA plus MLTCs (£842; 95% CI £377to £1521) were 3.1 times higher than RA alone (£530; 95% CI £273to £854). The relative proportion of direct costs increased with LTC category, ranging from 77.2% to 84.1%. In addition to increased costs with LTCs, costs also increased with age and were higher for men regardless of LTC category. CONCLUSIONS MLTCs impact on COI early in the course of RA. The presence of LTCs is associated with significant increases in both direct and indirect costs among people with early RA.
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Affiliation(s)
- Ping-Hsuan Hsieh
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan .,Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- School of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
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Mustufvi Z, Twigg J, Kerry J, Chesterman J, Pavitt S, Tugnait A, Mankia K. Does periodontal treatment improve rheumatoid arthritis disease activity? A systematic review. Rheumatol Adv Pract 2022; 6:rkac061. [PMID: 35993013 PMCID: PMC9390064 DOI: 10.1093/rap/rkac061] [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: 02/08/2022] [Accepted: 07/10/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
The association of periodontal disease in people diagnosed with RA is emerging as an important driver of the RA autoimmune response. Screening for and treating periodontal disease might benefit people with RA. We performed a systematic literature review to investigate the effect of periodontal treatment on RA disease activity.
Methods
Medline/PubMed, Embase and Cochrane databases were searched. Studies investigating the effect of periodontal treatment on various RA disease activity measures were included. The quality of included studies was assessed. Data were grouped and analysed according to RA disease outcome measures, and a narrative synthesis was performed.
Results
We identified a total of 21 studies, of which 11 were of non-randomized experimental design trials and 10 were randomized controlled trials. The quality of the studies ranged from low to serious/critical levels of bias. RA DAS-28 was the primary outcome for most studies. A total of 9 out of 17 studies reported a significant intra-group change in DAS-28. Three studies demonstrated a significant intra-group improvement in ACPA level after non-surgical periodontal treatment. Other RA biomarkers showed high levels of variability at baseline and after periodontal treatment.
Conclusion
There is some evidence to suggest that periodontal treatment improves RA disease activity in the short term, as measured by DAS-28. Further high-quality studies with longer durations of follow-up are needed. The selection of the study population, periodontal interventions, biomarkers and outcome measures should all be considered when designing future studies. There is a need for well-balanced subject groups with prespecified disease characteristics.
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Affiliation(s)
| | | | - Joel Kerry
- Library and Information Service, Leeds Teaching Hospitals NHS Trust
| | | | - Sue Pavitt
- School of Dentistry, University of Leeds
| | | | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds , Leeds, UK
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Van Hoovels L, Vander Cruyssen B, Sieghart D, Bonroy C, Nagy E, Pullerits R, Čučnik S, Dahle C, Heijnen I, Bernasconi L, Benkhadra F, Bogaert L, Van Den Bremt S, Van Liedekerke A, Vanheule G, Robbrecht J, Studholme L, Wirth C, Müller R, Kyburz D, Sjöwall C, Kastbom A, Ješe R, Jovancevic B, Kiss E, Jacques P, Aletaha D, Steiner G, Verschueren P, Bossuyt X. Multicentre study to improve clinical interpretation of rheumatoid factor and anti-citrullinated protein/peptide antibodies test results. RMD Open 2022; 8:rmdopen-2021-002099. [PMID: 35321875 PMCID: PMC8943733 DOI: 10.1136/rmdopen-2021-002099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Rheumatoid factor (RF) and anti-citrullinated protein/peptide antibodies (ACPA) are important biomarkers for diagnosis of rheumatoid arthritis (RA). However, there is poor harmonisation of RF and ACPA assays. The aim of this study was to refine RF and ACPA interpretation across commercial assays. MATERIALS AND METHODS Six total RF isotype-non-specific assays, 3 RF IgM isotype-specific assays and 9 ACPA immunoglobulin G assays of 13 different companies were evaluated using 398 diagnostic samples from patients with RA and 1073 disease controls. RESULTS Using cut-offs proposed by the manufacturer, there was a large variability in diagnostic sensitivity and specificity between assays. Thresholds of antibody levels were determined based on predefined specificities and used to define test result intervals. Test result interval-specific likelihood ratios (LRs) were concordant across the different RF and ACPA assays. For all assays, the LR for RA increased with increasing antibody level. Higher LRs were found for ACPA than for RF. ACPA levels associated with LRs >80 were found in a substantial fraction (>22%) of patients with RA. CONCLUSION Defining thresholds for antibody levels and assigning test result interval-specific LRs allows alignment of clinical interpretation for all RF and ACPA assays.
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Affiliation(s)
- Lieve Van Hoovels
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium .,Department of Laboratory Medicine, OLV Ziekenhuis, Aalst, Belgium
| | | | - Daniela Sieghart
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Carolien Bonroy
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Eszter Nagy
- Department of Laboratory Medicine, National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
| | - Rille Pullerits
- Department of Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital, Gotheburg, Sweden.,Department of Rheumatology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Saša Čučnik
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Charlotte Dahle
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingmar Heijnen
- Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Farid Benkhadra
- Department of Laboratory Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Laura Bogaert
- Department of Laboratory Medicine, OLV Ziekenhuis, Aalst, Belgium
| | | | - Ann Van Liedekerke
- Department of Laboratory Medicine, AZ Sint-Elisabeth Ziekenhuis Zottegem, Zottegem, Belgium
| | - Geert Vanheule
- Department of Laboratory Medicine, AZ Rivierenland Campus Bornem, Bornem, Belgium
| | - Johan Robbrecht
- Department of Laboratory Medicine, AZ Sint-Lucas Brugge, Brugge, Belgium
| | - Lucy Studholme
- National Institute for Biological Standards and Control, Hertfordshire, UK
| | - Claudine Wirth
- Department of Rheumatology, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Rüdiger Müller
- Department of Rheumatology, Rheumazentrum Ostschweiz, St. Gallen, Switzerland
| | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Christopher Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alf Kastbom
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Rok Ješe
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Boja Jovancevic
- Department of Rheumatology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Emese Kiss
- Department of Clinical Immunology, Adult and Pediatric Rheumatology, National Institute of Locomotor Diseases and Disabilities, Budapest, Hungary
| | - Peggy Jacques
- Department of Rheumatology, University Hospital Ghent and VIB Inflammation Research Center, Ghent, Belgium
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Guenter Steiner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Patrick Verschueren
- Department of Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, KU Leuven University Hospitals Leuven, Leuven, Belgium
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Van Hoovels L, Studenic P, Sieghart D, Steiner G, Bossuyt X, Rönnelid J. Impact of autoimmune serology test results on RA classification and diagnosis. J Transl Autoimmun 2022; 5:100142. [PMID: 35036891 PMCID: PMC8749172 DOI: 10.1016/j.jtauto.2022.100142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 12/04/2022] Open
Abstract
Rheumatoid arthritis (RA) is the most common systemic autoimmune disease and also the most severe arthritic disorder. The measurement of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) in serum supports the diagnosis of RA, which gained increasing significance over the last 65 years. However, a high variability between RF and ACPA methods has been described, impacting the diagnostic performance of the current ACR/EULAR RA classification criteria. The great number of commercially available assays, often lacking traceability to an international standard, is a major factor attributing to this in-between assay variability. The adoption of an international standard for ACPA, as is since long available for rheumatoid factor, is therefore highly desirable. Further harmonization in clinical interpretation of RF/ACPA assays could be obtained by harmonization of the cut-offs, for both the low and high antibody levels, based on predefined specificity in disease controls. Reporting test result specific likelihood ratios (LR) adds value in the interpretation of autoantibody tests. However, a good understanding of the control population used to define antibody test result interval-associated LRs is crucial in defining the diagnostic performance characteristics of antibody serology. Finally, specificity in RA classification can be improved by refining serological weight scoring taking into account the nature of the antibody, the antibody level and double RF + ACPA positivity.
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Affiliation(s)
- Lieve Van Hoovels
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, OLV Hospital, Aalst, Belgium
| | - Paul Studenic
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Division of Rheumatology, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Daniela Sieghart
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Günter Steiner
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Mahmoudian A, Lohmander LS, Mobasheri A, Englund M, Luyten FP. Early-stage symptomatic osteoarthritis of the knee - time for action. Nat Rev Rheumatol 2021; 17:621-632. [PMID: 34465902 DOI: 10.1038/s41584-021-00673-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
Osteoarthritis (OA) remains the most challenging arthritic disorder, with a high burden of disease and no available disease-modifying treatments. Symptomatic early-stage OA of the knee (the focus of this Review) urgently needs to be identified and defined, as efficient early-stage case finding and diagnosis in primary care would enable health-care providers to proactively and substantially reduce the burden of disease through proper management including structured education, exercise and weight management (when needed) and addressing lifestyle-related risk factors for disease progression. Efforts to define patient populations with symptomatic early-stage knee OA on the basis of validated classification criteria are ongoing. Such criteria, as well as the identification of molecular and imaging biomarkers of disease risk and/or progression, would enable well-designed clinical studies, facilitate interventional trials, and aid the discovery and validation of cellular and molecular targets for novel therapies. Treatment strategies, relevant outcomes and ethical issues also need to be considered in the context of the cost-effective management of symptomatic early-stage knee OA. To move forwards, a multidisciplinary and sustained international effort involving all major stakeholders is required.
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Affiliation(s)
- Armaghan Mahmoudian
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium.,Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Frank P Luyten
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium.
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11
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Isnardi CA, Capelusnik D, Schneeberger EE, Bazzarelli M, Berloco L, Blanco E, Benítez CA, Luján Benavidez F, Scarafia S, Lázaro MA, Pérez Alamino R, Colombres F, Kohan MP, Sosa J, Gonzalez Lucero L, Barbaglia AL, Maldonado Ficco H, Citera G. Depression Is a Major Determinant of Functional Capacity in Rheumatoid Arthritis. J Clin Rheumatol 2021; 27:S180-S185. [PMID: 32732521 DOI: 10.1097/rhu.0000000000001506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of depression among rheumatoid arthritis (RA) Argentinean patients and its association with sociodemographic and clinical factors. METHODS We performed a cross-sectional study of consecutive adults with RA. Sociodemographic data, comorbidities, RA disease activity, and current treatment were assessed. The following instruments were used to evaluate quality of life (EQ-5D-3 L [EURO Quality 5-dimension 3 lines], QOL-RA [Quality of Life-Rheumatoid Arthritis]), functional capacity (HAQ-A [Health Assessment Questionnaire-Argentinean version]), and depression (PHQ-9 [Patient Health Questionnaire 9]; scores 5-9: mild, 10-14: moderate, 15-19: moderate-severe, and ≥20: severe depression, a cutoff value ≥10 is diagnostic of major depression). RESULTS Two hundred fifty-eight patients were included, with a median disease duration of 9 years (interquartile range, 3.6-16.7 years). The m PHQ-9 score was 6 (interquartile range, 2-12.3 years). The prevalence of major depression was 33.8%. The frequency of mild, moderate, moderate/severe, and severe depression was 66 (25.6%), 42 (16.3%), 27 (10.5%), and 18 (7%), respectively. Patients with major depression had worse functional capacity (HAQ-A: mean ± SD, 1.6 ± 0.8 vs. 0.7 ± 0.7; p < 0.0001), poorer quality of life (QOL-RA: mean ± SD, 5.4 ± 1.8 vs. 7.3 ± 1.6; p < 0.0001), greater pain (visual analog scale: mean ± SD, 56.2 ± 27.5 mm vs. 33.4 ± 25.7 mm; p < 0.0001), higher disease activity (Disease Activity Score in 28 joints: mean ± SD, 4.3 ± 1.4 vs. 3.3 ± 1.3; p < 0.0001), higher frequency of comorbidities (67% vs. 33%; p = 0.017), and lower frequency of physical activity (22% vs. 35%; p = 0.032). In the multivariate analysis, patients with moderate and severe depression had worse functional capacity (odds ratio, 2.1; 95% confidence interval, 1.6-4.3; p < 0.0001) and quality of life (odds ratio, 0.7; 95% confidence interval, 0.5-0.8; p < 0.0001), independently of disease activity. CONCLUSIONS A third of RA patients in this Argentinean cohort had major depression. In those patients, depression was associated with worst functional capacity and quality of life.
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Affiliation(s)
- Carolina A Isnardi
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| | - Dafne Capelusnik
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| | - Emilce Edith Schneeberger
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| | - Marcela Bazzarelli
- Section of Rheumatology, Hospital Interzonal General de Agudos Petrona V. de Cordero
| | - Laura Berloco
- Section of Rheumatology, Hospital Interzonal General de Agudos Petrona V. de Cordero
| | - Eliana Blanco
- Section of Rheumatology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires
| | - Cristian A Benítez
- Section of Rheumatology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires
| | - Federico Luján Benavidez
- Section of Rheumatology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires
| | | | - María A Lázaro
- Instituto de Asistencia Reumatológica Integral, Buenos Aires
| | | | | | - María P Kohan
- Section of Rheumatology, Hospital General de Agudos Dr. Enrique Tornú, Ciudad Autónoma de Buenos Aires, Buenos Aires
| | - Julia Sosa
- Section of Rheumatology, Hospital General de Agudos Dr. Enrique Tornú, Ciudad Autónoma de Buenos Aires, Buenos Aires
| | | | | | | | - Gustavo Citera
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
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Rodríguez‐Montaño R, Bernard‐Medina AG, Oregon‐Romero E, Martínez‐Rodríguez VMDC, Pita‐López ML, Gómez‐Meda BC, Guerrero‐Velázquez C. IL-23/IL-17 axis and soluble receptors isoforms sIL-23R and sIL-17RA in patients with rheumatoid arthritis-presenting periodontitis. J Clin Lab Anal 2021; 35:e23963. [PMID: 34403509 PMCID: PMC8418468 DOI: 10.1002/jcla.23963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/21/2021] [Accepted: 08/07/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) and periodontitis (P) are chronic inflammatory diseases characterized by joint and radiographic bone loss, respectively. IL-23 and IL-17 have an essential role in the immunopathogenesis of RA, and P. IL-23 stimulates Th17 cells through which produces IL-17, IL-21, and RANKL. IL-17 stimulates fibroblasts to produce RANKL, which initiates bone loss in the joints in RA and the periodontal tissue in periodontitis. The aim of this study was to determine the expression pattern of IL-23/IL-17 axis and soluble receptors isoforms sIL-23R and sIL-17RA of patients with RA presenting P (RAP). MATERIAL AND METHODS Healthy subjects (HS) (n = 42), patients with P (n = 40), RA (n = 20), and patients with RAP (n = 40) were included. Plasma samples were obtained to evaluate the IL-23, IL-17A, sIL-23R, and sIL-17RA by ELISA technique. A nonparametric Mann-Whitney U test was used to compare the differences between groups. A Chi-square was used to compare gender, grade and stage of periodontitis, and DAS28-ESR between the groups. Spearman's rank correlation coefficient was used to study the association between the molecules and clinical parameters. RESULTS IL-23 levels were increased in the RAP group, and lower sIL-23R levels were found in the RAP groups. However, IL-17A was lower in the P and RAP group but not in RA patients. RAP group showed a decrease IL-17A levels in advanced stages of the periodontal disease. CONCLUSION These results suggest that IL-23 and IL-17A tend to downregulate their expression patterns when patients present both rheumatoid arthritis and periodontitis.
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Affiliation(s)
- Ruth Rodríguez‐Montaño
- Instituto de Investigación en OdontologíaDepartamento de Clínicas Odontológicas IntegralesCentro Universitario de Ciencias de la SaludUniversidad de GuadalajaraGuadalajaraMéxico
- Doctorado en Ciencias Biomédicas (Orientación Inmunología)Centro Universitario de Ciencias de la Salud. Universidad de GuadalajaraGuadalajaraMéxico
| | | | - Edith Oregon‐Romero
- Instituto de Investigación en Ciencias BiomédicasDepartamento de Biología Molecular y GenómicaCentro Universitario de Ciencias de la Salud. Universidad de GuadalajaraGuadalajaraMéxico
| | | | - María Luisa Pita‐López
- Centro de Investigación en Biología Molecular de las Enfermedades Crónicas (CIBIMEC)Departamento de Ciencias Básicas para la SaludCentro Universitario del Sur. Universidad de GuadalajaraGuadalajaraMéxico
| | - Belinda Claudia Gómez‐Meda
- Departamento de Biología Molecular y GenómicaInstituto de Genética Humana “Dr. Enrique Corona Rivera”Centro Universitario de Ciencias de la SaludUniversidad de GuadalajaraGuadalajaraMéxico
| | - Celia Guerrero‐Velázquez
- Instituto de Investigación en OdontologíaDepartamento de Clínicas Odontológicas IntegralesCentro Universitario de Ciencias de la SaludUniversidad de GuadalajaraGuadalajaraMéxico
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Barbich T, Cerda OL, Schneeberger EE, Citera G. Adherence to treatment with tofacitinib in patients with rheumatoid arthritis in daily clinical practice. ACTA ACUST UNITED AC 2021; 18:164-168. [PMID: 34301525 DOI: 10.1016/j.reumae.2020.11.003] [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: 06/17/2020] [Accepted: 11/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the adherence to treatment with Tofacitinib in patients with Rheumatoid Arthritis (RA) using two versions of the self-questionnaire Compliance Questionnaire Rheumatology, CQR19 and CQR5, to determine the variables associated with adherence to Tofacitinib and to compare the performance of both questionnaires. MATERIAL AND METHODS A cross-sectional study was carried out. We included patients ≥18 years old, with RA (ACR/EULAR criteria 2010) under treatment with Tofacitinib. Sociodemographic data, clinical characteristics, treatment and data on patient evaluation. All the patients completed self-questionnaires CQR19 and CQR5. STATISTICAL ANALYSIS Descriptive statistics. t-Test or Mann Whitney to compare the continuous variables, Chi2 test or Fisher's exact test for the categorical ones. Kappa concordance index. Multiple logistic regression. RESULTS We included 52 patients, 82.7% women, with a median (m) age of 57.7 years, disease duration m 16 years, 63.5% had comorbidities. Of the patients, 86.5% were treated with Tofacitinib (5 mg BID) and 48% received Tofacitinib as monotherapy. The median time of Tofacitinib treatment was 13 months, 42.3% suspended treatment, and only one patient permanently stopped treatment due to lack of provision. Median CQR19 was 89.5% and 84.6% had an adherence ≥ 80%. The variables significantly associated with adherence ≥ 80% were the presence of comorbidities (p = .014) and older age (p = .033). Considering the CQR5, a similar percentage of patients (82.7%) were adherents to treatment, however, the concordance with CQR19 was low. In the multivariate analysis, older age was the only variable independently associated with good adherence to treatment. CONCLUSIONS Treatment adherence to Tofacitinib was very good for both presentations. Older age was associated with higher adherence. The agreement between the questionnaires CQR19 and CQR5 was low.
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Affiliation(s)
- Tatiana Barbich
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina
| | - Osvaldo Luis Cerda
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina
| | | | - Gustavo Citera
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina.
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Barbich T, Cerda OL, Schneeberger EE, Citera G. Adherence to Treatment with Tofacitinib in Patients with Rheumatoid Arthritis in Daily Clinical Practice. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(20)30274-6. [PMID: 33461871 DOI: 10.1016/j.reuma.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/25/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the adherence to treatment with tofacitinib in patients with rheumatoid arthritis (RA) using two versions of the self-questionnaire Compliance Questionnaire Rheumatology, CQR19 and CQR5, to determine the variables associated with adherence to tofacitinib and to compare the performance of both questionnaires. MATERIAL AND METHODS A cross-sectional study was carried out. We included patients ≥18years old, with RA (ACR/EULAR criteria 2010) under treatment with tofacitinib. Sociodemographic data, clinical characteristics, treatment and data on patient evaluation. All the patients completed self-questionnaires CQR19 and CQR5. STATISTICAL ANALYSIS Descriptive statistics. T-test or Mann Whitney to compare the continuous variables, chi2 test or Fisher's exact test for the categorical ones. Kappa concordance index. Multiple logistic regression. RESULTS We included 52 patients, 82.7% women, with a median (m) age of 57.7years, disease duration m 16years, 63.5% had comorbidities. Of the patients, 86.5% were treated with tofacitinib (5mg BID) and 48% received tofacitinib as monotherapy. The median time of tofacitinib treatment was 13months, 42.3% suspended treatment, and only one patient permanently stopped treatment due to lack of provision. Median CQR19 was 89.5%, and 84.6% had an adherence ≥80%. The variables significantly associated with adherence ≥80% were the presence of comorbidities (P=.014) and older age (P=.033). Considering the CQR5, a similar percentage of patients (82.7%) were adherents to treatment, however, the concordance with CQR19 was low. In the multivariate analysis, older age was the only variable independently associated with good adherence to treatment. CONCLUSIONS Treatment adherence to tofacitinib was very good for both presentations. Older age was associated with higher adherence. The agreement between the questionnaires CQR19 and CQR5 was low.
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Affiliation(s)
- Tatiana Barbich
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina
| | - Osvaldo Luis Cerda
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina
| | | | - Gustavo Citera
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina.
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15
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A useful tool to assess quality of LIFE in rheumatoid arthritis patients that does not require a license: QOL-RA II. Clin Rheumatol 2020; 39:3309-3315. [PMID: 32430630 DOI: 10.1007/s10067-020-05139-8] [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: 01/20/2020] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
To validate the Quality of Life-Rheumatoid Arthritis Scale II (QOL-RA II) in an Argentinean cohort of patients with rheumatoid arthritis (RA). Patients ≥ 18 years old, with a diagnosis of RA according to ACR-EULAR 2010 criteria, were included in a cross-sectional study. Sociodemographic data, comorbidities, RA characteristics, disease activity, and current treatment were registered. Questionnaires were administered, including EQ-5D-3 L, QOL-RA II, HAQ-A, and PHQ-9. The QOL-RA II was re-administered in 20 patients to evaluate reproducibility. Four hundred and thirty patients were included. Median QOL-RA was 6.6 (IQR 5.3-8). Mean time to complete it was 1.7 ± 0.57 min and to calculate it was 12 ± 1.7 s. It showed very good reliability (Cronbach's alpha 0.97), reproducibility (ICC, 0.96), and good correlation between the different items and the total questionnaire, without evidence of redundancy. Besides, QOL-RA II presented good correlation with EQ-5D-3L (Rho, 0.6) and moderate with DAS28 (Rho, 0.38), and CDAI (Rho, 0.46). Worse quality of life was observed in patients not doing physical activity, unemployed, and current smokers. Patients with higher disease activity had a significant poorer quality of life. Adjusting by age, sex and disease duration, unemployment, higher disease activity, disability, and the presence of depression were independently associated to worse quality of life. QOL-RA II demonstrated good construct validity, reproducibility, and reliability. It was easy to complete and calculate and does not require a license for its use, thus making it the optimal tool for assessing the quality of life in Spanish-speaking patients with RA. Key Points • The evaluation of quality of life is very important in patients with Rheumatoid Arthritis. • Most of the questionnaires used to assess the quality of life require a license to use. • QOL-RA II is a valid and simple questionnaire to evaluate the quality of life of patients with RA and does not require a license for its use.
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16
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Precision medicine and management of rheumatoid arthritis. J Autoimmun 2020; 110:102405. [PMID: 32276742 DOI: 10.1016/j.jaut.2020.102405] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/20/2022]
Abstract
Precision medicine (PM) is a very commonly used term that implies a highly individualized and tailored approach to patient management. There are, however, many layers of precision, as for example taking an appropriate patient history, or performing additional lab or imaging tests are already helping to better tailor treatments to the right patient. All this adds to the narrower definition of PM, which implies using the unique molecular characteristics of a patient for management decisions. Big data has become an essential part of PM, including as much information as possible to improve precision of disease management, although integration of multi-source data continues to be a challenge in practical application. In research big data can identify new (sub-)phenotypes in unsupervised analyses, which ultimately advance precision by allowing new targeted therapeutic approaches. We will discuss the current status of PM in rheumatoid arthritis (RA) in the management areas of diagnosis, prognosis, selection of therapy, and decision to reduce therapy. PM markers for diagnosis of RA are usually markers of RA classification rather than diagnosis, and subtypes of RA are potentially underrecognized. Prognostic precision is well established for RA, including markers of disease activity or structure, as well as autoantibodies and genetics. The choice of the right compound in a patient identified to have a poor prognosis, however, remains widely arbitrary. Finally and most recently, the most reliable markers for a safe withdrawal of therapy continue to be lower levels of disease activity and longer presence of remission.
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Norli ES, Brinkmann GH, Kvien TK, Bjørneboe O, Haugen AJ, Nygaard H, Thunem C, Lie E, Mjaavatten MD. Joint Distribution and Two-Year Outcome in 347 Patients With Monoarthritis of Less Than Sixteen Weeks' Duration. Arthritis Care Res (Hoboken) 2020; 72:705-710. [PMID: 28777897 DOI: 10.1002/acr.23334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/01/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The present study was undertaken to investigate the joint distribution and 2-year outcome of patients with recent-onset monoarthritis. METHODS Adult patients with clinically apparent monoarthritis of ≤16 weeks' duration were included in a multicenter 2-year longitudinal study. Clinical characteristics, joint distribution, development of chronic inflammatory rheumatic disease (CIRD), as well as classification criteria according to the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2010 criteria for RA were studied. Predictors for development of CIRD were analyzed by multivariable logistic regression analyses. RESULTS The knee (49.3%), ankle (16.7%), and wrist (14.1%) were the most frequently affected joints among the 347 included patients. A total of 91 patients (26.2%) developed CIRD during follow-up; 21 (6.1%) were diagnosed with RA, and 16 (4.6%) with psoriatic arthritis. Longer duration of joint swelling, joint localization, and anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) positivity were independent predictors of CIRD. Six of 58 patients (10.3%) with ankle monoarthritis and 21 of 49 patients (42.9%) with wrist monoarthritis developed CIRD during follow-up. The 2010 ACR/EULAR Criteria for RA identified all patients diagnosed with seropositive RA at an early stage, mostly within 3 months. CONCLUSION Approximately one-fourth of patients with recent-onset monoarthritis developed CIRD over 2 years. Patients presenting with ankle arthritis rarely developed CIRD, whereas patients presenting with wrist arthritis more frequently did so. Longer duration of joint swelling and ACPA and RF positivity were also predictive of CIRD. Our findings facilitate the early identification of patients with monoarthritis who have an unfavorable prognosis.
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Affiliation(s)
- Ellen Sauar Norli
- Martina Hansens Hospital, Sandvika, Norway, Diakonhjemmet Hospital, and University of Oslo, Oslo, Norway
| | | | | | | | | | - Halvor Nygaard
- Lillehammer Hospital For Rheumatic Diseases, Lillehammer, Norway
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Molto A, Sahuguet J, Fechtenbaum J, Etcheto A, López-Medina C, Richette P, Dougados M, Roux C, Briot K. Response to ‘Everything we see is a perspective, not the truth’ by Chattopadhyay et al. Ann Rheum Dis 2020; 79:e46. [DOI: 10.1136/annrheumdis-2019-215131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/03/2022]
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Pseudoerosions of Hands and Feet in Rheumatoid Arthritis: Anatomic Concepts and Redefinition. J Clin Med 2019; 8:jcm8122174. [PMID: 31835340 PMCID: PMC6947149 DOI: 10.3390/jcm8122174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 01/05/2023] Open
Abstract
Rheumatoid arthritis is a chronic inflammatory disease characterized by the development of osseous and cartilaginous damage. The correct differentiation between a true erosion and other entities—then often called “pseudoerosions”—is essential to avoid misdiagnosing rheumatoid arthritis and to correctly interpret the progress of the disease. The aims of this systematic review were as follows: to create a definition and delineation of the term “pseudoerosion”, to point out morphological pitfalls in the interpretation of images, and to report on difficulties arising from choosing different imaging modalities. A systematic review on bone erosions in rheumatoid arthritis was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following search terms were applied in PubMed and Scopus: “rheumatoid arthritis”, “bone erosion”, “ultrasonography”, “radiography”, “computed tomography” and “magnetic resonance imaging”. Appropriate exclusion criteria were defined. The systematic review registration number is 138826. The search resulted ultimately in a final number of 25 papers. All indications for morphological pitfalls and difficulties utilizing imaging modalities were recorded and summarized. A pseudoerosion is more than just a negative definition of an erosion; it can be anatomic (e.g., a normal osseous concavity) or artefact-related (i.e., an artificial interruption of the calcified zones). It can be classified according to their configuration, shape, content, and can be described specifically with an anatomical term. “Calcified zone” is a term to describe the deep components of the subchondral, subligamentous and subtendinous bone, and may be applied for all non-cancellous borders of a bone, thus representing a third type of the bone matrix beside the cortical and the trabecular bone.
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Huang W, Zhang L, Cheng C, Shan W, Ma R, Yin Z, Zhu C. Parallel comparison of fibroblast-like synoviocytes from the surgically removed hyperplastic synovial tissues of rheumatoid arthritis and osteoarthritis patients. BMC Musculoskelet Disord 2019; 20:591. [PMID: 31812161 PMCID: PMC6898940 DOI: 10.1186/s12891-019-2977-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022] Open
Abstract
Background Fibroblast-like synoviocytes (FLS) are essential cellular components in inflammatory joint diseases such as osteoarthritis (OA) and rheumatoid arthritis (RA). Despite the growing use of FLS isolated from OA and RA patients, a detailed functional and parallel comparison of FLS from these two types of arthritis has not been performed. Methods In the present study, FLS were isolated from surgically removed synovial tissues from twenty-two patients with OA and RA to evaluate their basic cellular functions. Results Pure populations of FLS were isolated by a sorting strategy based on stringent marker expression (CD45−CD31−CD146−CD235a−CD90+PDPN+). OA FLS and RA FLS at the same passage (P2-P4) exhibited uniform fibroblast morphology. OA FLS and RA FLS expressed a similar profile of cell surface antigens, including the fibroblast markers VCAM1 and ICAM1. RA FLS showed a more sensitive inflammatory status than OA FLS with regard to proliferation, migration, apoptosis, inflammatory gene expression and pro-inflammatory cytokine secretion. In addition, the responses of OA FLS and RA FLS to both the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α) and the anti-inflammatory drug methotrexate (MTX) were also evaluated here. Conclusion The parallel comparison of OA FLS and RA FLS lays a foundation in preparation for when FLS are considered a potential therapeutic anti-inflammatory target for OA and RA.
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Affiliation(s)
- Wei Huang
- Department of Orthopaedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People's Republic of China
| | - Linlin Zhang
- Department of Orthopaedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People's Republic of China
| | - Chao Cheng
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Wenshan Shan
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Ruixiang Ma
- Department of Orthopaedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People's Republic of China
| | - Zongsheng Yin
- Department of Orthopaedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Chen Zhu
- Department of Orthopaedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People's Republic of China.
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Effect of Moxibustion on HIF-1 α and VEGF Levels in Patients with Rheumatoid Arthritis. Pain Res Manag 2019; 2019:4705247. [PMID: 31885755 PMCID: PMC6900949 DOI: 10.1155/2019/4705247] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/13/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023]
Abstract
Background Moxibustion has a therapeutic effect of reducing swelling and relieving pain in patients with rheumatoid arthritis (RA) but its mechanism is uncertain. Objective To evaluate the effect of moxibustion on serum levels of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in patients with RA and to explore the possible mechanism of moxibustion. Methods This study involved 46 RA patients who had fulfilled the inclusion criteria and were randomly assigned to a treatment group and a control group in an equal ratio. The control group was treated with methotrexate or leflunomide, while the treatment group received methotrexate or leflunomide and moxibustion at ST 36 (Zusanli), BL 23 (Shenshu), and Ashi points. Patients' clinical symptoms, RA-associated serum markers, and serum levels of TNF-α, IL-1β, HIF-1α, and VEGF were compared in the two groups before and after intervention. Statistical analysis was performed using SPSS 21.0 statistical software. Results 37 of 46 RA patients eventually completed the whole treatment course. Compared with the control group, the treatment group significantly improved the clinical symptoms (P < 0.05) but with no significant differences in RA-associated serum markers (P > 0.05). There were significant differences in TNF-α and IL-1β among the groups after 8 weeks of treatment (P < 0.05). HIF-1α and VEGF were decreased in the treatment group after therapy (P < 0.05). VEGF was reduced in the control group (P < 0.05), while HIF-1α was not significantly improved (P > 0.05). The reductions of HIF-1α and VEGF in the treatment group were superior to the control group (P < 0.05). Conclusions Moxibustion enhanced the anti-inflammatory and analgesic effects of conventional medicine and can enhance the effect of conventional medicine, downregulating HIF-1α/VEGF contents to inhibit angiogenesis.
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Fujikawa K, Kawashiri SY, Endo Y, Mizokami A, Tsukada T, Mine M, Uetani M, Kawakami A. Diagnostic efficacy of ultrasound detection of enthesitis in peripheral spondyloarthritis. Mod Rheumatol 2019; 30:1060-1066. [PMID: 31663417 DOI: 10.1080/14397595.2019.1687113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: We investigated the diagnostic efficacy of power Doppler ultrasound (PDUS) to detect enthesitis in Japanese patients with peripheral spondyloarthritis (SpA).Methods: This was a single-center cohort study of patients with peripheral symptoms suggestive of SpA. Articular synovia, tendons, and entheses were assessed by PDUS at baseline. Clinical, laboratory, and radiologic findings and classification criteria for SpA were also evaluated.Results: 136 patients were consecutively evaluated. A definite diagnosis was obtained in 111 patients, including 72 with SpA and 39 non-SpA. Among the patients with SpA, PDUS demonstrated articular synovitis in 40 of the 72 patients (56%), tenosynovitis or peritendinitis in 48 (67%), and enthesitis in 63 (88%). Considering PDUS alone, enthesitis in at least one site was the most useful means of differentiating SpA from non-SpA (sensitivity 87.5%; specificity 82.1%; accuracy 85.6%; positive likelihood ratio 4.88). Combining that finding along with fulfillment of Amor, European Spondyloarthropathy Study Group, or Assessment of SpondyloArthritis international Society criteria for peripheral SpA increased the specificity of the diagnosis (92.5%, 92.3%, and 97.4%, respectively).Conclusion: PDUS enthesitis is useful for the diagnosis of SpA with peripheral symptoms. Combining PDUS enthesitis with established SpA classification criteria is beneficial in diagnosing peripheral SpA.
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Affiliation(s)
- Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yushiro Endo
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan.,Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Toshiaki Tsukada
- Department of Rheumatology, Aino Memorial Hospital, Unzen, Japan
| | - Masanobu Mine
- Department of Rheumatology, Suga Orthopedic Hospital, Isahaya, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Abd-Allah NM, Hassan AA, Omar G, Hamdy M, Abdelaziz STA, Abd El Hamid WM, Moussa RA. Evaluation of patients with dry eye for the presence of primary or secondary Sjӧgren's syndrome. Clin Ophthalmol 2019; 13:1787-1797. [PMID: 31571817 PMCID: PMC6750845 DOI: 10.2147/opth.s217433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/16/2019] [Indexed: 11/27/2022] Open
Abstract
Purpose To assess the frequency of Sjӧgren’s syndrome (SS), either primary or secondary to rheumatic disease, in a cohort of patients with aqueous-deficient dry eye and to determine the most accurate objective test for diagnosis of SS. Methods A total of 111 patients with dry eye were recruited from Minia University's Ophthalmology Outpatient Clinic (69 patients) and Rheumatology Outpatient Clinic (42 patients). The patients were screened for aqueous tear–deficient dry eye by abnormal test results of Schirmer test I (<10 mm) and tear-film break-up time (<10 seconds) in at least one eye. The diagnosis of SS was made according to the 2012 American College of Rheumatology criteria. A complete work up for SS was performed, including clinical examination, serological tests, ocular tests, and labial salivary–gland biopsy (LSGB). Results Of the 111 patients, 58 had aqueous-deficient dry eye: 23 in the ophthalmology clinic cohort (group I) and 35 in the rheumatology clinic cohort (group II). Three patients had pSS, and its frequency was 13% in group I and 5.2% among all studied patients. The ocular staining score is the most diagnostic ocular test (sensitivity 100% and specificity 90.9%). Anti-SSA/Ro antibody is the most accurate serological method (sensitivity 33.3% and specificity 100%). LSGB histopathology is the most diagnostic method for SS, with sensitivity, specificity, and positive and negative predictive values of 100%. Conclusion SS was detected with reasonable frequency among dry-eye patients, particularly pSS. Screening of dry eye for SS can select SS patients early in the disease course.
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Affiliation(s)
- Nashwa M Abd-Allah
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Amal Aly Hassan
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Gihan Omar
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mona Hamdy
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Minia University, Minia, Egypt
| | | | | | - Rabab A Moussa
- Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt
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Gautam S, Kumar U, Kumar M, Kanga U, Dada R. Association of HLA-G 3’UTR Polymorphisms with Soluble HLA-G Levels and Disease Activity in Patients with Rheumatoid Arthritis: A Case-Control Study. Immunol Invest 2019; 49:88-105. [DOI: 10.1080/08820139.2019.1657146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Surabhi Gautam
- Laboratory for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kumar
- Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Kumar
- Laboratory for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Uma Kanga
- Department of Transplant Immunology and Immunogenetics, All India Institute of Medical Sciences, New Delhi, India
| | - Rima Dada
- Laboratory for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences, New Delhi, India
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O'Shaughnessy MA, Kannas S, Ernste F, Rizzo M. Team Approach: Role of Medical and Surgical Management in Rheumatoid Arthritis of the Hand and Wrist. JBJS Rev 2019; 7:e10. [PMID: 31460989 DOI: 10.2106/jbjs.rvw.18.00196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Maureen A O'Shaughnessy
- Departments of Orthopedic Surgery (M.A.O. and M.R.), Physical Medicine and Rehabilitation (S.K.), and Rheumatology (F.E.), Mayo Clinic, Rochester, Minnesota
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Cohen EM, Edwards RR, Bingham CO, Phillips K, Bolster MB, Moreland LW, Neogi T, Marder W, Wohlfahrt A, Clauw D, Lee YC. Pain and Catastrophizing in Patients With Rheumatoid Arthritis: An Observational Cohort Study. J Clin Rheumatol 2019; 25:232-236. [PMID: 30035754 PMCID: PMC6309592 DOI: 10.1097/rhu.0000000000000834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aims of this study were to define changes in catastrophizing that occur with initiation of a new disease-modifying antirheumatic drug (DMARD) and to examine the relationship between changes in Clinical Disease Activity Index (CDAI) and changes in catastrophizing. METHODS Participants in an ongoing multisite, observational study completed the Pain Catastrophizing Scale (PCS) before and 12 weeks after DMARD initiation. We used multivariable linear regression models to examine the association between changes in CDAI as the exposure and change in pain catastrophizing as the outcome. We also assessed the relationship between changes in each component of CDAI and change in PCS, using multivariable linear regression models. RESULTS Among the 165 rheumatoid arthritis patients with data on CDAI at both time points, CDAI decreased from 22 to 11.5 on a 76-point scale (p < 0.0001) after 12 weeks. Pain intensity decreased from a median of 5 to 3 on a 10-point numeric rating scale (p < 0.0001), and catastrophizing decreased, from 16.0 to 12.0 on the 52-point PCS (p = 0.0005). Among the 163 with complete data for the regression analysis, changes in CDAI were positively correlated with changes in catastrophizing (standardized β = 0.19, p = 0.01). Of the components of the CDAI, change in assessor global score was most strongly associated with changes in catastrophizing (standardized β = 0.24, p = 0.003). CONCLUSIONS Pain catastrophizing decreases, in conjunction with disease activity, after initiation of a new DMARD. These findings provide support for catastrophizing as a dynamic construct that can be altered with treatment directed at decreasing inflammatory disease activity and pain.
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Affiliation(s)
- Ezra M. Cohen
- Division of Immunology, Boston Children’s Hospital, Boston, MA
| | | | - Clifton O. Bingham
- Division of Rheumatology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Kristine Phillips
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Marcy B. Bolster
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA
| | - Larry W. Moreland
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Tuhina Neogi
- Sections of Clinical Epidemiology and Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Wendy Marder
- Department of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Alyssa Wohlfahrt
- Department of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
| | - Daniel Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Yvonne C. Lee
- Department of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA
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Zhu JN, Nie LY, Lu XY, Wu HX. Meta-analysis: compared with anti-CCP and rheumatoid factor, could anti-MCV be the next biomarker in the rheumatoid arthritis classification criteria? ACTA ACUST UNITED AC 2019; 57:1668-1679. [PMID: 31141478 DOI: 10.1515/cclm-2019-0167] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
Abstract
Abstract
Background
Previous reviews of the diagnosis for rheumatoid arthritis (RA) have not compared anti-mutated citrullinated vimentin (MCV) with anti-cyclic citrullinated peptide (CCP) and rheumatoid factor (RF) in respect of sensitivity, specificity and the area under the curve (AUC) against disease controls for differential diagnosis. This meta-analysis aims to evaluate the value of anti-MCV in the diagnosis for RA, the combined sensitivity of anti-MCV and anti-CCP, and certain clinical characteristics related to the performance of anti-MCV.
Methods
Medline, Embase, Cochrane Library and Web of Science were searched for articles published up to 25 August 2018. A total of 33 studies including 6044 RA patients and 5094 healthy or disease controls achieved inclusive criteria. QUADAS-2 was applied to evaluate the quality of the included studies. The bivariate random effects model was employed in primary data synthesis to evaluate the diagnostic performance.
Results
The sensitivity of anti-MCV, anti-CCP and RF in RA diagnosis against a disease control group was 0.71, 0.71, 0.77, with the specificity of 0.89, 0.95, 0.73, and the AUC of the SROC of 0.89, 0.95, 0.82, respectively. The predesign of the primary study and diagnostic criteria were statistically significant as sources of heterogeneity. Anti-MCV and anti-CCP tests demonstrated a sensitivity of 0.77 when performed in parallel, with a sensitivity of 0.60 when performed in series; whereas, the combination of anti-MCV and RF presented a sensitivity of 0.64 when used in series.
Conclusions
Anti-MCV demonstrates comparable diagnostic value to anti-CCP and RF, thus it can be an effective diagnostic marker for RA and may be written into the next authoritative criteria.
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Affiliation(s)
- Jia-Ning Zhu
- Department of Rheumatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Liu-Yan Nie
- Department of Rheumatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Xiao-Yong Lu
- Department of Rheumatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Hua-Xiang Wu
- Department of Rheumatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China
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Zhao WH, Zhang LX, Liu CX, Niedermann K, Yang HZ, Luo W. Validation of the Chinese version of joint protection self-efficacy scale in patients with rheumatoid arthritis. Clin Rheumatol 2019; 38:2119-2127. [PMID: 30972575 DOI: 10.1007/s10067-019-04510-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/07/2019] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop and validate the Chinese version of the Joint Protection Self-Efficacy Scale (CJP-SES) in patients with rheumatoid arthritis (RA) in China. METHOD (1) Translation of the original German/English version JP-SES and cultural adaptation into the Chinese language; (2)Validation of the CJP-SES with the Chinese versions of the Arthritis Self-Efficacy Scale-8 (ASES-8), the Laffrey Health Conception Scale (LHCS), 10-item Perceived Efficacy in Patient-Physician Interactions Scale (PEPPI-10), Disease Activity Score-28 (DAS-28) and Health Assessment Questionnaire (HAQ). Instrument measurement included reliability testing, item generation, construct validity, test-retest reliability, and correlation with other measurements. Confirmatory factor analysis was applied to determine construct validity and internal consistency. One hundred fifteen patients with RA were investigated. RESULT Finally, 105 RA patients were included in the analysis. Confirmatory factor analysis demonstrated fit for a unidimensional model of the JP-SES. Additionally, the scale showed internal consistency (Cronbach's α coefficient 0.922), kappa coefficient (0.653), and test-retest reliability (ICC = 0.94). Weak correlations with other scores for the other instruments, such as the Chinese version of ASES-8 (0.263) and PEPPI-10 (0.326). Correlation with duration (0.274), moderate correlation with BMI (- 0.438) and DAS-28 (- 0.493), and strong correlation with HAQ (- 0.644) were found in this research. CONCLUSION This is the first study to adapt and validate the JP-SES into Chinese for use in patients with RA. Our research showing that the CJP-SES has a good construct validity, internal consistency, and test-retest reliability. This scale can help doctors and nurses to assess the self-efficacy of patients with RA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: TJYY-YLS-036.
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Affiliation(s)
- Wen H Zhao
- Joint Department, The 2nd Ward of Joint Surgery, Tianjin Hospital, 406 Jiefangnan Rd, Tianjin, 300211, People's Republic of China
| | - Li X Zhang
- Joint Department, The 1st Ward of Joint Surgery, Tianjin Hospital, Tianjin, China
| | - Chan X Liu
- Department of rheumatology, Tianjin Hospital, Tianjin, China
| | - Karin Niedermann
- Institut of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - Han Z Yang
- College of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wen Luo
- Joint Department, The 2nd Ward of Joint Surgery, Tianjin Hospital, 406 Jiefangnan Rd, Tianjin, 300211, People's Republic of China.
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Cerda OL, de Los Angeles Correa M, Granel A, Marcos AI, Giraldo C, Rillo O, Schneeberger EE, Citera G. Tuberculin test conversion in patients with chronic inflammatory arthritis receiving biological therapy. Eur J Rheumatol 2019; 6:19-22. [PMID: 30407165 PMCID: PMC6459330 DOI: 10.5152/eurjrheum.2018.18096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/15/2018] [Indexed: 11/25/2022] Open
Abstract
Objective The blockade of inflammatory mediators produced by biological therapies is associated with an increased risk of opportunistic infections, as for example Mycobacterium tuberculosis (MT). Given the endemic situation of tuberculosis (TB) in some countries and immunosuppression/anergy of patients with chronic inflammatory arthritis, we wonder whether it is necessary to monitor the MT infection after starting the biological treatment. To evaluate the frequency of the tuberculin skin test (TST) conversion and its association with an active TB infection and other disease variables. Methods Patients with rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), and spondyloarthritis (SpA) receiving treatment with anti-TNF, tocilizumab, and/or abatacept agents were included into the study. Patients had to have a negative TST (<5 mm) at the baseline, and a second TST was performed 2–22 months after the initiation of biologic therapy. The TST conversion was considered as a variation ≥5 mm between the two TSTs performed within an interval between 2 months and 2 years. Results A total of 85 patients were included into the study, and 78.8% were women, with a median schooling duration of 12 years. A total of 74.1% of patients had RA, 16.5% psoriatic arthritis, and 4.7% AIJ and ankylosing spondylitis. Regarding treatment, 75.3% received anti-TNF therapy (31.8% etanercept, 21.2% adalimumab, 17.6% infliximab, 3.5% golimumab, and 1.2% certolizumab), 15.3% tocilizumab, and 9.4% abatacept. Eight patients (9.4%) developed a TST conversion. The shift was more frequent in men (62.5%) than in women (37.5%) (p=0.009), and in those with a prolonged disease duration (X 226±109 vs X130±105 [p=0.017]). This association remained after adjusting for other variables. All patients who developed a TST conversion received prophylactic isoniazid, and only one patient with other risk factors developed active TB. Conclusion The frequency of a TST conversion in patients with chronic inflammatory arthritis was low and was associated with male gender and longer disease duration.
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Affiliation(s)
| | | | | | | | - Claudia Giraldo
- Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires Argentina
| | - Oscar Rillo
- Hospital General de Agudos Dr. Ignacio Pirovano, Buenos Aires Argentina
| | | | - Gustavo Citera
- Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
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Endo Y, Fujikawa K, Koga T, Mizokami A, Mine M, Tsukada T, Uetani M, Kawakami A. Characteristics of late-onset spondyloarthritis in Japan: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e14431. [PMID: 30762750 PMCID: PMC6407927 DOI: 10.1097/md.0000000000014431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Spondyloarthritis may be increasingly present in older patients as life expectancy increases. We investigated clinical differences between early-onset and late-onset spondyloarthritis in Japan.We retrospectively reviewed 114 patients consecutively diagnosed with spondyloarthritis. The clinical course of each patient was observed for ≥1 year. We defined early-onset and late-onset spondyloarthritis as <57 or ≥57 years at a median age of this study group, respectively. We compared clinical characteristics between these 2 groups.Disease duration was significantly shorter before diagnosis in the late-onset group (P < .01). Inflammatory back pain (IBP) was significantly more common in the early-onset group (P < .01), whereas dactylitis frequency was significantly higher in the late-onset group. Significantly more patients with early-onset spondyloarthritis were human leukocyte antigen (HLA) B27-positive (P < .01). Articular synovitis, particularly of the wrist, was significantly more common on power Doppler ultrasound (PDUS) in the late-onset group (P < .01). Tenosynovitis or peritendinitis, particularly in the finger and wrist flexors were also more frequent in the late-onset group (P < .001 and P < .05, respectively). Enthesitis of the finger collateral ligament and lateral collateral ligament were significantly more common in the late-onset group (both P < .05). Multiple logistic regression analysis revealed that, comparatively, IBP was significantly and independently much more likely to occur in the early-onset group.The patients with late-onset spondyloarthritis had a lower frequency of IBP and HLA B27 and a higher frequency of dactylitis and PDUS findings in peripheral involvement.
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Affiliation(s)
- Yushiro Endo
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital
| | - Masanobu Mine
- Department of Rheumatology, Suga Orthopedic Hospital
| | | | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
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Mahajan NP, Palange ND, Pawar E, Supe A. Surgical Treatment of Tenosynovitis of Extensor Tendons of Fourth Compartment of Wrist in Nonrheumatoid Patients-A Case Series of 10 Patients in India. J Hand Microsurg 2018; 11:45-49. [PMID: 30911211 DOI: 10.1055/s-0038-1669368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose Proliferative tenosynovitis of the extensor tendons is a very common painful wrist condition that can occur both in presence and absence of rheumatoid arthritis (RA). This study aims to evaluate a series of patients without RA, having extensor tendon tenosynovitis, its pathology, and results of surgical treatment. Materials and Methods A consecutive series of 10 patients without RA, having tenosynovitis of fourth extensor compartment were treated surgically and evaluated in the study. All patients were operated upon by a single surgeon, and intraoperative specimens were sent for histopathologic evaluation by a single pathologist. The functional outcome of the patients was evaluated by comparing the post- and preoperative wrist extension. Results All patients presented with painful mass over dorsum of the wrist, overlying the fourth extensor compartment. On clinical examination, there was severe limitation of active wrist extension with extended fingers and improvement in wrist extension on flexing the fingers. All patients had significant improvement in wrist extension after surgery. The histopathologic examination of the intraoperative samples revealed similar findings of tenosynovitis in all cases, which was different than that seen in RA. Conclusion This study reveals a distinct tenosynovitis in a group of patients without RA resembling traumatic tenosynovitis on histopathologic examination. Radiologic and intraoperative findings reveal presence of nodular mass in the affected tendon due to proliferative tenosynovitis, which blocks effective proximal excursion of the tendon, leading to decreased wrist extension. This study shows that surgical treatment in the form of tenosynovectomy gives excellent relief to these patients. Type of Study This is a Level IV, therapeutic study.
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Affiliation(s)
- Neetin Pralhad Mahajan
- Department of Orthopaedics, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Nikhil D Palange
- Department of Orthopaedics, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Eknath Pawar
- Department of Orthopaedics, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
| | - Amit Supe
- Department of Orthopaedics, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India
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Survivin improves the early recognition of rheumatoid arthritis among patients with arthralgia: A population-based study within two university cities of Sweden. Semin Arthritis Rheum 2018; 47:778-785. [PMID: 29174794 DOI: 10.1016/j.semarthrit.2017.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/11/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022]
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Hirata A, Miyamura T, Suenaga Y, Katayama M, Suematsu E, Tohma S. Latent psychological distress existing behind a set of assessment measures is comparable to or more important than symptoms or disability in the association with quality of life and working status of patients with rheumatoid arthritis. Mod Rheumatol 2018; 28:968-975. [DOI: 10.1080/14397595.2018.1428043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Akie Hirata
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Tomoya Miyamura
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Yasuo Suenaga
- Department of Internal Medicine and Rheumatology, National Hospital Organization, Beppu Medical Center, Oita, Japan
| | - Masao Katayama
- Department of Internal Medicine and Rheumatology, National Hospital Organization, Nagoya Medical Center, Aichi, Japan
| | - Eiichi Suematsu
- Department of Internal Medicine and Rheumatology, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Shigeto Tohma
- Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
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Medina YF, Ruíz-Gaviria RE, Buitrago-Lopez A, Villota C. Physical articular examination in the activity of rheumatoid arthritis: a systematic review of the literature : Systematic review of the literature regarding physical examination in rheumatoid arthritis. Clin Rheumatol 2018; 37:1457-1464. [PMID: 29464524 DOI: 10.1007/s10067-018-4015-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/17/2018] [Accepted: 01/29/2018] [Indexed: 12/16/2022]
Abstract
To summarize evidence concerning the articular examination needed to determine rheumatoid arthritis (RA) activity (follow-up or control) via a systematic review. A search of Medline, Embase, Lilacs, SciELO, the Web of Science, the National Technical Reports Library, and the reference lists of relevant studies through March 2017 was conducted using a systematic methodology to identify studies of patients with RA older than 18 years in which a detailed description of the physical examination or a description of the components of the articular examination was provided. Of 8322 references, 74 studies were included according to the selection criteria, and 6 references were ultimately included at the end of the review. Most of the included studies (n = 5) were associated with a moderate risk of bias. There was great variability among the studies and the articular examination methods used. Some studies presented the examination with a complete specification of the technique (n = 2), the consensus of rheumatologists (n = 2), or training through audiovisual materials and face-to-face courses (n = 2), but none of the studies explicitly showed the technique by which the physical examination was performed. Despite the importance of the clinical evaluation and physical examination of patients with RA for diagnosis, prognosis, clinimetrics, and follow-up, evidence concerning how to perform the articular examination is scarce.
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Affiliation(s)
- Yimy F Medina
- Universidad Nacional de Colombia, Bogota, Colombia. .,Clinical epidemiology Program, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Rafael Eduardo Ruíz-Gaviria
- Hospital Universitario San Ignacio, Bogota, Colombia.,Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Adriana Buitrago-Lopez
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia.,School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Catalina Villota
- School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
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Sarazin J, Schiopu E, Namas R. Case series: Monoarticular rheumatoid arthritis. Eur J Rheumatol 2018; 4:264-267. [PMID: 29308281 DOI: 10.5152/eurjrheum.2017.17011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/29/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Monoarticular presentation of rheumatoid arthritis is infrequent and has been previously reported to involve large joints such as the hip and knee joints. Here we report a case series of four patients presenting to the University of Michigan in 2015 with monoarticular rheumatoid arthritis, one with small and three with large joint involvement. Material and Methods In total, four patients with monoarticular rheumatoid arthritis were treated in the Division of Rheumatology, University of Michigan. All the patients were retrospectively reviewed with permission from our Institutional Review Board; informed consent was provided by the patients for enrollment in a clinical trial for patients with rheumatoid arthritis. All the patients were assessed using the 2010 ACR/EULAR classification criteria for rheumatoid arthritis. Results All the patients presented with monoarthritis; three patients had large joint involvement and one had small joint involvement. Serologies were positive, with each patient having positive Anti-cyclic citrullinated peptide (anti-CCP) antibodies, two patients having a positive rheumatoid factor, three patients having elevated CRP levels, and one patient having positive ESR. All patients met the criteria of the duration of symptoms being at least 6 weeks. The findings of imaging, although not a part of the criteria, were consistent with active rheumatoid arthritis in all the patients. Conclusion While the 2010 ACR/EULAR classification criteria are the most sensitive criteria for diagnosing RA to date, the exclusion of these cases of monoarthritis demonstrates that further specificity can still be achieved for diagnosing these types of patients as early as possible using the current guidelines. Further, we suggest the inclusion of an imaging measure added to the inclusion criteria to further increase the yield in establishing diagnosis of rheumatoid arthritis in the current reported patient population.
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Affiliation(s)
- Jeffrey Sarazin
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Elena Schiopu
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rajaie Namas
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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36
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Calcification of coronary arteries in early rheumatoid arthritis prior to anti-rheumatic therapy. Rheumatol Int 2017; 38:211-217. [DOI: 10.1007/s00296-017-3860-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/19/2017] [Indexed: 02/04/2023]
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Value of Measuring Anti-Carbamylated Protein Antibodies for Classification on Early Arthritis Patients. Sci Rep 2017; 7:12023. [PMID: 28931886 PMCID: PMC5607236 DOI: 10.1038/s41598-017-09657-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/27/2017] [Indexed: 01/30/2023] Open
Abstract
Classification of patients with rheumatoid arthritis (RA) as quickly as possible improves their prognosis. This reason motivates specially dedicated early arthritis (EA) clinics. Here, we have used 1062 EA patients with two years of follow-up to explore the value of anti-carbamylated protein (anti-CarP) antibodies, a new type of RA specific autoantibodies, for classification. Specifically, we aimed to determine whether the addition of anti-CarP antibodies to IgM rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, which are helpful in RA classification, improves it or not. Our analysis showed that incorporation of the anti-CarP antibodies to combinations of the other two antibodies (all joint by the OR Boolean operator) produces a modest increase in sensitivity (2.2% higher), at the cost of decreased specificity (8.1% lower). The cost-benefit ratio was more favorable in the patients lacking the other autoantibodies. However, it did not improve by considering different titer levels of the anti-CarP antibodies, or after exhaustively exploring other antibody combinations. Therefore, the place in RA classification of these antibodies is questionable in the context of current treatments and biomarkers. This conclusion does not exclude their potential value for stratifying patients in joint damage, disease activity, disability, or mortality categories.
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Hua C, Daien CI, Combe B, Landewe R. Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis. RMD Open 2017; 3:e000406. [PMID: 28155923 PMCID: PMC5237764 DOI: 10.1136/rmdopen-2016-000406] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To update the evidence pertaining to the diagnosis, prognosis and classification of patients with early arthritis (EA), and to inform the 2016 European League Against Rheumatism (EULAR) recommendations for the management of patients with EA. METHODS MEDLINE, EMBASE and Cochrane databases were searched up to October 2015. The first part of the systematic literature review (SLR) involved a search for studies investigating the recognition and referral of EA. The second part involved a search for studies to identify the place of laboratory and imaging tests in establishing a diagnosis and a prognosis in patients with EA. RESULTS Regarding the issue of referral of patients with EA (1643 hits), 4 studies were included. These studies were in support of early referral for patients with EA. Regarding the issue of diagnosis and prognosis of patients with EA (11 435 hits), 88 studies were included, evaluating mainly the value of rheumatoid factor (RF) and anticitrullinated-peptide antibodies (ACPAs). Sensitivity of these antibodies for a RA diagnosis in patients with EA was moderate (40-80%). Specificity was higher, notably for ACPAs (frequently >80%). ACPAs also showed better prognostic performance than RF (negative predictive values around 80%). We confirmed that structural damage on baseline X-rays is predictive of further radiographic progression in patients with EA. Regarding other imaging modalities, data are sparse. CONCLUSIONS This SLR highlights the importance of early referral for patients with EA and confirms that RF and mainly ACPAs as well as a search for structural X-rays changes may help in the diagnosis and prognosis of patients with EA.
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Affiliation(s)
- Charlotte Hua
- Rheumatology Department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Claire I Daien
- Rheumatology Department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Bernard Combe
- Rheumatology Department , Lapeyronie Hospital, Montpellier University , Montpellier , France
| | - Robert Landewe
- Department of Clinical Immunology & Rheumatology , Amsterdam Rheumatology Center, Amsterdam and Zuyderland Medical Centre , Heerlen , The Netherlands
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Combe B, Landewe R, Daien CI, Hua C, Aletaha D, Álvaro-Gracia JM, Bakkers M, Brodin N, Burmester GR, Codreanu C, Conway R, Dougados M, Emery P, Ferraccioli G, Fonseca J, Raza K, Silva-Fernández L, Smolen JS, Skingle D, Szekanecz Z, Kvien TK, van der Helm-van Mil A, van Vollenhoven R. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2016. [PMID: 27979873 DOI: 10.1136/annrheumdis-2016-210602 10.1136/annrheumdis-2016-210602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis. METHODS In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of 'management' and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process. RESULTS The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research. CONCLUSIONS These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis.
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Affiliation(s)
- Bernard Combe
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Robert Landewe
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam and Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Claire I Daien
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Charlotte Hua
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Jose María Álvaro-Gracia
- Biological Therapies Unit, Servicio de Reumatología. Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain
| | - Margôt Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Nina Brodin
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Catalin Codreanu
- Department of Rheumatology, Center for Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Richard Conway
- Department of Rheumatology, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin Academic Medical Centre, Dublin, Ireland
| | - Maxime Dougados
- Medicine Faculty, APHP, Rheumatology B Department, Paris Descartes University, Cochin Hospital, Paris, France
| | - Paul Emery
- Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Gianfranco Ferraccioli
- Fondazione Policlinico Gemelli Academic Hospital, Catholic University School of Medicine, Rome, Italy
| | - Joao Fonseca
- Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Lisbon.,Instituto de Medicina Molecular, Faculdade de Medicina Universidade de Lisboa, Portugal
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Lucía Silva-Fernández
- Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Diana Skingle
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Zoltan Szekanecz
- Faculty of Medicine, Department of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Annette van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ronald van Vollenhoven
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
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40
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Aga AB, Berner Hammer H, Christoffer Olsen I, Uhlig T, Kvien TK, van der Heijde D, Fremstad H, Madland TM, Lexberg ÅS, Haukeland H, Rødevand E, Høili C, Stray H, Noraas AL, Widding Hansen IJ, Bakland G, Lillegraven S, Lie E, Haavardsholm EA. Development of a feasible and responsive ultrasound inflammation score for rheumatoid arthritis through a data-driven approach. RMD Open 2016; 2:e000325. [PMID: 28074154 PMCID: PMC5174791 DOI: 10.1136/rmdopen-2016-000325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/29/2016] [Accepted: 10/22/2016] [Indexed: 11/15/2022] Open
Abstract
Objective To develop and validate a responsive and feasible ultrasound inflammation score for rheumatoid arthritis (RA). Methods We used data from cohorts of early RA (development) and established RA starting/switching biologic therapy (validation). 4 tendons and 36 joints were examined by a grey scale (GSUS) and power Doppler semiquantitative ultrasound (PDUS) scoring system (full score). Ultrasound score components were selected based on factor analyses of 3-month change in the development cohort. Responsiveness was assessed by standardised response means (SRMs). We assessed the proportion of information retained from the full score by linear regression. Results 118 patients with early and 212 patients with established RA were included. The final ultrasound score included 8 joints (metacarpophalangeal 1–2–3, proximal interphalangeal 2–3, radiocarpal, metatarsophalangeal 2–3) and 1 tendon (extensor carpi ulnaris) examined bilaterally. The 6-month SRMs for the final score were −1.24 (95% CI −1.47 to −1.02) for GSUS, and −1.09 (−1.25 to −0.92) for PDUS in early RA, with 87% of total information retained for GSUS and 90% for PDUS. The new score performed somewhat better than formerly proposed scores in the validation cohort. Conclusions The Ultrasound in Rheumatoid Arthritis 9 joint/tendon score (USRA9) inflammation score showed good responsiveness, retained most of the information from the original full score and overall performed better than previous scores in a validation cohort. Trial registration numbers NCT01205854, ACTRN12610000284066; Post-results.
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Affiliation(s)
| | | | | | - Till Uhlig
- Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - Tore K Kvien
- Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - Désirée van der Heijde
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hallvard Fremstad
- Department of Rheumatology , Ålesund Hospital, Helse Møre og Romsdal HF , Ålesund , Norway
| | - Tor Magne Madland
- Department of Rheumatology , Haukeland University Hospital, Helse Bergen HF , Bergen , Norway
| | - Åse Stavland Lexberg
- Department of Rheumatology , Drammen Hospital, Vestre Viken HF , Drammen , Norway
| | - Hilde Haukeland
- Department of Rheumatology , Martina Hansens Hospital AS , Bærum , Norway
| | - Erik Rødevand
- Department of Rheumatology , St Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Christian Høili
- Department of Rheumatology , Hospital Østfold HF , Moss , Norway
| | - Hilde Stray
- Haugesund Rheumatism HospitalAS , Haugesund , Norway
| | | | | | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, University of Tromsø, Norway
| | - Siri Lillegraven
- Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - Elisabeth Lie
- Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
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41
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Combe B, Landewe R, Daien CI, Hua C, Aletaha D, Álvaro-Gracia JM, Bakkers M, Brodin N, Burmester GR, Codreanu C, Conway R, Dougados M, Emery P, Ferraccioli G, Fonseca J, Raza K, Silva-Fernández L, Smolen JS, Skingle D, Szekanecz Z, Kvien TK, van der Helm-van Mil A, van Vollenhoven R. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2016; 76:948-959. [PMID: 27979873 DOI: 10.1136/annrheumdis-2016-210602] [Citation(s) in RCA: 305] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/24/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Since the 2007 recommendations for the management of early arthritis have been presented, considerable research has been published in the field of early arthritis, mandating an update of the 2007 European League Against Rheumatism (EULAR) recommendations for management of early arthritis. METHODS In accordance with the 2014 EULAR Standardised Operating Procedures, the expert committee pursued an approach that was based on evidence in the literature and on expert opinion. The committee involved 20 rheumatologists, 2 patients and 1 healthcare professional representing 12 European countries. The group defined the focus of the expert committee and target population, formulated a definition of 'management' and selected the research questions. A systematic literature research (SLR) was performed by two fellows with the help of a skilled librarian. A set of draft recommendations was proposed on the basis of the research questions and the results of the SLR. For each recommendation, the categories of evidence were identified, the strength of recommendations was derived and the level of agreement was determined through a voting process. RESULTS The updated recommendations comprise 3 overarching principles and 12 recommendations for managing early arthritis. The selected statements involve the recognition of arthritis, referral, diagnosis, prognostication, treatment (information, education, pharmacological and non-pharmacological interventions), monitoring and strategy. Eighteen items were identified as relevant for future research. CONCLUSIONS These recommendations provide rheumatologists, general practitioners, healthcare professionals, patients and other stakeholders with an updated EULAR consensus on the entire management of early arthritis.
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Affiliation(s)
- Bernard Combe
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Robert Landewe
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam and Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Claire I Daien
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Charlotte Hua
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, UMR 5535, Montpellier, France
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Jose María Álvaro-Gracia
- Biological Therapies Unit, Servicio de Reumatología. Hospital Universitario de la Princesa, IIS-IP, Madrid, Spain
| | - Margôt Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Nina Brodin
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Orthopaedics, Danderyd Hospital, Stockholm, Sweden
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Catalin Codreanu
- Department of Rheumatology, Center for Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Richard Conway
- Department of Rheumatology, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin Academic Medical Centre, Dublin, Ireland
| | - Maxime Dougados
- Medicine Faculty, APHP, Rheumatology B Department, Paris Descartes University, Cochin Hospital, Paris, France
| | - Paul Emery
- Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Gianfranco Ferraccioli
- Fondazione Policlinico Gemelli Academic Hospital, Catholic University School of Medicine, Rome, Italy
| | - Joao Fonseca
- Rheumatology Department, Hospital de Santa Maria, Lisbon Academic Medical Centre, Lisbon.,Instituto de Medicina Molecular, Faculdade de Medicina Universidade de Lisboa, Portugal
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Lucía Silva-Fernández
- Rheumatology Department, Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Diana Skingle
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Zoltan Szekanecz
- Faculty of Medicine, Department of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Annette van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ronald van Vollenhoven
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
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Kobayashi Y, Ikeda K, Nakamura T, Yamagata M, Nakazawa T, Tanaka S, Furuta S, Umibe T, Nakajima H. Severity and Diurnal Improvement of Morning Stiffness Independently Associate with Tenosynovitis in Patients with Rheumatoid Arthritis. PLoS One 2016; 11:e0166616. [PMID: 27851825 PMCID: PMC5113064 DOI: 10.1371/journal.pone.0166616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 11/01/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although morning stiffness has long been recognized as a characteristic feature of rheumatoid arthritis (RA), it is no more included in the 2010 ACR/EULAR Classification Criteria or in the current major instruments for evaluating disease activity of RA. In this cross-sectional study, we aimed to determine the independent value and the optimal measurement of morning stiffness by clarifying the associations between morning stiffness and synovial inflammation. PATIENTS AND METHODS We enrolled 76 consecutive RA patients who underwent musculoskeletal ultrasound examination and agreed to participate in the study. In addition to asking the duration of morning stiffness, we asked patients to complete a diagram which represents the time course of their morning stiffness in the dominant hand. Based on this diagram, we calculated the severity and the diurnal improvement of morning stiffness. We also determined the activity of intra-articular synovitis in 11 joints and tenosynovitis in 8 tendons/tendon compartments in the same hand by using power Doppler (PD) ultrasound with a semiquantitative score (0-3). RESULTS For intra-articular synovitis, swollen/tender joint counts more strongly correlated with total PD scores (ρ = 0.379-0.561, p ≤ 0.001) than did any parameters of morning stiffness (ρ = 0.217-0.314, p = 0.006-0.021). For tenosynovitis, however, the severity on awakening and the improvement of morning stiffness more strongly correlated with total PD scores (ρ = 0.503-0.561, p < 0.001) than did swollen/tender joint counts (ρ = 0.276-0.388, p = 0.001-0.016). Multivariate analyses identified the severity on awakening and the improvement but not the duration of morning stiffness as factors that independently associate with the total tenosynovial PD score. CONCLUSIONS Our data demonstrate a pathophysiological link between morning stiffness and tenosynovitis and also give an insight into the optimal measurement of morning stiffness. Our data support an independent value of evaluating morning stiffness in the management of RA.
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Affiliation(s)
- Yoshihisa Kobayashi
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Rheumatology Center, Matsudo City Hospital, Matsudo, Chiba, Japan
- Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- * E-mail:
| | - Takayuki Nakamura
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Chiba, Japan
| | - Mieko Yamagata
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, Japan
| | - Takuya Nakazawa
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
- Department of Rheumatology, Allergy, and Clinical Immunology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
| | - Shigeru Tanaka
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Takeshi Umibe
- Rheumatology Center, Matsudo City Hospital, Matsudo, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
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Torrente-Segarra V, Acosta Pereira A, Morla R, Ruiz JM, Clavaguera T, Figuls R, Corominas H, Geli C, Roselló R, de Agustín JJ, Alegre C, Pérez C, García A, Rodríguez de la Serna A. VARIAR Study: Assessment of Short-term Efficacy and Safety of Rituximab Compared to an Tumor Necrosis Factor Alpha Antagonists as Second-line Drug Therapy in Patients With Rheumatoid Arthritis Refractory to a First Tumor Necrosis Factor Alpha Antagonist. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.reumae.2015.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Estudio VARIAR: VAloración de la eficacia y seguridad a corto plazo en artritis reumatoide del uso de RItuximab comparado con Antagonistas del factor de necrosis tumoral alfa en segunda línea terapéutica en pacientes con artritis reumatoide Refractarios a un primer antagonista del factor de necrosis tumoral alfa. ACTA ACUST UNITED AC 2016; 12:319-322. [DOI: 10.1016/j.reuma.2015.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 02/03/2023]
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45
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Taljanovic MS, Melville DM, Gimber LH, Scalcione LR, Miller MD, Kwoh CK, Klauser AS. High-Resolution US of Rheumatologic Diseases. Radiographics 2016; 35:2026-48. [PMID: 26562235 DOI: 10.1148/rg.2015140250] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For the past 15 years, high-resolution ultrasonography (US) is being routinely and increasingly used for initial evaluation and treatment follow-up of rheumatologic diseases. This imaging technique is performed by using high-frequency linear transducers and has proved to be a powerful diagnostic tool in evaluation of articular erosions, simple and complex joint and bursal effusions, tendon sheath effusions, and synovitis, with results comparable to those of magnetic resonance imaging, excluding detection of bone marrow edema. Crystal deposition diseases including gouty arthropathy and calcium pyrophosphate deposition disease (CPPD) have characteristic appearances at US, enabling differentiation between these two diseases and from inflammatory arthropathies. Enthesopathy, which frequently accompanies psoriatic and reactive arthritis, also has a characteristic appearance at high-resolution US, distinguishing these two entities from other inflammatory and metabolic arthropathies. The presence of Doppler signal in examined joints, bursae, and tendon sheaths indicates active synovitis. Microbubble echo contrast agents augment detection of tissue vascularity and may act in the future as a drug delivery vehicle. Frequently, joint, tendon sheath, and bursal fluid aspirations and therapeutic injections are performed under US guidance. The authors describe the high-resolution US technique including gray-scale, color or power Doppler, and contrast agent-enhanced US that is used in evaluation of rheumatologic diseases of the wrist and hand and the ankle and foot in their routine clinical practice. This article demonstrates imaging findings of normal joints, rheumatoid arthritis, gouty arthritis, CPPD, psoriatic and reactive arthritis, and osteoarthritis.
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Affiliation(s)
- Mihra S Taljanovic
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - David M Melville
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Lana H Gimber
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Luke R Scalcione
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Margaret D Miller
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - C Kent Kwoh
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Andrea S Klauser
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
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Katchamart W, Narongroeknawin P, Chevaisrakul P, Dechanuwong P, Mahakkanukrauh A, Kasitanon N, Pakchotanon R, Sumethkul K, Ueareewongsa P, Ukritchon S, Bhurihirun T, Duangkum K, Intapiboon P, Intongkam S, Jangsombatsiri W, Jatuworapruk K, Kositpesat N, Leungroongroj P, Lomarat W, Petcharat C, Sittivutworapant S, Suebmee P, Tantayakom P, Tipsing W, Asavatanabodee P, Chiowchanwisawakit P, Foocharoen C, Koolvisoot A, Louthrenoo W, Siripaitoon B, Totemchokchyakarn K, Kitumnuaypong T. Evidence-based recommendations for the diagnosis and management of rheumatoid arthritis for non-rheumatologists: Integrating systematic literature research and expert opinion of the Thai Rheumatism Association. Int J Rheum Dis 2016; 20:1142-1165. [DOI: 10.1111/1756-185x.12905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Wanruchada Katchamart
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Pongthorn Narongroeknawin
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Parawee Chevaisrakul
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Ramathibodi Hospital; Mahidol; Bangkok Thailand
| | - Pornchai Dechanuwong
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Vajira Hospital; Navamindradhiraj University; Bangkok Thailand
| | - Ajanee Mahakkanukrauh
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Nuntana Kasitanon
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Rattapol Pakchotanon
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Kittiwan Sumethkul
- Rheumatology Unit; Department of Internal Medicine; Rajavithi Hospital; Bangkok Thailand
| | - Parichat Ueareewongsa
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Sittichai Ukritchon
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Thitirat Bhurihirun
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Kittikorn Duangkum
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Porntip Intapiboon
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Samanan Intongkam
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Wimol Jangsombatsiri
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Ramathibodi Hospital; Mahidol; Bangkok Thailand
| | - Kanon Jatuworapruk
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Naravadee Kositpesat
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Pawinee Leungroongroj
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Ramathibodi Hospital; Mahidol; Bangkok Thailand
| | - Wiyanoot Lomarat
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Chonachan Petcharat
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | | | - Patcharawan Suebmee
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Pongchirat Tantayakom
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Worakan Tipsing
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Vajira Hospital; Navamindradhiraj University; Bangkok Thailand
| | - Paijit Asavatanabodee
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Praveena Chiowchanwisawakit
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Chingching Foocharoen
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Ajchara Koolvisoot
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Worawit Louthrenoo
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Boonjing Siripaitoon
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Kitti Totemchokchyakarn
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Ramathibodi Hospital; Mahidol; Bangkok Thailand
| | - Tasanee Kitumnuaypong
- Rheumatology Unit; Department of Internal Medicine; Rajavithi Hospital; Bangkok Thailand
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Self-limiting arthritis among patients fulfilling the 2010 ACR/EULAR classification criteria for rheumatoid arthritis in a very early arthritis cohort. Semin Arthritis Rheum 2016; 46:272-278. [PMID: 27546493 DOI: 10.1016/j.semarthrit.2016.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/24/2016] [Accepted: 07/18/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To study occurrence of and factors associated with self-limiting arthritis among patients fulfilling the 2010 ACR/EULAR classification criteria for rheumatoid arthritis (RA) (2010 RA criteria) in patients with ≤16 weeks׳ duration of joint swelling. METHODS We applied the 2010 RA criteria in 1118 patients included in a 2-year longitudinal cohort. In all, 256 patients fulfilled the 2010 RA criteria at baseline; outcome was defined as either "self-limiting arthritis" (no DMARD use during follow-up, no swollen joints at last assessment, and no final clinical diagnosis of RA) or "persistent disease." The associations between baseline characteristics, including the components of the 2010 RA criteria score, and outcomes were studied. RESULTS In total, 36 of 256 patients (14.1%) classified as having RA had self-limiting arthritis. These patients differed from patients with persistent disease according to ACPA positivity (11.1% vs. 65.0%, p < 0.001), duration of joint swelling (median = 47.5 vs. 66.0 days, p = 0.002), 2010 RA criteria points (median = 6.0 vs. 7.0, p < 0.001), and ever smoking (52.8% vs. 74.5%, p = 0.01). Having no serology points and no duration points were independent predictors of self-limiting arthritis. The rate of self-limiting arthritis was 2.7% vs. 29.4% among ACPA positive vs. ACPA negative patients (p < 0.001), and 32.5% when duration of joint swelling was <4 weeks vs. 10.6% with longer duration (p < 0.001). CONCLUSIONS Negative ACPA status, short duration of joint swelling and being a never smoker were factors associated with self-limiting arthritis in early arthritis patients classified as having RA at presentation. Our findings contribute to identify patients who potentially do not need DMARDs and who should not be included in early RA clinical drug trials.
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Li L, Deng C, Chen S, Zhang S, Wu Z, Hu C, Zhang F, Li Y. Meta-Analysis: Diagnostic Accuracy of Anti-Carbamylated Protein Antibody for Rheumatoid Arthritis. PLoS One 2016; 11:e0159000. [PMID: 27437936 PMCID: PMC4954701 DOI: 10.1371/journal.pone.0159000] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/24/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The anti-carbamylated protein (CarP) antibody is a novel biomarker that might help in the diagnosis of rheumatoid arthritis (RA). We aim to assess the diagnostic value of anti-CarP antibody for RA. METHODS We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus for studies published by December 15, 2015. Studies in any language that evaluated the utility of the anti-CarP antibody in the diagnosis of RA in which healthy donors or patients without arthritis or arthralgia served as controls were included. Two investigators independently evaluated studies for inclusion, assessed study quality and abstracted data. A bivariate mixed-effects model was used to summarize the diagnostic indexes from 7 eligible studies. RESULTS The pooled sensitivity, specificity, and positive and negative likelihood ratios for anti-CarP antibody were 42% (95% CI, 38% to 45%), 96% (95% CI, 95% to 97%), 10.2 (95% CI, 7.5 to 13.9), and 0.61 (95% CI, 0.57 to 0.65), respectively. The summary diagnostic odds ratio was 17 (95% CI, 12 to 24), and the area under summary receiver operator characteristic curve was 80% (95% CI, 77% to 84%). CONCLUSION Anti-CarP antibody has a moderate value in the diagnosis of RA with high specificity but relatively low sensitivity.
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Affiliation(s)
- Liubing Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chuiwen Deng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Si Chen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
- Department of Clinical Laboratory, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shulan Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Ziyan Wu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chaojun Hu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yongzhe Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Esaily HA, Hewala AESA, Soliman SG, Galbat EA, Al-Ela DHA. Evaluation of serum undercarboxylated osteocalcin in premenopausal rheumatoid arthritis patients: its correlation with disease activity and bone mineral density. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2016. [DOI: 10.4103/1110-161x.189822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Radwan WM, Khalifa KA, Esaily HA, Lashin NA. CD14++CD16+ monocyte subset expansion in rheumatoid arthritis patients: Relation to disease activity and interleukin-17. THE EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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