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Liou LB, Fang YF, Tsai PH, Chen YF, Chang CT, Chen CC, Chiang WY. Immunoregulatory Cells and Cytokines Discriminate Disease Activity Score 28-Remission Statuses and Ultrasound Grades in Rheumatoid Arthritis Patients with Non-High Disease Activity. Int J Mol Sci 2024; 25:8694. [PMID: 39201379 PMCID: PMC11354682 DOI: 10.3390/ijms25168694] [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: 06/23/2024] [Revised: 07/29/2024] [Accepted: 08/08/2024] [Indexed: 09/02/2024] Open
Abstract
It is not clear whether immunoregulatory cytokines and cells are associated with Disease Activity Score 28 (DAS28) scores and ultrasound grades/scores. Here, we investigated the relationships between immunoregulatory cytokines or cells and different DAS28 scores or ultrasound grades/scores in patients with rheumatoid arthritis (RA). This study enrolled 50 RA patients (with 147 visits) who had remission/low/moderate DAS28-ESR scores (92% in remission and low disease activity) at baseline. Blood was collected and an ultrasound was performed three times in a year. Percentages of regulatory B cells and T regulatory type 1 cells and M2 macrophage numbers in the blood were examined. Plasma levels of 10 immunoregulatory cytokines IL-4, IL-5, IL-9, IL-10, IL-13, IL-27, IL-35, TGF-β1, sTNF-R1, and sTNF-R2 and monocyte chemotactic protein-1 (MCP-1) were assessed using ELISA assay. The correlations of cytokines and cells with different DAS28 scores and ultrasound grades were investigated, and cytokines and cells were compared between different categories of DAS28 scores and ultrasound grades. Plasma TGF-β1 levels were higher in the DAS28-ESR < 2.6 (remission) subgroup than in the DAS28-ESR ≥ 2.6 (nonremission) subgroup (p = 0.037). However, plasma TGF-β1 levels were higher in the high ultrasound grade subgroup than those in the low ultrasound grade subgroup (p = 0.007). The number of M2 macrophages was lower in the DAS28-MCP-1 < 2.2 subgroup than in the DAS28-MCP-1 ≥ 2.2 subgroup (p = 0.036). The levels of TGF-β1, sTNF-R2, IL-10, and IL-27 were higher in patients with high ultrasound grades than in those with low ultrasound grades. IL-27 was also higher in the nonremission DAS28-ESR subgroup than the remission one (p = 0.025). Moreover, sTNF-R1 levels in the 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission subgroup were significantly lower than in the 2011 ACR/EULAR nonremission subgroup (p = 0.007). This trend was reflected in that lower sTNF-R1 levels correlated with low DAS28-MCP-1 scores (rho = 0.222, p = 0.007). We conclude that high plasma TGF-β1 levels indicate the DAS28-ESR remission (<2.6) subgroup and the high ultrasound grade subgroup. IL-27 probably connects the nonremission DAS28-ESR to high ultrasound grades. Low sTNF-R1 levels probably link low DAS28-MCP-1 scores with the 2011 ACR/EULAR remission subgroup. It suggests that incongruent immuno-inflammatory abnormalities exist between DAS28 scores and ultrasound grades, and are also dissimilar among various DAS28-formula categories. Therefore, this study may provide a basis for further research into individual cytokines and immunoregulatory cells behind each DAS28 formula and ultrasound grades/scores.
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Affiliation(s)
- Lieh-Bang Liou
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital at Keelung, Keelung City 204, Taiwan
- Division of Rheumatology, Allergy, and Immunology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
- School of Medicine, Chang Gung University College of Medicine, Taoyuan City 333, Taiwan
| | - Yao-Fan Fang
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
| | - Ping-Han Tsai
- Division of Rheumatology, Allergy, and Immunology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
| | - Yen-Fu Chen
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
| | - Che-Tzu Chang
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan
| | - Chih-Chieh Chen
- Division of Rheumatology, Allergy, and Immunology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Wen-Yu Chiang
- Division of Rheumatology, Allergy, and Immunology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
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Liu C, Yan Z, Zhang X, Xia T, Ashaolu JO, Olatunji OJ, Ashaolu TJ. Food-derived bioactive peptides potentiating therapeutic intervention in rheumatoid arthritis. Heliyon 2024; 10:e31104. [PMID: 38778960 PMCID: PMC11109807 DOI: 10.1016/j.heliyon.2024.e31104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects the joints of the human body and is projected to have a prevalence age-standardized rate of 1.5 million new cases worldwide by 2030. Several conventional and non-conventional preventive and therapeutic interventions have been suggested but they have their side effects including nausea, abdominal pain, liver damage, ulcers, heightened blood pressure, coagulation, and bleeding. Interestingly, several food-derived peptides (FDPs) from both plant and animal sources are increasingly gaining a reputation for their potential in the management or therapy of RA with little or no side effects. In this review, the concept of inflammation, its major types (acute and chronic), and RA identified as a chronic type were discussed based on its pathogenesis and pathophysiology. The conventional treatment options for RA were briefly outlined as the backdrop of introducing the FDPs that potentiate therapeutic effects in the management of RA.
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Affiliation(s)
- Chunhong Liu
- Second People's Hospital of Wuhu City, 241001, Anhui, China
| | - Zheng Yan
- Second People's Hospital of Wuhu City, 241001, Anhui, China
| | - Xiaohai Zhang
- Second People's Hospital of Wuhu City, 241001, Anhui, China
| | - Taibao Xia
- Second People's Hospital of Wuhu City, 241001, Anhui, China
| | - Joseph Opeoluwa Ashaolu
- Department of Public Health, Faculty of Basic Medical Sciences, Redeemers University, PMB 230, Ede, Osun State, Nigeria
| | | | - Tolulope Joshua Ashaolu
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Viet Nam
- Faculty of Medicine, Duy Tan University, Da Nang, 550000, Viet Nam
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Tsai PH, Fang YF, Chen YF, Chen CC, Chiang WY, Chang CT, Huang YJ, Liou LB. Predictors of Remission or Combined Remission and Low Disease Activity in Rheumatoid Arthritis Patients in Taiwan: A Prospective Cohort Study. J Clin Med 2024; 13:2521. [PMID: 38731049 PMCID: PMC11084563 DOI: 10.3390/jcm13092521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Objectives: This study aimed to identify predictors of remission or low disease activity (LDA) in patients with rheumatoid arthritis (RA) and low-ultrasound inflammation. Methods: A total of 80 patients with RA who fulfilled the 1987 ACR criteria for RA with a disease activity score of 28 joints (DAS28) > 3.2 were recruited. Over 1 year of therapy, we conducted blood tests every 6 months to examine erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), monocyte chemotactic protein-1 (MCP-1), neuraminidase 3 (Neu3), and α-2,3-sialyltrasnferse I (ST3Gal-1) levels in B cells and monocytes. Additionally, we evaluated physical function by using the Health Assessment Questionnaire-Disability Index (HAQ-DI). Data on demographic and clinical parameters were collected, and musculoskeletal ultrasonography was performed twice a year on 12 specific joints to assess synovial changes. One year later, we compared all collected data and laboratory or ultrasound results between patients achieving remission or LDA and those who did not in order to determine the predictors. Results: Age, the presence or absence of rheumatoid factor, and the number of conventional disease-modifying anti-rheumatic drugs used were not correlated with remission or LDA for DAS28 or Simplified Disease Activity Index formulas. However, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores were associated with a higher likelihood of achieving remission or LDA for DAS28-ESR. Negative anticyclic citrullinated peptide (CCP) and low HAQ-DI scores were predictors of remission or LDA for DAS28-MCP-1. Interestingly, having less than two comorbidities is a good predictor of a combined remission/low disease activity state for SDAI and DAS28-MCP-1. Furthermore, Neu3 and ST3Gal-1 levels and ST3Gal-1/Neu3 ratios in B cells and monocytes had no significant correlation with total ultrasound scores. Nevertheless, monocyte ST3Gal-1 and Neu3 correlated significantly with DAS28-ESR >5.1 and DAS-MCP-1 >4.8 (both categories belong to high disease activity), respectively (rho = 0.609 with p = 0.012, and rho = 0.727 with p = 0.011, respectively). Monocyte ST3Gal-1/Neu3 ratios connected with DAS28-ESR >5.1 and 3.3 < SDAI ≦ 11 (low disease activity), respectively (rho = 0.662 with p = 0.005, and rho = 0.342 with p = 0.048, respectively). Conclusions: In patients with RA in Taiwan, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores are predictors of remission or LDA for DAS28-ESR, which differ from the predictors for DAS28-MCP-1. Moreover, monocyte ST3Gal-1, Neu3, and their ratios correlated with different disease activity categories of DAS28-ESR, DAS28-MCP-1, and SDAI scores.
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Affiliation(s)
- Ping-Han Tsai
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (P.-H.T.); (C.-C.C.); (W.-Y.C.)
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Yao-Fan Fang
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Yen-Fu Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Chih-Chieh Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (P.-H.T.); (C.-C.C.); (W.-Y.C.)
| | - Wen-Yu Chiang
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (P.-H.T.); (C.-C.C.); (W.-Y.C.)
| | - Che-Tzu Chang
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Yun-Ju Huang
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Lieh-Bang Liou
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (P.-H.T.); (C.-C.C.); (W.-Y.C.)
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
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Bordean L, Chis M, Cimpean AM, Barb AC, Cosma AA, Fenesan MP, Cotoi OS, Nicolescu L, Nicolescu CM, Avram C. Age, Sex, Metabolic and Pharmacologic Factors May Predict Nonresponse Status to Rheumatoid Arthritis Therapies. In Vivo 2023; 37:2387-2401. [PMID: 37652478 PMCID: PMC10500531 DOI: 10.21873/invivo.13344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND/AIM A real challenge for patients with rheumatoid arthritis (RA) and rheumatologists is primary nonresponse status (PNRS) or secondary nonresponse status (SNRS) to various therapies. Despite their detrimental influence on patient life quality, PNRS and SNRS have no accurate definition and no early predictive criteria for their development exist. Patients with RA under 40 years of age are rare, hence PNRS and SNRS data for this age group are scarce. This study examined the PNRS and SNRS according to sex, age, BMI, therapy type, and duration. PATIENTS AND METHODS Retrospectively, 115 patients with RA having PNRS and/or SNRS were stratified by age (22-39, 40-59, and 60-81). The association between body mass index (BMI), proinflammatory cytokines inhibitors, JAK inhibitors, and TNF-alpha inhibitors, sex, age, and PNRS and SNRS was examined. RESULTS All three proinflammatory cytokine inhibitors (rituximab, tocilizumab, and abatacept) were associated with PNRS and SNRS in women with a high BMI aged 40-59 years. Abatacept-related PNRS and SNRS was significant in women with normal BMI aged 60-81 years. Adalimumab, infliximab, and golimumab affected SNRS differently in women with normal BMI aged 22-39 years and women with high BMI aged 60-81 years. Etanercept and infliximab were associated with SNRS status in men with high-BMI aged 40-59 years. CONCLUSION PNRS and SNRS development in patients with RA is significantly influenced by age, sex, and BMI, but most importantly is closely and differentially related to therapy type and duration.
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Affiliation(s)
- Liliana Bordean
- Department ME2/Rheumatology, Rehabilitation, Physical Medicine and Balneology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş (UMPhST), Targu Mures, Romania
- Clinic of Rheumatology, Emergency County Hospital of Târgu Mureş, Targu Mures, Romania
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | - Monica Chis
- Department ME2/Rheumatology, Rehabilitation, Physical Medicine and Balneology, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş (UMPhST), Targu Mures, Romania;
- Clinic of Rheumatology, Emergency County Hospital of Târgu Mureş, Targu Mures, Romania
| | - Anca Maria Cimpean
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania;
- Center of Expertise for Rare Vascular Disease in Children, Emergency Hospital for Children Louis Turcanu, Timisoara, Romania
| | - Alina Cristina Barb
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- OncoHelp Hospital, Timisoara, Romania
| | - Andrei Alexandru Cosma
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- OncoHelp Hospital, Timisoara, Romania
| | - Mihaela Pasca Fenesan
- Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- OncoHelp Hospital, Timisoara, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Targu Mures, Romania
- Department of Pathology, County Clinical Hospital Mureș, Targu Mures, Romania
| | - Laura Nicolescu
- Department of Medicine, Faculty of Medicine, Vasile Goldiş Western University of Arad, Arad, Romania
- Department of Physical Medicine and Rehabilitation, Emergency County Hospital, Arad, Romania
| | - Cristian Mircea Nicolescu
- Department of Anesthesia and Intensive Care, Emergency County Hospital, Arad, Romania
- Department of Biology and Life Sciences, Vasile Goldiş Western University of Arad, Arad, Romania
| | - Claudiu Avram
- Department XVI/Balneology, Rehabilitation and Rheumatology, University of Medicine and Pharmacy Victor Babes Timisoara, Timisoara, Romania
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Zhao Q, Ren H, Yang N, Xia X, Chen Q, Zhou D, Liu Z, Chen X, Chen Y, Huang W, Zhou H, Xu H, Zhang W. Bifidobacterium pseudocatenulatum-Mediated Bile Acid Metabolism to Prevent Rheumatoid Arthritis via the Gut-Joint Axis. Nutrients 2023; 15:nu15020255. [PMID: 36678126 PMCID: PMC9861548 DOI: 10.3390/nu15020255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Early intervention in rheumatoid arthritis (RA) is critical for optimal treatment, but initiation of pharmacotherapy to prevent damage remains unsatisfactory currently. Manipulation of the gut microbiome and microbial metabolites can be effective in protecting against RA. Thus, probiotics can be utilized to explore new strategies for preventing joint damage. The aim of this study was to explore the metabolites and mechanisms by which Bifidobacterium pseudocatenulatum affects RA. Based on 16S rRNA sequencing and UPLC-MS/MS assays, we focused on bile acid (BA) metabolism. In a collagen-induced arthritis (CIA) mouse model, B. pseudocatenulatum prevented joint damage by protecting the intestinal barrier and reshaped gut microbial composition, thereby elevating bile salt hydrolase (BSH) enzyme activity and increasing the levels of unconjugated secondary BAs to suppress aberrant T-helper 1/17-type immune responses; however, these benefits were eliminated by the Takeda G protein-coupled receptor 5 (TGR5) antagonist SBI-115. The results suggested that a single bacterium, B. pseudocatenulatum, can prevent RA, indicating that prophylactic administration of probiotics may be an effective therapy.
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Affiliation(s)
- Qing Zhao
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
| | - Huan Ren
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
| | - Nian Yang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
| | - Xuyang Xia
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qifeng Chen
- Department of Pathology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Dingding Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
| | - Zhaoqian Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
| | - Xiaoping Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
| | - Yao Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
| | - Weihua Huang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
| | - Honghao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
| | - Heng Xu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wei Zhang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
- Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, 110 Xiangya Road, Changsha 410078, China
- Engineering Research Center of Applied Technology of Pharmacogenomics, Ministry of Education, 110 Xiangya Road, Changsha 410078, China
- National Clinical Research Center for Geriatric Disorders, 87 Xiangya Road, Changsha 410008, China
- Correspondence: ; Tel.: +86-731-84805380
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Choida V, Madenidou AV, Sen D, Hall-Craggs MA, Ciurtin C. The role of whole-body MRI in musculoskeletal inflammation detection and treatment response evaluation in inflammatory arthritis across age: A systematic review. Semin Arthritis Rheum 2022; 52:151953. [PMID: 35038643 DOI: 10.1016/j.semarthrit.2022.151953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the relation between whole-body MRI (WBMRI) outcomes and disease activity measures, including clinical examination, composite scores, and other imaging outcomes, and the ability of WBMRI to detect treatment response in patients with inflammatory arthritis (IA) across age. METHODS Human studies published as full text or abstract in the PubMed and MEDLINE and Cochrane databases from inception to 11th April 2021 were systematically and independently searched by two reviewers. Studies including patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondyloarthritis (SpA), juvenile idiopathic arthritis (JIA) or unclassified inflammatory arthritis (UA) who underwent WBMRI and which reported on disease outcomes were included. RESULTS Nineteen full-text studies were eligible for inclusion: 2 interventional, 7 retrospective and 10 prospective observational studies, comprising 540 participants (SpA 38.7%, RA 24.8%, JIA 17.8%, PsA 11.5%, healthy controls 5.9%, UA 1.3%). Abstracts of 6 conference papers were reported separately. Five studies in PsA and SpA and 4 in RA measured the frequency of WBMRI-detected and clinically-detected synovitis, and all found the former to be more frequent. Less enthesitis was detected by WBMRI than clinical examination in 5/8 studies. After biologic treatment, the WBMRI inflammation scores declined in 3 studies in SpA and 2 in RA, whilst in 3 studies the results were equivocal. CONCLUSION The ability of WBMRI to assess disease activity and treatment response in IA was adequate overall. Further studies are needed to corroborate WBMRI findings with IA outcomes and investigate the clinical value of subclinical inflammation.
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Affiliation(s)
- Varvara Choida
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK
| | - Anastasia-Vasiliki Madenidou
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK
| | - Debajit Sen
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK
| | - Margaret A Hall-Craggs
- Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK; Department of Radiology, University College London Hospital, Ground Floor 235 Euston Road, London NW1 2BU, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, University College London, Rayne Building, 5 University Street, London WC1E 6JF, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, 3rd Floor 250 Euston Road, London NW1 2PG, UK.
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7
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Berso JDL, Montes EG, Vellosa JCR, Mansani FP, Toledo Júnior ADO, Schafranski MD. Comparison between DAS28-ESR and DAS28- CRPus for patients with rheumatoid arthritis: application in a population of southern Brazil. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Liu F, Li W, Zhu J, Liu F, Fan W, Chen Z. Predictive role of ultrasound remission for progressive ultrasonography-detected structural damage in patients with rheumatoid arthritis. J Investig Med 2021; 70:391-395. [PMID: 34518320 DOI: 10.1136/jim-2021-001885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
Regarding the persistence of subclinical synovitis, the concept of ultrasound remission has been proposed in addition to clinical remission. However, there have been no studies that explored the different time points of ultrasound remission to predict non-progressive structural damage. Given this, the aim of our study is to explore whether early ultrasound remission in patients with rheumatoid arthritis (RA) has predictive value for non-progressive structural damage in the subsequent 12 months. Sixty-one patients with RA were prospectively studied. Synovial hypertrophy, power Doppler (PD) signal, and bone erosions of bilateral wrists, metacarpophalangeal joints I-V, and proximal interphalangeal joints II-III were assessed by ultrasonography at baseline and at 3, 6, and 12 months. Ultrasound remission was defined as no PD signal. Clinical remission was defined as Disease Activity Score in 28 Joints <2.6. Ultrasonography-detected joint damage progression was defined as increase in bone erosion score of ≥1 in the subsequent 12 months. Baseline ultrasonographic factors were not significantly correlated with progressive ultrasonography-detected joint damage in patients with RA at 12 months (all p>0.05). Ultrasound remission at 3 and 6 months was significantly correlated with non-progressive ultrasonography-detected structural damage at 12 months (p=0.006 and p=0.004), with relatively low sensitivity and high specificity. Clinical remission at 3 months was significantly correlated with non-progression of ultrasonography-detected structural damage at 12 months (p=0.029), with relatively low sensitivity and moderate specificity. Ultrasound remission at 3 and 6 months has high specificity in predicting non-progressive structural damage in patients with RA at 12 months; however, the sensitivity is limited.
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Affiliation(s)
- Feifei Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Wenxue Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Fang Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Wenting Fan
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Zheng Chen
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
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9
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Rinkin C, Fosse P, Malaise O, Chapelier N, Horrion J, Seidel L, Albert A, Hustinx R, Malaise MG. Dissociation between 2-[ 18F]fluoro-2-deoxy-D-glucose positron emission computed tomography, ultrasound and clinical assessments in patients with non-severe rheumatoid arthritis, including remission. BMC Rheumatol 2021; 5:31. [PMID: 34344479 PMCID: PMC8336401 DOI: 10.1186/s41927-021-00196-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 04/28/2021] [Indexed: 07/31/2023] Open
Abstract
Background Inflammation of patients joints with severe disease activity of rheumatoid arthritis (RA) has already been visualized and quantified by 2-[18F]fluoro-2-deoxy-D-glucose positron emission computed tomography ([18F] FDG PET/CT), but little is known about the metabolic status and its relationship with clinical and ultrasonography (US) metrology in patients with low/moderate activity or in remission. Methods Clinical assessments [based on 28-joint disease activity score (DAS28-CRP) and Clinical Disease Activity Index (CDAI)], [18F] FDG PET/CT, US and X-ray were performed on 63 RA patients classified into remission or low/moderate or severe disease activity groups. PET/CT was visually and then semi-quantitatively analysed by determining the standardized uptake value (SUV) of positive joints. Results Of the 1764 joints, 21.1% were tender only, 13.7% swollen only, 27.6% tender or swollen, 7.3% tender and swollen, 20.5% PET/CT-positive and 8.6% US-positive. PET and US measurements were correlated, albeit with poor concordance. The positive predictive value of PET/CT for clinical evaluation (tender and/or swollen) was low, whereas its negative predictive value was high. Highly significant differences were found with the number of PET/CT-positive joints and with cumulative SUV between “severe” and “non-severe” patients (including those in remission and those with low/moderate activity) and not between those classified as “remission” and “non-remission” or “remission” and “low/moderate activity”. Moreover, the correlation between PET/CT measurements and clinical activity was positive only in the CDAI severe disease group. In patients in remission or with low/moderate activity, only 20–30% of joints were PET/CT-negative. In remission, PET/CT and US were positive in different joints, and PET/CT-positive but US-negative joints mainly exhibited RA (38.1%) or normal (49.2%) and not osteoarthritic (12.7%) X-ray patterns. Conclusions [18F] FDG PET/CT was effective at distinguishing patients with severely active disease from other patients. In non-severe RA patients, including those in remission, PET/CT results are discordant from US and clinical observations. A longitudinal analysis is needed to explore the clinical relevance of such infra-clinical disease. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00196-1.
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Affiliation(s)
- Charline Rinkin
- Department of Rheumatology, University Hospital of Liège, Room 155 BC + 3, CHU Sart-Tilman B35, Avenue de l'hôpital 1, B-4000, Liège, Belgium.
| | - Pacôme Fosse
- Department of Nuclear Medicine, University Hospital of Liège, Angers, France
| | - Olivier Malaise
- Department of Rheumatology, University Hospital of Liège, Room 155 BC + 3, CHU Sart-Tilman B35, Avenue de l'hôpital 1, B-4000, Liège, Belgium
| | - Nathalie Chapelier
- Department of Rheumatology, University Hospital of Liège, Room 155 BC + 3, CHU Sart-Tilman B35, Avenue de l'hôpital 1, B-4000, Liège, Belgium
| | - Jil Horrion
- Department of Radiology, University Hospital of Liège, Liège, Belgium
| | - Laurence Seidel
- Department of Biostatistics, University Hospital of Liège, Liège, Belgium
| | - Adelin Albert
- Department of Biostatistics, University Hospital of Liège, Liège, Belgium
| | - Roland Hustinx
- Department of Nuclear Medicine, University Hospital of Liège, Liège, Belgium
| | - Michel G Malaise
- Department of Rheumatology, University Hospital of Liège, Room 155 BC + 3, CHU Sart-Tilman B35, Avenue de l'hôpital 1, B-4000, Liège, Belgium
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Terslev L, Ostergaard M. Rheumatoid Arthritis Relapse and Remission - Advancing Our Predictive Capability Using Modern Imaging. J Inflamm Res 2021; 14:2547-2555. [PMID: 34163211 PMCID: PMC8215903 DOI: 10.2147/jir.s284405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/27/2021] [Indexed: 01/18/2023] Open
Abstract
Clinical remission has become an achievable target for the majority of patients with rheumatoid arthritis, but subclinical inflammation as assessed by ultrasound and magnetic resonance imaging (MRI) has been demonstrated to be frequent in patients in clinical remission. Subclinical synovitis has been shown to be linked to both subsequent structural damage progression and a risk of flare, demonstrating that subclinical synovitis represents incomplete suppression of inflammation and questions whether it is appropriate only to use clinical composite scores as treatment target in clinical practice. Maintaining a state of remission has proven important as sustained clinical remission impacts long-term outcome regarding joint damage progression, physical function and quality of life. Treating subclinical inflammation has been attempted and has led to more frequent strict clinical remission and better physical function, but also to more adverse events. Thus, an overall benefit of incorporating imaging goals in treat-to-target strategies has not been documented. However, in patients in clinical remission on biological disease-modifying anti-rheumatic drugs, both ultrasound and MRI may aid in the clinical decision regarding whether drug tapering or even discontinuation should be attempted.
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Affiliation(s)
- Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Tesei G, Cometi L, Nacci F, Terenzi R, Tofani L, Capassoni M, Bartoli F, Fiori G, Matucci-Cerinic M, Bruni C. Baricitinib in the treatment of rheumatoid arthritis: clinical and ultrasound evaluation of a real-life single-centre experience. Ther Adv Musculoskelet Dis 2021; 13:1759720X211014019. [PMID: 34025783 PMCID: PMC8120535 DOI: 10.1177/1759720x211014019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Ultrasound (US) is useful in monitoring RA patients, with the US7 score allowing grey-scale and power-Doppler (PD) semi-quantitative evaluation of synovitis and teno-synovitis. We evaluated real-life efficacy and safety of Baricitinib, an oral selective JAK1-2 inhibitor, in RA patients using clinical, clinimetric, and US assessments. Methods: Disease activity score in 28 joints calculated with C-reactive protein (DAS28-CRP), disease activity score in 28 joints calculated with erythrocyte sedimentation rate (DAS28-ESR), clinical disease activity index (CDAI), simplified disease activity index (SDAI), visual analogue scale (VAS)-pain, health assessment questionnaire (HAQ), COCHIN scale, adverse events (AE), concomitant medications, laboratory parameters, and US7 were performed/recorded at baseline, 1, 3, and 6 months in RA patients starting Baricitinib. Responder/non-responder status was determined according to the EULAR Response Criteria at 3 months. SDAI clinical remission or low disease activity (LDA) were calculated at 3 and 6 months. Results: In 43 enrolled patients, a significant improvement in disease activity and US7 components (except tendon PD) and a reduction of steroid dosage were observed. Responders at 3 months showed a significantly higher reduction of CDAI, SDAI, COCHIN scale, VAS-pain, and US7 synovialPD, compared with non-responders. At 3 and 6 months, remission/LDA was achieved by 12.8/53.8% and 21.6/51.3% patients, respectively. The csDMARD co-treatment was independently associated with remission/LDA at 3 months. Safety-related drop-outs were in line with literature data. The steroid dosage was associated with AE development at 6 months. Conclusion: The real-life data, also obtained with US evaluation, confirmed the Baricitinib efficacy in RA disease control, as well as the utility of assessment during the follow up of disease activity.
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Affiliation(s)
- Giulia Tesei
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, ItalyOspedale Infermi, Medicina e Reumatologia, Rimini, Italia
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Via delle Oblate 4, Firenze, 50141, Italy
| | - Francesca Nacci
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Lorenzo Tofani
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Marco Capassoni
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Francesca Bartoli
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Ginevra Fiori
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Cosimo Bruni
- Department Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
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12
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Hèctor C, Millan AM, Diaz-Torne C. Rheumatoid Arthritis: Defining Clinical and Ultrasound Deep Remission. Mediterr J Rheumatol 2021; 31:384-388. [PMID: 33521569 PMCID: PMC7841096 DOI: 10.31138/mjr.31.4.384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/04/2022] Open
Abstract
The prognosis of patients with rheumatoid arthritis (RA) has improved substantially in the last two decades due to the appearance of biological therapies, but above all, due to the improvement in the strategy and management of the disease. Our goal in RA should be to achieve remission, or in its absence, the lowest inflammatory activity. Achieving remission will prevent from structural and functional damage highly associated with RA itself. Clinical remission is defined as the absence of significant signs and symptoms of inflammatory disease activity, as well as the abrogation of any signs of systemic inflammation. Currently, there are some controversies about remission. Which is the real remission? Which remission criteria should be used and when? Does clinical remission mean ultrasound remission? In the present review, we try to answer and put some light into it, focusing on clinical and ultrasound deep remission.
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Affiliation(s)
- Corominas Hèctor
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Milena Millan
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cesar Diaz-Torne
- Arthritis Unit, Rheumatology and Autoimmune Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
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13
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Bilal M, Qindeel M, Nunes LV, Duarte MTS, Ferreira LFR, Soriano RN, Iqbal HMN. Marine-Derived Biologically Active Compounds for the Potential Treatment of Rheumatoid Arthritis. Mar Drugs 2020; 19:10. [PMID: 33383638 PMCID: PMC7823916 DOI: 10.3390/md19010010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease with a prevalence rate of up to 1% and is significantly considered a common worldwide public health concern. Commercially, several traditional formulations are available to treat RA to some extent. However, these synthetic compounds exert toxicity and considerable side effects even at lower therapeutic concentrations. Considering the above-mentioned critiques, research is underway around the world in finding and exploiting potential alternatives. For instance, marine-derived biologically active compounds have gained much interest and are thus being extensively utilized to confront the confines of in practice counterparts, which have become ineffective for 21st-century medical settings. The utilization of naturally available bioactive compounds and their derivatives can minimize these synthetic compounds' problems to treat RA. Several marine-derived compounds exhibit anti-inflammatory and antioxidant properties and can be effectively used for therapeutic purposes against RA. The results of several studies ensured that the extraction of biologically active compounds from marine sources could provide a new and safe source for drug development against RA. Finally, current challenges, gaps, and future perspectives have been included in this review.
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Affiliation(s)
- Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian 223003, China
| | - Maimoona Qindeel
- Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan;
| | - Leonardo Vieira Nunes
- Department of Medicine, Federal University of Juiz de Fora, Juiz de Fora-MG 36036-900, Brazil;
| | | | - Luiz Fernando Romanholo Ferreira
- Graduate Program in Process Engineering, Tiradentes University (UNIT), Av. Murilo Dantas, 300, Farolândia, Aracaju-Sergipe 49032-490, Brazil;
- Institute of Technology and Research (ITP), Tiradentes University (UNIT), Av. Murilo Dantas, 300, Farolândia, Aracaju-Sergipe 49032-490, Brazil
| | - Renato Nery Soriano
- Division of Physiology and Biophysics, Department of Basic Life Sciences, Federal University of Juiz de Fora, Governador Valadares-MG 35010-180, Brazil;
| | - Hafiz M. N. Iqbal
- School of Engineering and Sciences, Tecnologico de Monterrey, Monterrey 64849, Mexico
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14
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Abrar DB, Schleich C, Müller-Lutz A, Frenken M, Radke KL, Vordenbäumen S, Schneider M, Ostendorf B, Sewerin P. Cartilage Degradation in Psoriatic Arthritis Is Associated With Increased Synovial Perfusion as Detected by Magnetic Resonance Imaging. Front Med (Lausanne) 2020; 7:539870. [PMID: 33102496 PMCID: PMC7546830 DOI: 10.3389/fmed.2020.539870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/21/2020] [Indexed: 01/27/2023] Open
Abstract
Objective: Even though cartilage loss is a known feature of psoriatic arthritis (PsA), research is sparse on its role in the pathogenesis of PsA and its potential use for disease detection and monitoring. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and dynamic contrast-enhanced MRI (DCE MRI), research has shown that early cartilage loss is strongly associated with synovial inflammation in rheumatoid arthritis (RA). The aim of this study was to determine if acute inflammation is associated with early cartilage loss in small finger joints of patients with PsA. Methods: Metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution 3 Tesla dGEMRIC and DCE MRI using a dedicated 16-channel hand coil. Semi-quantitative and quantitative perfusion parameters were calculated. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS), total cartilage thickness (TCT), and joint space width (JSW). Results: We found significant negative correlations between perfusion parameters (except Kep) and dGEMRIC indices, with the highest value at the MCP joints (KTrans: τ = −0.54, p = 0.01; Kep: τ = −0.02, p = 0.90; IAUC: τ = −0.51, p = 0.015; Initial Slope: τ = −0.54, p = 0.01; Peak: τ = −0.67, p = 0.002). Heterogeneous correlations were detected between perfusion parameters and both, total PsAMRIS and PsAMRIS synovitis sub-scores. No significant correlation was seen between any perfusion parameter and JSW and/or TCT. Conclusion: As examined by DCE MRI and dGEMRIC, there is a potential association between early cartilage loss and acute synovial inflammation in small finger joints of PsA patients.
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Affiliation(s)
- Daniel B Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - Miriam Frenken
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - K Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Benedikt Ostendorf
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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15
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The Use of Oral Analgesics and Pain Self-Efficacy Are Independent Predictors of the Quality of Life of Individuals with Rheumatoid Arthritis. Pain Res Manag 2020; 2020:7409396. [PMID: 32774569 PMCID: PMC7396007 DOI: 10.1155/2020/7409396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
Objectives This study investigated the relationship between quality of life (QOL) and several factors, including pain assessments, in patients with rheumatoid arthritis (RA). Methods This cross-sectional, single-center study enrolled 85 patients with RA. The variables investigated included demographic characteristics, the 28-joint disease activity score with C-reactive protein (DAS28-CRP), painDETECT questionnaire (PDQ), pain self-efficacy questionnaire (PSEQ), and pain catastrophizing scale (PCS). QOL was measured using the Japanese validated version of the European Quality of Life questionnaire with five dimensions and five levels (EQ-5D-5L). Results The use of oral steroids and oral analgesics was significantly associated with low EQ-5D-5L scores (P < 0.05). EQ-5D-5L score had a significant positive association with PSEQ (r = 0.414) and significant negative association with age, disease duration, DAS28-CRP, PDQ, and PCS (r = −0.217, −0.343, −0.217, −0.277, and −0.384, respectively). Multiple regression analysis showed that the use of oral analgesics and PSEQ were independent predictors of EQ-5D-5L score (β = -0.248, P < 0.05 and β = 0.233, P < 0.05). Conclusions The use of oral analgesics by RA patients may influence their QOL, which, in turn, may affect their feelings of self-efficacy. Various pain management strategies, including surgical treatment, may be explored for the treatment of RA. Furthermore, the PSEQ may be a prominent part of the patient's overall assessment.
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16
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Fujita Y, Asano T, Matsuoka N, Temmoku J, Sato S, Matsumoto H, Furuya MY, Suzuki E, Watanabe H, Kawakami A, Migita K. Differential regulation and correlation between galectin-9 and anti-CCP antibody (ACPA) in rheumatoid arthritis patients. Arthritis Res Ther 2020; 22:80. [PMID: 32293530 PMCID: PMC7161013 DOI: 10.1186/s13075-020-02158-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/18/2020] [Indexed: 12/22/2022] Open
Abstract
Background Galectin-9 (Gal-9) is involved in the regulatory process of immune responses or inflammation. The aim of the present study is to characterize circulating Gal-9 in patients with rheumatoid arthritis (RA) and its relationship with RA disease activity and phenotype. Methods A total of 116 RA patients and 31 age-matched healthy controls were included in this study. Disease activity of RA patients was determined by Disease Activity Score of 28 joint scoring system (DAS28-ESR). Levels of Gal-9 in serum were determined by enzyme-linked immunosorbent assay (ELISA). Results Serum levels of Gal-9 were significantly higher in patients with RA compared to those in controls (median 7577 pg/ml [interquartile range (IQR) 5570–10,201] versus 4738 pg/ml [IQR 4267–5630], p = 0.001). There were significant differences in serum Gal-9 between RA patients with and without RA-ILD (9606 pg/ml [IQR 8522–12,167] versus 7078 pg/ml [IQR 5225–9447], p < 0.001) or those with and without advanced joint damage (stage II–IV, 9606 pg/ml [IQR 8522–12,167] versus 7078 pg/ml [IQR 5225–9447], p < 0.001). Although serum levels of Gal-9 correlated with the titers of ACPA (r = 0.275, p = 0.002), levels of ACPA titers conferred the different relationship, between serum Gal-9 and inflammatory mediators or RA disease activity. Although Gal-9 was correlated with ACPA titers (r = 0.508, p = 0.002), there was no correlation between Gal-9 levels and erythrocyte sedimentation rate (ESR), matrix metalloproteinase-3 (MMP-3), or DAS28-ESR in RA patients with high titers of ACPA (> 200 U/ml). Conversely, Gal-9 was correlated with MMP-3 (r = 0.300, p = 0.007) or DAS28-ESR (r = 0.331, p = 0.004) but not with ACPA titer in RA patients with low titers of ACPA titers (< 200 U/ml). Conclusions Serum levels of Gal-9 were increased in RA patients and associated with RA disease activity in RA patients without high titers of ACPA. The levels of ACPA titers may influence the values of circulating Gal-9 in RA patients with various clinical phenotypes. These data suggest that Gal-9 possessed the properties of pro-inflammatory or arthropathic biomarker under the status of ACPA titers.
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Affiliation(s)
- Yuya Fujita
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Tomoyuki Asano
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Naoki Matsuoka
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Jumpei Temmoku
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Shuzo Sato
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Haruki Matsumoto
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Makiko Yashiro Furuya
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Eiji Suzuki
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Hiroshi Watanabe
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences,, Nagasaki University, Sakamoto1-7-1, Nagasaki, 852-8501, Japan
| | - Kiyoshi Migita
- Department of Rheumatology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
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Raynor WY, Jonnakuti VS, Zirakchian Zadeh M, Werner TJ, Cheng G, Zhuang H, Høilund-Carlsen PF, Alavi A, Baker JF. Comparison of methods of quantifying global synovial metabolic activity with FDG-PET/CT in rheumatoid arthritis. Int J Rheum Dis 2019; 22:2191-2198. [PMID: 31721461 DOI: 10.1111/1756-185x.13730] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 07/07/2019] [Accepted: 09/14/2019] [Indexed: 11/26/2022]
Abstract
AIM 2-deoxy-2-[18 F]fluoro-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) can portray increased glycolysis due to inflammation in rheumatoid arthritis (RA). The aim of this study was to evaluate and compare the reliability and construct validity of two methods of quantifying RA disease activity using FDG-PET/CT. METHOD Nineteen RA patients and 19 healthy controls matched to sex and age underwent prospective FDG-PET/CT imaging. Metabolic and volumetric metrics were calculated using fixed and adaptive thresholding techniques and partial volume correction. Fixed thresholds segmented regions above average maximum physiological uptake in controls. Differences of means between RA and controls were assessed using t tests, and discrimination was assessed using receiver operating characteristics. Spearman correlation analysis was used to assess associations between FDG-PET/CT measures and clinical assessments of disease activity. RESULTS All FDG-PET/CT measures were substantially different and nearly non-overlapping between RA and controls (all P < .001). Area under the curve (AUC) for adaptive threshold parameters ranged from 0.986 to 0.997, and AUC for fixed threshold parameters ranged from 0.898 to 0.945. PET parameters were found to correlate positively with various clinical features, namely C-reactive protein, erythrocyte sedimentation rate, interleukin (IL)-6, IL-1, and swollen joint count. CONCLUSION All FDG-PET/CT parameters reflecting global RA disease activity differentiated between RA and controls, indicating high clinical utility to diagnose and assess RA. Adaptive thresholds can be used in a wider setting without control data, but methods utilizing fixed thresholds were more reproducible and more closely associated with indications of inflammation.
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Affiliation(s)
- William Y Raynor
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | - Thomas J Werner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Gang Cheng
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hongming Zhuang
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Abass Alavi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua F Baker
- Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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18
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Ultrasound remission can predict future good structural outcome in collagen-induced arthritis rats. Sci Rep 2019; 9:13294. [PMID: 31527701 PMCID: PMC6746853 DOI: 10.1038/s41598-019-49948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/03/2019] [Indexed: 11/08/2022] Open
Abstract
Regarding the persistence of subclinical synovitis, the concept of ultrasound remission has been proposed in addition to clinical remission. The present study aims to explore whether ultrasound remission has predictive value and ultrasound remission at which time point has predictive value for good structural outcome. Collagen-induced arthritis (CIA) was induced in 32 rats by immunizing with bovine type II collagen. Twenty-four CIA rats were treated with rhTNFR:Fc, and 8 rats were left untreated. Ultrasonography was performed to assess synovial hypertrophy, power Doppler (PD) signal, and bone erosion of the ankle joints of both hindpaws every week following the booster immunization. In the treated group, the scores for synovial hypertrophy, PD signal and bone erosions decreased from baseline to the end. Synovial hypertrophy, PD signal, and bone erosion at baseline were not significantly associated with good structural outcome. Ultrasound remission from 4 to 6 weeks after treatment was significantly associated with good outcome and had the highest area under the curve, sensitivity, specificity, and positive and negative predictive values. Therefore, we conclude that ultrasound remission from 4 to 6 weeks after treatment has a high value for predicting good structural outcome in CIA rats.
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19
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Blair JPM, Bager C, Platt A, Karsdal M, Bay-Jensen AC. Identification of pathological RA endotypes using blood-based biomarkers reflecting tissue metabolism. A retrospective and explorative analysis of two phase III RA studies. PLoS One 2019; 14:e0219980. [PMID: 31339920 PMCID: PMC6655687 DOI: 10.1371/journal.pone.0219980] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/05/2019] [Indexed: 12/31/2022] Open
Abstract
There is an increasing demand for accurate endotyping of patients according to their pathogenesis to allow more targeted treatment. We explore a combination of blood-based joint tissue metabolites (neoepitopes) to enable patient clustering through distinct disease profiles. We analysed data from two RA studies (LITHE (N = 574, follow-up 24 and 52 weeks), OSKIRA-1 (N = 131, follow-up 24 weeks)). Two osteoarthritis (OA) studies (SMC01 (N = 447), SMC02 (N = 81)) were included as non-RA comparators. Specific tissue-derived neoepitopes measured at baseline, included: C2M (cartilage degradation); CTX-I and PINP (bone turnover); C1M and C3M (interstitial matrix degradation); CRPM (CRP metabolite) and VICM (macrophage activity). Clustering was performed to identify putative endotypes. We identified five clusters (A-E). Clusters A and B were characterized by generally higher levels of biomarkers than other clusters, except VICM which was significantly higher in cluster B than in cluster A (p<0.001). Biomarker levels in Cluster C were all close to the median, whilst Cluster D was characterised by low levels of all biomarkers. Cluster E also had low levels of most biomarkers, but with significantly higher levels of CTX-I compared to cluster D. There was a significant difference in ΔSHP score observed at 52 weeks (p<0.05). We describe putative RA endotypes based on biomarkers reflecting joint tissue metabolism. These endotypes differ in their underlining pathogenesis, and may in the future have utility for patient treatment selection.
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Affiliation(s)
- J. P. M. Blair
- ProScion, Herlev, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- * E-mail:
| | | | - A. Platt
- Target & Translational Science, Respiratory, Inflammation and Autoimmunity (RIA), IMED Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - M. Karsdal
- Rheumatology, Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | - A. -C. Bay-Jensen
- Rheumatology, Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
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20
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Häupl T, Skapenko A, Hoppe B, Skriner K, Burkhardt H, Poddubnyy D, Ohrndorf S, Sewerin P, Mansmann U, Stuhlmüller B, Schulze-Koops H, Burmester GR. [Biomarkers and imaging for diagnosis and stratification of rheumatoid arthritis and spondylarthritis in the BMBF consortium ArthroMark]. Z Rheumatol 2019; 77:16-23. [PMID: 29691690 DOI: 10.1007/s00393-018-0458-x] [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] [Indexed: 02/06/2023]
Abstract
Rheumatic diseases are among the most common chronic inflammatory disorders. Besides severe pain and progressive destruction of the joints, rheumatoid arthritis (RA), spondyloarthritides (SpA) and psoriatic arthritis (PsA) impair working ability, reduce quality of life and if treated insufficiently may enhance mortality. With the introduction of biologics to treat these diseases, the demand for biomarkers of early diagnosis and therapeutic stratification has been growing continuously. The main goal of the consortium ArthroMark is to identify new biomarkers and to apply modern imaging technologies for diagnosis, follow-up assessment and stratification of patients with RA, SpA and PsA. With the development of new biomarkers for these diseases, the ArthroMark project contributes to research in chronic diseases of the musculoskeletal system. The cooperation between different national centers will utilize site-specific resources, such as biobanks and clinical studies for sharing and gainful networking of individual core areas in biomarker analysis. Joint data management and harmonization of data assessment as well as best practice characterization of patients with new imaging technologies will optimize quality of marker validation.
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Affiliation(s)
- T Häupl
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité-Universitätsmedizin Berlin, Campus Mitte (CCM), Charitéplatz 1, 10117, Berlin, Deutschland.
| | - A Skapenko
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, München, Deutschland
| | - B Hoppe
- Zentralinstitut für Laboratoriumsmedizin und Pathobiochemie, Charité, Berlin, Deutschland
| | - K Skriner
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité-Universitätsmedizin Berlin, Campus Mitte (CCM), Charitéplatz 1, 10117, Berlin, Deutschland
| | - H Burkhardt
- Abteilung für Rheumatologie, Johann-Wolfgang-Goethe-Universität, Frankfurt, Deutschland
| | - D Poddubnyy
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Berlin, Deutschland
| | - S Ohrndorf
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité-Universitätsmedizin Berlin, Campus Mitte (CCM), Charitéplatz 1, 10117, Berlin, Deutschland
| | - P Sewerin
- Medizinische Klinik für Endokrinologie, Diabetologie und Rheumatologie, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - U Mansmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität, München, Deutschland
| | - B Stuhlmüller
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité-Universitätsmedizin Berlin, Campus Mitte (CCM), Charitéplatz 1, 10117, Berlin, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, München, Deutschland
| | - G-R Burmester
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité-Universitätsmedizin Berlin, Campus Mitte (CCM), Charitéplatz 1, 10117, Berlin, Deutschland
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21
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Rubin DA. MR and ultrasound of the hands and wrists in rheumatoid arthritis. Part II. Added clinical value. Skeletal Radiol 2019; 48:837-857. [PMID: 30806723 DOI: 10.1007/s00256-019-03180-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 02/02/2023]
Abstract
Advanced imaging has become just as vital for diagnosing, staging, and monitoring disease in rheumatoid arthritis (RA) patients as it is for cancer patients. Part 1 of this review discussed synovitis, tenosynovitis, erosions, and osteitis-key imaging findings that occur in patients with RA. Part 2 will now show how these features, in combination with clinical and serologic data, can assist clinical decision-making at various stages of a patient's disease course. Specifically, assessing current disease activity and prognosticating future aggressiveness inform treatment decisions at initial presentation, during medical treatment, and at clinical remission. In addition to summarizing the current literature on advanced imaging in RA, clinical examples from different stages throughout the disease course will illustrate practical approaches for applying these research results. Last, this review will describe potential future roles of imaging in RA patients.
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Affiliation(s)
- David A Rubin
- Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd., St. Louis, MO, 63110, USA.
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22
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Wang F, Luo A, Xuan W, Qi L, Wu Q, Gan K, Zhang Q, Zhang M, Tan W. The Bone Marrow Edema Links to an Osteoclastic Environment and Precedes Synovitis During the Development of Collagen Induced Arthritis. Front Immunol 2019; 10:884. [PMID: 31068949 PMCID: PMC6491763 DOI: 10.3389/fimmu.2019.00884] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/05/2019] [Indexed: 01/16/2023] Open
Abstract
Objectives: To determine the relationship between bone marrow edema (BME), synovitis, and bone erosion longitudinally using a collagen induced arthritis mice (CIA) model and to explore the potential pathogenic role of BME in bone erosion. Methods: CIA was induced in DBA/1J mice. BME and corresponding clinical symptoms of arthritis and synovitis during the different time points of CIA development were assayed by magnetic resonance imaging (MRI), arthritis sore, and histologic analyses. The expression of osteoclasts (OCs), OCs-related cytokines, and immune cells in bone marrow were determined by flow cytometry, immunohistochemistry, immunofluorescence staining, and real-time PCR. The OCs formation was estimated using in vitro assays. Results: MRI detected BME could emerge at day 25 in 70% mice after the first immunization (n = 10), when there were not any arthritic symptoms, histological or MRI synovitis. At day 28, BME occurred in 90% mice whereas the arthritic symptom and histological synovitis were only presented in 30 and 20% CIA mice at that time (n = 10). The emergence of BME was associated with an increased bone marrow OCs number and an altered distribution of OCs adherent to subchondral bone surface, which resulted in increased subchondral erosion and decreased trabecular bone number during the CIA process. Obvious marrow environment changes were identified after BME emergence, consisting of multiple OCs related signals, including highly expressed RANKL, increased proinflammatory cytokines and chemokines, and highly activated T cells and monocytes. Conclusions: BME reflects a unique marrow "osteoclastic environment," preceding the arthritic symptoms and synovitis during the development of CIA.
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Affiliation(s)
- Fang Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Aishu Luo
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenhua Xuan
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Qi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Wu
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ke Gan
- Department of Traditional Chinese Medicine, Nanjing Traditional Chinese Medicine University, Nanjing, China
| | - Qiande Zhang
- Department of Chinese Medicine, Nanjing Medicine University Institute of Integration of Traditional Chinese and Western Medicine, Nanjing, China
| | - Miaojia Zhang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenfeng Tan
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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23
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Sewerin P, Schleich C, Brinks R, Müller-Lutz A, Fichter F, Eichner M, Schneider M, Ostendorf B, Vordenbäumen S. Assessing Associations of Synovial Perfusion, Cartilage Quality, and Outcome in Rheumatoid Arthritis Using Dynamic Contrast-enhanced Magnetic Resonance Imaging. J Rheumatol 2019; 47:15-19. [PMID: 30877219 DOI: 10.3899/jrheum.180832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess associations of synovial perfusion, cartilage quality, and outcome in rheumatoid arthritis (RA). METHODS Synovial perfusion and cartilage quality were assessed by dynamic contrast-enhanced magnetic resonance imaging in metacarpophalangeal joints of 28 treatment-naive patients with RA at baseline and at 3 and 6 months after methotrexate. Analysis was by linear mixed modeling. RESULTS Synovial perfusion variables were associated with remission (p < 0.05) and cartilage quality (p < 0.004). Maximum synovial enhancement was associated to European League Against Rheumatism response (p < 0.05). Synovial perfusion improved in nonresponders over time (p < 0.05). CONCLUSION Synovial perfusion relates to remission, response, and cartilage quality in a cohort of therapy-naive patients with early RA.
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Affiliation(s)
- Philipp Sewerin
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany. .,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work.
| | - Christoph Schleich
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Ralph Brinks
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Anja Müller-Lutz
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Florian Fichter
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Markus Eichner
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Matthias Schneider
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Benedikt Ostendorf
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
| | - Stefan Vordenbäumen
- From Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology, and Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany.,P. Sewerin, MD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; C. Schleich, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; R. Brinks, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; A. Müller-Lutz, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; F. Fichter, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Eichner, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology; M. Schneider, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; B. Ostendorf, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology; S. Vordenbäumen, MD, PhD, Heinrich-Heine-University Düsseldorf, Medical Faculty, Department and Hiller-Research-Unit for Rheumatology. P. Sewerin and C. Schleich contributed equally to this work
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Frenken M, Schleich C, Brinks R, Abrar DB, Goertz C, Schneider M, Ostendorf B, Sewerin P. The value of the simplified RAMRIS-5 in early RA patients under methotrexate therapy using high-field MRI. Arthritis Res Ther 2019; 21:21. [PMID: 30642376 PMCID: PMC6332674 DOI: 10.1186/s13075-018-1789-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 12/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate a simplified version of the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) for five joints of the hand (RAMRIS-5) in patients with early rheumatoid arthritis (RA) before and after the initiation of methotrexate (MTX) therapy using high-resolution, 3-T magnetic resonance imaging (MRI). METHODS Twenty-eight patients with a seropositive, early RA (disease duration of less than 6 months (range 2-23 weeks)) according to 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria (mean age 56.8 years, range 39-74) were prospectively assessed with a baseline investigation including clinical assessment (disease activity score of 28 joints (DAS-28) and C-reactive protein (CRP)) and 3-T MRI of the clinically dominant hand. Follow-up visits were performed 3 and 6 months after initiation of a MTX therapy at baseline. MRI scans were analyzed in accordance with RAMRIS and the simplified RAMRIS-5. RESULTS DAS-28 and CRP decreased significantly after initiation of MTX therapy. Even though erosion scores increased over time, RAMRIS and RAMRIS-5 also decreased significantly after the start of therapy. There was a strong correlation between the total RAMRIS-5 and RAMRIS at baseline (r = 0.838; P <0.001) and follow-up (3 months: r = 0.876; P <0.001; 6 months: r = 0.897; P <0.001). In the short term (3-month follow-up), RAMRIS and RAMRIS-5 demonstrated similar ability to detect changes for all subgroups (bone edema, erosion, and synovitis). In the long-term comparison (6-month follow-up), RAMRIS-5 also showed similar effectiveness when detecting changes in bone edema and erosion compared with RAMRIS. Deviations occurred regarding only synovitis, where change was slightly higher in RAMRIS-5: SRM (RAMRIS) = 0.07 ± 0.14; SRM (RAMRIS-5) = 0.34 ± 0.06. CONCLUSIONS Three-Tesla MRI-based RAMRIS-5 is a simplified and resource-saving RAMRIS score which compares favorably with the RAMRIS when detecting changes in early RA. Even though there is a slight abbreviation between RAMRIS-5 and the original score regarding the change of synovitis, it may be used for diagnosis and therapy monitoring in follow-up evaluations.
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Affiliation(s)
- Miriam Frenken
- Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christoph Schleich
- Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Ralph Brinks
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Daniel Benjamin Abrar
- Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christine Goertz
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Matthias Schneider
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Benedikt Ostendorf
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Philipp Sewerin
- Department and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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Mangoni AA, Al Okaily F, Almoallim H, Al Rashidi S, Mohammed RHA, Barbary A. Relapse rates after elective discontinuation of anti-TNF therapy in rheumatoid arthritis: a meta-analysis and review of literature. BMC Rheumatol 2019; 3:10. [PMID: 30886998 PMCID: PMC6408847 DOI: 10.1186/s41927-019-0058-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 02/26/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Inhibitors of tumor necrosis factor alpha (TNF-α) are current mainstay of therapies for rheumatoid arthritis (RA). The decision when to withdraw TNF-α inhibitors after achieving remission and the incidence of relapse rates with elective discontinuation are both important questions that demand intense survey in these patients. In this meta-analysis we aimed to estimate the magnitude of relapse rate after elective TNF-α inhibitor discontinuation in RA patients with remission. METHODS Systematic searches of PubMed/MEDLINE, Cochrane Library databases, grey literature (unpublished and ongoing trials) from the WHO International Clinical Trials Registry Platform and the US National Institutes of Health were performed for studies reporting the outcomes of elective discontinuation of TNF-α inhibitor in RA patients after remission. Random-effects models for meta-analyses were conducted on extracted data. RESULTS Out of 390 references screened, 16 RCTs were included. Meta-analysis of 1264 patient data revealed a relapse rate of 0.47 (95% CI 0.41-0.54). Sensitivity analysis showed that none of the studies had higher influence on the results. CONCLUSIONS Almost half of all the RA patients in remission relapse after elective TNF-α inhibitor discontinuation. This information might be useful when considering this management option with individual patients.
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Affiliation(s)
- Arduino A Mangoni
- 1Department of Clinical Pharmacology, Flinders University and Flinders Medical Centre, Bedford Park, SA 5042 Australia
| | | | - Hani Almoallim
- 3Department of Medicine, Umm Alqura University, Jeddah, Kingdom of Saudi Arabia
| | | | - Reem Hamdy A Mohammed
- 4Rheumatology and Clinical Immunology, Department of Rheumatology and Rehabilitation, School of Medicine, Cairo University Hospitals, Cairo, Egypt
- 5Internal Medicine Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Amal Barbary
- 6Department of Rheumatology and Rehabilitation, Tanta University Faculty of Medicine, Elgesh Street, Tanta, Gharbeia Egypt
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Inoue EN, de Andrade AP, Skare T. Evaluation of foot functionality in cases of rheumatoid arthritis through the FFI-BR and FHSQ-BR questionnaires: a cross-sectional observational study. SAO PAULO MED J 2018; 136:520-524. [PMID: 30892482 PMCID: PMC9897132 DOI: 10.1590/1516-3180.2018.0175161118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 04/28/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) can affect the feet, thus compromising the patient's gait and autonomy. In this study, we investigated foot disability in RA patients using the Brazilian versions of the Foot Health Status Questionnaire (FHSQ-BR) and Foot Function Index (FFI-BR). DESIGN AND SETTING Cross-sectional, observational study conducted in a tertiary care hospital. METHODS Two hundred individuals were studied: 100 with RA and 100 controls. Demographic variables and FFI-BR and FHSQ-BR scores were analyzed. In relation to RA patients, data on medications used and on the following clinical variables were collected: Disease Activity Score-28-ESR; erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level and rheumatoid factor (RF) level. The groups were compared and the scores and clinical variables were correlated. RESULTS RA patients' scores in the pain, difficulty and disability domains of the FFI-BR questionnaire were worse (P < 0.0001). The FHSQ-BR showed that there were differences between RA patients and controls in relation to the pain and foot function domains: shoes (P < 0.0001), foot health (P < 0.0001), general health (P=0.0002), physical activity (P < 0.0001), social capacity (P = 0.0006) and vigor (P = 0.01). There were correlations between FFI-BR and DAS-28-ESR scores (rho = 0.45), ESR (rho = 0.27) and CRP (rho = 0.24). According to the FHSQ-BR questionnaire, there was a correlation between DAS-28-ESR and worse foot health (rho = 0.29). CONCLUSION RA patients' scores in the foot health assessment questionnaires were worse than those of controls. A correlation between inflammatory activity and worse foot function was found.
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Affiliation(s)
- Elinah Narumi Inoue
- Undergraduate Medical Student, Faculdade Evangélica do Paraná (FEPAR), Curitiba (PR), Brazil.
| | | | - Thelma Skare
- MD, PhD. Professor, Department of Rheumatology, Hospital Universitário Evangélico de Curitiba, Curitiba (PR), Brazil.
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Murray E, Ellis A, Butylkova Y, Skup M, Kalabic J, Garg V. Systematic review and network meta-analysis: effect of biologics on radiographic progression in rheumatoid arthritis. J Comp Eff Res 2018; 7:959-974. [PMID: 30129776 DOI: 10.2217/cer-2017-0106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To evaluate the comparative effectiveness of biologics in inhibiting radiographic progression among rheumatoid arthritis (RA) patients. MATERIALS & METHODS Bayesian network meta-analysis of published trials investigating the USA FDA approved biologics treatment in RA patients, using methotrexate (MTX) as the reference comparator. RESULTS Nine trials met the inclusion criteria for base case analysis. Compared with MTX, most biologics (except golimumab) + MTX had significantly lower rates of radiographic progression at 1 year. Mean difference in radiographic progression rates between MTX monotherapy and biologics + MTX was highest for adalimumab + MTX (-3.8) and lowest for tocilizumab + MTX (-0.7). Inhibition of radiographic progression was sustained. CONCLUSION Biologics inhibit radiographic progression in patients with RA at 1 year; however, published evidence beyond 1 year is limited.
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Affiliation(s)
- Erin Murray
- Doctor Evidence, Santa Monica, CA, 90401, USA
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Kaeley GS, Ranganath VK. Chasing the Ghost of Imaging Remission in Rheumatoid Arthritis. J Rheumatol 2018; 45:881-883. [PMID: 29961675 DOI: 10.3899/jrheum.180035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Gurjit S Kaeley
- University of Florida College of Medicine, Jacksonville, Florida;
| | - Veena K Ranganath
- University of California at Los Angeles, Los Angeles, California, USA
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AC-CUTE: An Open-Label Study to Evaluate Progression of Structural Joint Damage and Inflammation in Subjects with Moderate to Severe Rheumatoid Arthritis. Int J Rheumatol 2018; 2018:8721753. [PMID: 29849651 PMCID: PMC5925169 DOI: 10.1155/2018/8721753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/13/2018] [Accepted: 02/26/2018] [Indexed: 11/21/2022] Open
Abstract
Aim Examine the efficacy of once-weekly subcutaneous tocilizumab (SC-TCZ) on joint damage at 24 weeks based on radiography of the hands and feet and magnetic resonance imaging (MRI) of the hand in subjects with moderate to severe rheumatoid arthritis (RA). Methods In this Australian open-label, multicentre, prospective, single-arm study, subjects received 162 mg SC-TCZ weekly. Primary endpoint was change in radiographic Genant-modified Total Sharp Score (TSS) between baseline and Week 24. Secondary endpoints included change from baseline to Week 24 in RA MRI scoring (RAMRIS) of erosions, synovitis, and osteitis and Cartilage Loss Score (CARLOS) in the dominant hand and disease activity score 28 (DAS28). Results 52 subjects were enrolled (80% female, mean (SD) age 57 (12) years). Radiography showed mild but not significant progression of joint damage (mean (SD) change in TSS 0.46 (1.29)). Synovitis reduced significantly on MRI; however, osteitis, erosion, and cartilage loss did not change significantly. DAS28 improved significantly by Week 24; 78% of subjects achieved DAS28 remission. SC-TCZ was generally well tolerated. Conclusion Synovitis and DAS28 decreased significantly; however, no significant change in osteitis or joint damage was observed at Week 24. Trial registration This trial is registered with Clinicaltrials.gov registration number NCT01951170 (ML28703).
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Gadeholt O. Forward to the past: ultrasound might be necessary in some patients with rheumatoid arthritis. Ann Rheum Dis 2018; 78:e56. [DOI: 10.1136/annrheumdis-2018-213278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 11/04/2022]
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