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Schenone C, Pacini G, Gotelli E, Hysa E, Campitiello R, Sammorì S, Paolino S, Sulli A, Cutolo M. Updating on pregnancy in rheumatoid arthritis. Expert Rev Clin Immunol 2024:1-12. [PMID: 38748553 DOI: 10.1080/1744666x.2024.2356164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Rheumatoid arthritis (RA), the most prevalent autoimmune disease in reproductive years, exhibits a higher incidence in females, suggesting involvement of estrogens, genetics and environmental factors in disease onset. Literature shows smaller families in RA patients, driving increased interest in Assisted Reproductive Techniques. AREAS COVERED This review elucidates how immunotolerance mechanisms contribute to favorable pregnancy outcomes in RA, emphasizing the need for a careful pregnancy planning to mitigate fetal complications and postnatal flares, which surpass those in the general population. A thorough medication evaluation, orchestrated by a multidisciplinary team, is imperative during pregnancy, weighing potential teratogenic effects against safer alternatives to balance medication safety with disease control. A systematic literature search on PubMed and MEDLINE, using specific terms, covered relevant academic journals up to the latest date. EXPERT OPINION This narrative review comprehensively addresses pregnancy-related considerations in RA patients, prioritizing meticulous disease management with pregnancy and breastfeeding-compatible drugs in line with the latest recommendations and registry data. The focus remains on evaluating glucocorticoids, conventional, and biological disease-modifying drugs for compatibility during pregnancy and breastfeeding. Additionally, the evolving landscape of targeted synthetic drugs during pregnancy is explored, providing insights into the latest developments in rheumatological care.
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Affiliation(s)
- Carlotta Schenone
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
| | - Greta Pacini
- Rheumatology Unit, Santa Chiara Hospital, APSS Trento, Trento, Italy
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
| | - Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
| | - Rosanna Campitiello
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Silvia Sammorì
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, Genova, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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Balog JÁ, Zvara Á, Bukovinszki V, Puskás LG, Balog A, Szebeni GJ. Comparative single-cell multiplex immunophenotyping of therapy-naive patients with rheumatoid arthritis, systemic sclerosis, and systemic lupus erythematosus shed light on disease-specific composition of the peripheral immune system. Front Immunol 2024; 15:1376933. [PMID: 38726007 PMCID: PMC11079270 DOI: 10.3389/fimmu.2024.1376933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/03/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Systemic autoimmune diseases (SADs) are a significant burden on the healthcare system. Understanding the complexity of the peripheral immunophenotype in SADs may facilitate the differential diagnosis and identification of potential therapeutic targets. Methods Single-cell mass cytometric immunophenotyping was performed on peripheral blood mononuclear cells (PBMCs) from healthy controls (HCs) and therapy-naive patients with rheumatoid arthritis (RA), progressive systemic sclerosis (SSc), and systemic lupus erythematosus (SLE). Immunophenotyping was performed on 15,387,165 CD45+ live single cells from 52 participants (13 cases/group), using an antibody panel to detect 34 markers. Results Using the t-SNE (t-distributed stochastic neighbor embedding) algorithm, the following 17 main immune cell types were determined: CD4+/CD57- T cells, CD4+/CD57+ T cells, CD8+/CD161- T cells, CD8+/CD161+/CD28+ T cells, CD8dim T cells, CD3+/CD4-/CD8- T cells, TCRγ/δ T cells, CD4+ NKT cells, CD8+ NKT cells, classic NK cells, CD56dim/CD98dim cells, B cells, plasmablasts, monocytes, CD11cdim/CD172dim cells, myeloid dendritic cells (mDCs), and plasmacytoid dendritic cells (pDCs). Seven of the 17 main cell types exhibited statistically significant frequencies in the investigated groups. The expression levels of the 34 markers in the main populations were compared between HCs and SADs. In summary, 59 scatter plots showed significant differences in the expression intensities between at least two groups. Next, each immune cell population was divided into subpopulations (metaclusters) using the FlowSOM (self-organizing map) algorithm. Finally, 121 metaclusters (MCs) of the 10 main immune cell populations were found to have significant differences to classify diseases. The single-cell T-cell heterogeneity represented 64MCs based on the expression of 34 markers, and the frequency of 23 MCs differed significantly between at least twoconditions. The CD3- non-T-cell compartment contained 57 MCs with 17 MCs differentiating at least two investigated groups. In summary, we are the first to demonstrate the complexity of the immunophenotype of 34 markers over 15 million single cells in HCs vs. therapy-naive patients with RA, SSc, and SLE. Disease specific population frequencies or expression patterns of peripheral immune cells provide a single-cell data resource to the scientific community.
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Affiliation(s)
- József Á. Balog
- Laboratory of Functional Genomics, Institute of Genetics, HUN-REN Biological Research Centre, Szeged, Hungary
- Core Facility, HUN-REN Biological Research Centre, Szeged, Hungary
| | - Ágnes Zvara
- Laboratory of Functional Genomics, Institute of Genetics, HUN-REN Biological Research Centre, Szeged, Hungary
- Core Facility, HUN-REN Biological Research Centre, Szeged, Hungary
| | - Vivien Bukovinszki
- Department of Rheumatology and Immunology, Faculty of Medicine, Albert Szent-Gyorgyi Health Centre, University of Szeged, Szeged, Hungary
| | - László G. Puskás
- Laboratory of Functional Genomics, Institute of Genetics, HUN-REN Biological Research Centre, Szeged, Hungary
- Core Facility, HUN-REN Biological Research Centre, Szeged, Hungary
| | - Attila Balog
- Department of Rheumatology and Immunology, Faculty of Medicine, Albert Szent-Gyorgyi Health Centre, University of Szeged, Szeged, Hungary
| | - Gábor J. Szebeni
- Laboratory of Functional Genomics, Institute of Genetics, HUN-REN Biological Research Centre, Szeged, Hungary
- Core Facility, HUN-REN Biological Research Centre, Szeged, Hungary
- Department of Internal Medicine, Hematology Centre, Faculty of Medicine University of Szeged, Szeged, Hungary
- Astridbio Technologies Ltd., Szeged, Hungary
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Hakeem OB, Abubakar Y, Courage U, Joshua OG, Olujimi S, Abdulaziz U, Uyi IE, Ojo O, Adelowo O, Olusegun OA, Nwankwo H, Ibukunoluwa D, Ibrahim D, Ahmed H, Ajibade A, Ehi A, Dungwom PS, Okwara C, Harriet E, Osuagwu N, Uchechukwu T, Egbe T, Ako I, Idowu A, Akpabio AA, Tito A, Abdulhakeem A, Ochiagha O, Janetta I. Rheumatoid arthritis knowledge gap and intervention in Nigeria study. Int J Rheum Dis 2024; 27:e14993. [PMID: 38108585 DOI: 10.1111/1756-185x.14993] [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: 10/14/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Family physicians are often the first healthcare providers to encounter patients with rheumatoid arthritis (RA) in Nigeria, given the paucity of rheumatology services nationwide. This study aimed to assess and address the knowledge gap regarding RA among family physicians in Nigeria. METHODS A cross-sectional survey involving 609 family physicians from all six geopolitical zones of Nigeria was conducted in October 2022. Pre-intervention questionnaires were administered to assess the participants' knowledge of RA. An investigator-led PowerPoint presentation on RA was then delivered as an intervention, followed by the same participants completing post-intervention questionnaires to evaluate knowledge improvement. Data were analyzed using the Statistical Package for Social Science, version 25. RESULTS The mean age of participants was 42 ± 15 years, predominantly male (63.9%). The median pre-intervention knowledge score was 3.2 (IQR: 2.0-4.5), with 77.0% scoring <5. After the intervention, the median score significantly improved to 7.1 (IQR: 4.3-8.6) (p = .001), with 62.6% scoring >7. Significant improvements were observed in several knowledge areas where gaps existed pre-intervention, including the understanding that NSAIDs are not the mainstay of management (p < .001), the effectiveness of glucosamine and chondroitin sulfate (p < .001), confidence in diagnosing RA (p = .016), the recognition of joint deformities as a characteristic feature (p < .001), and the understanding that rheumatoid factor is not definitive for diagnosis (p < .001). CONCLUSION This study highlights the importance of interventions in closing the knowledge gap about RA diagnosis and management. We recommend the implementation of a comprehensive approach to rheumatology education and services by policymakers.
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Affiliation(s)
- Olaosebikan B Hakeem
- Department of Medicine, Rheumatology Unit, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Yerima Abubakar
- Department of Medicine, Rheumatology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Uhunmwangho Courage
- Department of Medicine, Rheumatology Unit, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Odunlami Gbenga Joshua
- Department of Medicine, Rheumatology Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Shodipo Olujimi
- Department of Family Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Umar Abdulaziz
- Department of Medicine, Rheumatology Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria
| | - Ima-Edomwonyi Uyi
- Department of Medicine, Rheumatology Unit, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Osaze Ojo
- Kubwa General Hospital, Abuja, Nigeria
| | - Olufemi Adelowo
- Department of Medicine, Rheumatology Unit, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Oguntona A Olusegun
- Rheumatology Unit, Olabisi Onabanjo University Teaching Hospital, Shagamu, Nigeria
| | - Henry Nwankwo
- Department of Medicine, Rheumatology Unit, Nnamdi Azikwe University Teaching Hospital, Nnewi, Nigeria
| | - Dedeke Ibukunoluwa
- Department of Medicine, Rheumatology Unit, University College Hospital, Ibadan, Nigeria
| | - Daiyabu Ibrahim
- Department of Medicine, Rheumatology Unit, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Hamidu Ahmed
- Department of Medicine, Rheumatology Unit, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Adenitan Ajibade
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Gombe, Nigeria
| | - Aigbokhan Ehi
- Department of Medicine, Rheumatology Unit, University of Benin Teaching Hospital, Benin, Nigeria
| | - Pam Stephen Dungwom
- Department of Medicine, Rheumatology Unit, Jos University Teaching Hospital, Jos, Nigeria
| | - Chibuzor Okwara
- Department of Medicine, Rheumatology Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Ezike Harriet
- Department of Medicine, Rheumatology Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Njideka Osuagwu
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Owerri, Nigeria
| | - Tralagba Uchechukwu
- Department of Medicine, Rheumatology Unit, University of Port Harcourt, Port Harcourt, Nigeria
| | - Tamara Egbe
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Yenagoa, Nigeria
| | - Itam Ako
- Department of Medicine, Rheumatology Unit, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Alabi Idowu
- Department of Medicine, Rheumatology Unit, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Akpabio A Akpabio
- Department of Medicine, Rheumatology Unit, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Asekhame Tito
- Department of Medicine, Rheumatology Unit, Nnamdi Azikwe Teaching Hospital, Nnewi, Nigeria
| | - Awesu Abdulhakeem
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Katsina, Nigeria
| | - Olisa Ochiagha
- Department of Medicine, Rheumatology Unit, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ikoro Janetta
- Department of Medicine, Rheumatology Unit, Federal Medical Centre, Yenagoa, Nigeria
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Riitano G, Recalchi S, Capozzi A, Manganelli V, Misasi R, Garofalo T, Sorice M, Longo A. The Role of Autophagy as a Trigger of Post-Translational Modifications of Proteins and Extracellular Vesicles in the Pathogenesis of Rheumatoid Arthritis. Int J Mol Sci 2023; 24:12764. [PMID: 37628944 PMCID: PMC10454292 DOI: 10.3390/ijms241612764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease, characterized by persistent joint inflammation, leading to cartilage and bone destruction. Autoantibody production is directed to post-translational modified (PTM) proteins, i.e., citrullinated or carbamylated. Autophagy may be the common feature in several types of stress (smoking, joint injury, and infections) and may be involved in post-translational modifications (PTMs) in proteins and the generation of citrullinated and carbamylated peptides recognized by the immune system in RA patients, with a consequent breakage of tolerance. Interestingly, autophagy actively provides information to neighboring cells via a process called secretory autophagy. Secretory autophagy combines the autophagy machinery with the secretion of cellular content via extracellular vesicles (EVs). A role for exosomes in RA pathogenesis has been recently demonstrated. Exosomes are involved in intercellular communications, and upregulated proteins and RNAs may contribute to the development of inflammatory arthritis and the progression of RA. In RA, most of the exosomes are produced by leukocytes and synoviocytes, which are loaded with PTM proteins, mainly citrullinated proteins, inflammatory molecules, and enzymes that are implicated in RA pathogenesis. Microvesicles derived from cell plasma membrane may also be loaded with PTM proteins, playing a role in the immunopathogenesis of RA. An analysis of changes in EV profiles, including PTM proteins, could be a useful tool for the prevention of inflammation in RA patients and help in the discovery of personalized medicine.
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Affiliation(s)
| | | | | | | | | | | | - Maurizio Sorice
- Department of Experimental Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (G.R.); (S.R.); (A.C.); (V.M.); (R.M.); (T.G.); (A.L.)
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