Innovative Education and Engagement Tools for Rheumatology and Immunology Public Engagement with Augmented Reality.
Adv Exp Med Biol. 2019;1205:105-116
Authors: Kosa T, Bennett L, Livingstone D, Goodyear C, Loranger B
Rheumatoid arthritis (RA) affects around 1% of the population, which places a heavy burden on society and has severe consequences for the individuals affected. The early diagnosis and implementation of disease-modifying anti-rheumatic drugs significantly increase the chance of achieving long-term sustained remission. Therefore, raising awareness of RA amongst the general public is important in order to decrease the time of diagnosis of the disease. Augmented reality (AR) can be tremendously valuable in a teaching and learning context, as the coexistence of real and virtual objects aids learners in understanding abstract ideas and complicated spatial relationships. It has also been suggested that it raises motivation in users through interactivity and novelty. In this chapter we explore the use AR in public engagement, and detail the design, development and evaluation of a blended learning experience utilising AR. A set of informative printed posters was produced, enhanced by an accompanying interactive AR application. The main user testing was conducted with 27 participants at a science outreach event at the Glasgow Science Centre. Findings report mean positive attitudes regarding all aspects of the study, highlighting the potential of AR for public engagement with topics such as RA.
PMID: 31894573 [PubMed - indexed for MEDLINE]
Association between rainfall and readmissions of rheumatoid arthritis patients: a time-stratified case-crossover analysis.
Int J Biometeorol. 2020 Jan;64(1):145-153
Authors: Xie J, Zhu Y, Fan Y, Xin L, Liu J
It has been reported that local weather is associated with the symptoms of joint pain in patients with rheumatoid arthritis (RA), and many people believe their pain becomes worse when facing rainy days. However, limited studies explored the effects of weather on RA patients' healthcare-seeking behavior. Our study aimed to investigate the relationship between rainfall and readmission behavior of patients with RA in Hefei, China, based on hospitalization data from the First Affiliated Hospital of Anhui University of Chinese Medicine from May 2012 to June 2016 and weather data from National Meteorological Information Center during the same study period. Using a time-stratified case-crossover study design and conditional logistic regression, we found a negative association between current day rainfall and readmission (unadjusted: OR = 0.82, p < 0.05; adjusted: OR = 0.83, p < 0.1), which is contrary to our common belief. In lagged models, we observed that rainfall was significantly and positively associated with readmissions at lag 6 days (unadjusted: OR = 1.12, p < 0.1; adjusted: OR = 1.17, p < 0.05) and lag 7 days (unadjusted: OR = 1.13, p < 0.05; adjusted: OR = 1.21, p < 0.01). Additionally, stratified analyses showed the unanticipated finding was only statistically significant for younger patients (< 65 years) and females. Our study adds new evidence that the association between the healthcare-seeking behavior of patients with RA and local rainfall may be different, compared with the positive relationship between symptoms of joint pain and rainfall.
PMID: 31650297 [PubMed - indexed for MEDLINE]
Low-Dose Irradiation Differentially Impacts Macrophage Phenotype in Dependence of Fibroblast-Like Synoviocytes and Radiation Dose.
J Immunol Res. 2019;2019:3161750
Authors: Deloch L, Fuchs J, Rückert M, Fietkau R, Frey B, Gaipl US
Rheumatoid arthritis (RA) is a multifactorial autoimmune disease whose main hallmark is inflammation and destruction of the joints. Two cell types within the synovium that play an important role in RA are fibroblast-like synoviocytes (FLS) and macrophages. The latter innate immune cells show a high plasticity in their phenotype and are central in inflammatory processes. Low-dose radiotherapy (LD-RT) with particularly a single dose of 0.5 Gy has been demonstrated to have a positive impact on pain, inflammation, and bone in inflamed joints. We now examined for the first time how LD-RT influences FLS and bone marrow-derived macrophages in co-culture systems of an experimental model of RA to reveal further mechanisms of immune modulatory effects of low and intermediate dose of ionizing radiation. For this, the bone marrow of hTNF-α tg mice was differentiated either with cytokines to obtain key macrophage phenotypes (M0, M1, and M2) or with supernatants (SN) of untreated or irradiated FLS. Flow cytometry analyses were used to analyse the impact of radiation (0.1, 0.5, 1.0, and 2.0 Gy) on the phenotype of macrophages in the presence or absence of SN of FLS. LD-RT had no impact on cytokine-mediated macrophage polarization in M0, M1, or M2 macrophages. However, SN of irradiated FLS particularly reduced CD206 expression on macrophages. Macrophage phenotype was stable when being in contact with SN of nonirradiated FLS, but significantly increased surface expression of CD206 and slightly decreased CD80 and CD86 expression were observed when macrophage themselves were irradiated with 0.5 Gy under these microenvironmental conditions, again highlighting discontinuous dose dependencies in the low and intermediate dose range. One can conclude that FLS-dependent microenvironmental conditions have a slight influence on the modulation of macrophage phenotype under radiation exposure conditions. Future studies are needed to reveal the impact of radiation exposure on the functions of treated macrophages under such microenvironmental conditions.
PMID: 31485459 [PubMed - indexed for MEDLINE]
Evaluation of the Value of Anti-Citrullinated α-enolase Peptide 1 Antibody in the Diagnosis of Rheumatoid Arthritis.
Ann Clin Lab Sci. 2019 Sep;49(4):503-506
Authors: Zhou J, Feng L, Zhang H, Wang T, Cui L
GOALS: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease. The α enolase is a nuclear glycolytic enzyme. Antibodies to citrullinated-enolase peptide1(anti-CEP-1) are found in approximately 40% of patients with RA, but the diagnostic value of anti-CEP-1 for RA is not clear.
METHODS: We enrolled 282 patients with RA according to the 2010 ACR Classification criteria, referred to the department of Rheumatology in Peking University Third Hospital, 120 sex- and age-matched healthy donors (HD), and 30 patients with osteoarthritis (OA). Anti-CEP-1 IgG antibodies were assessed with a commercially available ELISA kit (Euroimmun, Germany) according to the manufacturers' instructions. Anti-CCP antibodies were assessed with ECLIA (Roche, Germany). Data was processed with SPSS 19. The scatter diagram was drawn in GraphPad Prism.
RESULTS: The specificity and sensitivity was 83.3% and 65.2%, respectively. The positive predictive value was 88% and the negative predictive value was 56%. The AUC of anti-CEP1 for diagnosis of RA is 0.80, while that of Anti-CCP is 0.919; the value of anti-CCP combined with anti-CEP1 is 0.914. Ten anti-CEP1 positive results are found in 48 patients of RA with anti-CCP negative result.
CONCLUSION: The anti-CEP-1 is suitable for diagnosing of RA, but not superior to anti-CCP.
PMID: 31471340 [PubMed - indexed for MEDLINE]
Platelet/Lymphocyte, Lymphocyte/Monocyte, and Neutrophil/Lymphocyte Ratios as Biomarkers in Patients with Rheumatoid Arthritis and Rheumatoid Arthritis-Associated Interstitial Lung Disease.
Med Sci Monit. 2019 Aug 29;25:6474-6481
Authors: Chen Q, Chen DY, Xu XZ, Liu YY, Yin TT, Li D
BACKGROUND The objective of this study was to assess the diagnostic value of platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and neutrophil/lymphocyte ratio (NLR) as biomarkers in patients with rheumatoid arthritis (RA) and rheumatoid arthritis-associated interstitial lung disease (RA-ILD). MATERIAL AND METHODS Demographic and laboratory data were acquired for 198 RA and 103 RA-ILD patients and 290 healthy controls. The subjects were categorized into female and male groups and further subcategorized based on age into <60 years and ≥60 years subgroups. One-way analysis of variance (ANOVA), receiver operating characteristics (ROC), Pearson analysis, multiple linear regression analysis, and logistic regression analysis were performed to analyze the association of PLR, NLR, and LMR with RA and RA-ILD. RESULTS Mean PLR and NLR were lowest in the control group, followed by the RA and RA-ILD groups (p<0.05). Mean LMR was lowest in the RA-ILD group, followed by the RA and control groups (p<0.05). The area under the ROC (AUROC) values of the PLR to distinguish between RA and controls, RA-ILD and controls, and RA-ILD and RA were 0.676, 0.776, and 0.650, respectively (p<0.001). Multiple linear regression analysis suggested a significantly positive association between the level of PLR and the level of DAS28 (p<0.001). The odds ratio of PLR was 1.101 for RA (p=0.023) and 1.217 for RA-ILD (p<0.001) when compared to the controls. CONCLUSIONS PLR may be applied as a new biomarker for predicting and diagnosing RA and RA-ILD and for distinguishing RA-ILD patients from RA patients and healthy subjects.
PMID: 31462627 [PubMed - indexed for MEDLINE]
Galectin-9 Is a Possible Promoter of Immunopathology in Rheumatoid Arthritis by Activation of Peptidyl Arginine Deiminase 4 (PAD-4) in Granulocytes.
Int J Mol Sci. 2019 Aug 19;20(16):
Authors: Wiersma VR, Clarke A, Pouwels SD, Perry E, Abdullah TM, Kelly C, Soyza A, Hutchinson D, Eggleton P, Bremer E
The aetiology of rheumatoid arthritis (RA) is unknown, but citrullination of proteins is thought to be an initiating event. In addition, it is increasingly evident that the lung can be a potential site for the generation of autoimmune triggers before the development of joint disease. Here, we identified that serum levels of galectin-9 (Gal-9), a pleiotropic immunomodulatory protein, are elevated in RA patients, and are even further increased in patients with comorbid bronchiectasis, a lung disease caused by chronic inflammation. The serum concentrations of Gal-9 correlate with C-reactive protein levels and DAS-28 score. Gal-9 activated polymorphonuclear leukocytes (granulocytes) in vitro, which was characterized by increased cytokine secretion, migration, and survival. Further, granulocytes treated with Gal-9 upregulated expression of peptidyl arginine deiminase 4 (PAD-4), a key enzyme required for RA-associated citrullination of proteins. Correspondingly, treatment with Gal-9 triggered citrullination of intracellular granulocyte proteins that are known contributors to RA pathogenesis (i.e., myeloperoxidase, alpha-enolase, MMP-9, lactoferrin). In conclusion, this study identifies for the first time an immunomodulatory protein, Gal-9, that triggers activation of granulocytes leading to increased PAD-4 expression and generation of citrullinated autoantigens. This pathway may represent a potentially important mechanism for development of RA.
PMID: 31430907 [PubMed - indexed for MEDLINE]
Similar Transition Processes in Synovial Fibroblasts from Rheumatoid Arthritis and Osteoarthritis: A Single-Cell Study.
J Immunol Res. 2019;2019:4080735
Authors: Cai S, Ming B, Ye C, Lin S, Hu P, Tang J, Zheng F, Dong L
Rheumatoid arthritis (RA) and osteoarthritis (OA) are common rheumatic disorders that primarily involve joints. The inflammation of the synovium can be observed in both of the two diseases. Synovial fibroblasts (SFs) play an important role in the inflammatory process of the synovium. The functional states of synovial fibroblasts are heterogeneous, and the detailed transition process of their functional states is still unclear. By using transcriptomic data of SFs at a single-cell level, we found a similar transition process for SFs in RA and OA. We also identified the potential regulatory effects of the WNT signaling pathway, the TGF-β signaling pathway, the FcεRI signaling pathway, and the ERBB signaling pathway on modifying the SFs' functional state. These findings indicate potentially overlapped pathogenic mechanisms in these two diseases, which may help uncover new therapeutic targets to ameliorate disease progression.
PMID: 31428656 [PubMed - indexed for MEDLINE]
Plasma Long Non-Coding RNA Expression Profiles in Patients with Rheumatoid Arthritis.
Clin Lab. 2019 Aug 01;65(8):
Authors: Qin W, Wang TH, Xie BH, Sun QQ, Huang H, Zhao BJ, Cen H, Wu XD
BACKGROUND: Recently, long non-coding RNAs (lncRNAs) have attracted substantial attention owing to their unforeseen critical roles in a wide range of biological processes. The aim of our study was to provide an overview of lncRNA expression profiles in plasma of RA patients.
METHODS: The Agilent LncRNA + mRNA Human Gene Expression Microarray V4.0 was employed to determine differentially expressed (DE) lncRNAs and mRNAs in plasma of four female newly diagnosed and DMARD-naïve RA patients and four female age-matched healthy controls. The KOBAS (KEGG Orthology Based Annotation System) software was applied to determine the gene ontology (GO) terms and pathway in which the DE mRNAs were enriched. Furthermore, a lncRNA-mRNA co-expression network was constructed according to the correlation between DE lncRNAs and mRNAs.
RESULTS: Compared with healthy controls, a total of 289 DE lncRNAs (169 up-regulated and 120 down-regulated) and 468 DE mRNAs (280 up-regulated and 188 down-regulated) were found in the plasma of patients with RA. Bioinformatics analysis indicated that the DE mRNAs might be involved in the pathogenesis of RA mainly through platelets. In addition, a co-expression network composed of 229 network nodes and 340 connections between 116 lncRNAs and 113 mRNAs was constructed.
CONCLUSIONS: We characterized the plasma lncRNA expression profiles in RA patients for the first time. Our results could shed new light on the pathogenesis of RA and help identify lncRNAs as novel diagnostic biomarkers and therapeutic targets for RA.
PMID: 31414744 [PubMed - indexed for MEDLINE]
Renal tubular acidosis as the initial presentation of Sjögren's syndrome.
BMJ Case Rep. 2019 Aug 13;12(8):
Authors: Ho K, Dokouhaki P, McIsaac M, Prasad B
We present a 44-year-old female with an initial presentation with distal renal tubular acidosis (RTA) after she presented with hypokalaemia and normal anion gap acidosis. Three years following the diagnosis, she presented with progressive renal impairment. In the absence of any clinical, biochemical and radiological clues, she underwent a renal biopsy which showed severe tubulitis secondary to lymphocytic infiltration. Serological investigations subsequently revealed positive anti-nuclear, anti-Sjögren's syndrome related antigen A (SS-A), and anti-Sjögren's syndrome related antigen B (SS-B) antibodies, supporting the diagnosis of Sjögren's syndrome. This case is unique in that distal RTA was the presenting clinical manifestation of Sjögren's syndrome. We hope that a consideration for Sjögren's syndrome is made in patients with seemingly idiopathic RTA.
PMID: 31413059 [PubMed - indexed for MEDLINE]
Cross-Disease Innate Gene Signature: Emerging Diversity and Abundance in RA Comparing to SLE and SSc.
J Immunol Res. 2019;2019:3575803
Authors: Petrackova A, Horak P, Radvansky M, Skacelova M, Fillerova R, Kudelka M, Smrzova A, Mrazek F, Kriegova E
Overactivation of the innate immune system together with the impaired downstream pathway of type I interferon-responding genes is a hallmark of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc). To date, limited data on the cross-disease innate gene signature exists among those diseases. We compared therefore an innate gene signature of Toll-like receptors (TLRs), seven key members of the interleukin (IL)1/IL1R family, and CXCL8/IL8 in peripheral blood mononuclear cells from well-defined patients with active stages of RA (n = 36, DAS28 ≥ 3.2), SLE (n = 28, SLEDAI > 6), and SSc (n = 22, revised EUSTAR index > 2.25). Emerging diversity and abundance of the innate signature in RA patients were detected: RA was characterized by the upregulation of TLR3, TLR5, IL1RAP/IL1R3, IL18R1, and SIGIRR/IL1R8 when compared to SSc (P corr < 0.02) and of TLR2, TLR5, and SIGIRR/IL1R8 when compared to SLE (P corr < 0.02). Applying the association rule analysis, six rules (combinations and expression of genes describing disease) were identified for RA (most frequently included high TLR3 and/or IL1RAP/IL1R3) and three rules for SLE (low IL1RN and IL18R1) and SSc (low TLR5 and IL18R1). This first cross-disease study identified emerging heterogeneity in the innate signature of RA patients with many upregulated innate genes compared to that of SLE and SSc.
PMID: 31396542 [PubMed - indexed for MEDLINE]
Intracranial Methotrexate-Associated Lymphoproliferative Disorder in Rheumatoid Arthritis.
World Neurosurg. 2019 Oct;130:138-141
Authors: Miyaza S, Matsuda R, Nakamura M, Nakagawa I, Motoyama Y, Nakase H
BACKGROUND: Methotrexate (MTX) is widely used as an anchor drug for the treatment of rheumatoid arthritis (RA) because of its ability to control pain and inflammation. However, few studies have shown that long-term MTX use can lead to lymphoproliferative disorders (LPDs) in these patients. Here we describe a rare case of intracranial MTX-associated LPD in a patient with RA.
CASE DESCRIPTION: A 68-year-old woman was admitted to our hospital because of progressive right limb palsy. She was diagnosed with RA 15 years ago and has been receiving MTX therapy for the past 5 years. Magnetic resonance imaging of the head revealed a ring-enhancing lesion in the left parietal lobe. Open biopsy was performed for making a definite diagnosis and planning treatment. Hematoxylin-eosin stain revealed dense proliferation of atypical lymphocytes in the perivascular lesion. Immunohistochemistry results were positive for CD20; this lesion was observed as a strong nuclear signal on in-situ hybridization for the Epstein-Barr virus-encoded RNA. Finally, the patient was diagnosed with MTX-associated LPD. We discontinued MTX administration and initiated steroid therapy for RA. The intracranial lesion reduced in size, and her symptoms resolved after MTX discontinuation; no recurrence has been observed at 3 years after MTX discontinuation.
CONCLUSIONS: Intracranial MTX-associated LPD is extremely rare. Here we describe a particular case and review the literature pertaining to intracranial MTX-associated LPD. More attention should be paid to LPD in a patient receiving immunosuppressive treatment for RA.
PMID: 31295614 [PubMed - indexed for MEDLINE]
Intense pulsed light therapy: A promising complementary treatment for dry eye disease.
Arch Soc Esp Oftalmol. 2019 Jul;94(7):331-336
Authors: Mejía LF, Gil JC, Jaramillo M
OBJECTIVE: To propose the Intense Pulsed Light (IPL) therapy as a helpful supplementary treatment in patients with dry eye disease.
MATERIAL AND METHODS: Retrospective cross sectional design. Medical records of patients in whom dry eye disease symptoms were not satisfactorily controlled with medical therapy alone and who underwent additional IPL with at least three sessions completed. Data were analyzed before therapy and 3weeks after its completion to asses improvement. Determination of symptoms, through a visual analog scale; tear film stability, through tear Break Up Time (tBUT); measurement of tear secretion, through Schirmer Test; and ocular surface staining with Van Bijsterveld score were evaluated. SPSS software and nonparametric analysis of repeated measures were used. The study was approved by the ethics committee.
RESULTS: 50 eyes from 25 subjects were reviewed. There were 9 males (36%) and 16 females (64%), with a median age of 59years (IQR 52-64). The median of the symptoms scale was 8 (IQR 8-9) and 3 (IQR 2-4) before and after the therapy respectively (P<.05). The median of BUT was 4 (IQR 3-5) and 10 (IQR 8-11), Schirmer test was 13 (IQR 12-15) and 15 (IQR 13-20), and Van Bijsterveld score was 3 (RIC 3-4) and 2 (IQR 2-3) before and after the therapy respectively (P<.05, for all measurements).
CONCLUSION: IPL treatment has excellent results regarding both: dry eye disease symptoms improvement and in office objective tests such as tBUT, Schirmer test and Van Bijsterveld score; IPL could be considered as an effective adjunct for dry eye disease.
PMID: 31079987 [PubMed - indexed for MEDLINE]
Drug tolerability and reasons for discontinuation of seven biologics in elderly patients with rheumatoid arthritis -The ANSWER cohort study.
PLoS One. 2019;14(5):e0216624
Authors: Ebina K, Hashimoto M, Yamamoto W, Hirano T, Hara R, Katayama M, Onishi A, Nagai K, Son Y, Amuro H, Yamamoto K, Maeda Y, Murata K, Jinno S, Takeuchi T, Hirao M, Kumanogoh A, Yoshikawa H
BACKGROUND: The aim of this study is to evaluate the retention rates and reasons for discontinuation for seven biological disease-modifying antirheumatic drugs (bDMARDs) in a real-world setting of elderly patients (65 years of age or older) with rheumatoid arthritis (RA).
METHODS: This multi-center, retrospective study assessed 1,098 treatment courses of 661 patients with bDMARDs from 2009 to 2018 (females, 80.7%; baseline age, 71.7 years; disease duration 10.5 years; rheumatoid factor positivity 81.3%; Disease Activity Score in 28 joints using erythrocyte sedimentation rate, 4.6; concomitant prednisolone dose 2.8 mg/day (45.6%) and methotrexate dose 4.4 mg/week (56.4%); and 60.2% patients were bio-naïve). Treatment courses included abatacept (ABT; n = 272), tocilizumab (TCZ; n = 234), etanercept (ETN; n = 184), golimumab (GLM; n = 159), infliximab (IFX; n = 101), adalimumab (ADA; n = 97), and certolizumab pegol (CZP; n = 51). Drug retention rates and discontinuation reasons were estimated at 36 months using the Kaplan-Meier method and adjusted for potential clinical confounders (age, sex, disease duration, concomitant PSL and MTX, starting date and switched number of bDMARDs) by Cox proportional hazards modeling.
RESULTS: A total of 51.2% of treatment courses were stopped, with 25.1% stopping due to lack of effectiveness, 11.8% due to toxic adverse events, 9.7% due to non-toxic reasons, and 4.6% due to remission. Drug retention rates for each discontinuation reason were as follows; lack of effectiveness [from 55.4% (ETN) to 81.6% (ABT); with significant differences between groups (Cox P<0.001)], toxic adverse events [from 79.3% (IFX) to 95.4% (ABT), Cox P = 0.043], and remission [from 94.2% (TCZ) to 100.0% (CZP), Cox P = 0.58]. Finally, overall retention rates excluding non-toxic reasons and remission for discontinuation ranged from 50.0% (ETN) to 78.1% (ABT) (Cox P<0.001).
CONCLUSIONS: ABT showed lowest discontinuation rate by lack of effectiveness and by toxic adverse events, which lead to highest overall retention rates (excluding non-toxic reasons and remission) among seven bDMARDs in adjusted model of elderly RA patients.
PMID: 31067271 [PubMed - indexed for MEDLINE]
Physician's Experience and Disease Activity Affect the Impact of Ultrasound on the Treatment Decision in Rheumatoid Arthritis.
J Clin Rheumatol. 2019 Aug;25(5):209-216
Authors: Sifuentes-Cantú C, Contreras-Yáñez I, Gutiérrez M, Torres-Ruiz J, Zamora-Medina MDC, Romo-Tena J, Castillo JP, Ruiz-Medrano E, Martín-Nares E, Quintanilla-González L, Bermúdez-Bermejo P, Pérez-Rodríguez R, López-Morales J, Whittall-García L, García-Galicia J, Valdés-Corona L, Pascual-Ramos V
BACKGROUND/OBJECTIVE: The aim of this cross-sectional study was to explore which factors affect the impact of musculoskeletal ultrasound (MUS) on the treatment proposal among rheumatologists with different degree of experience.
METHODS: Sixteen clinical vignettes summarized data from rheumatoid arthritis (RA) outpatients; vignettes included clinical evaluation and a blank section for a first treatment proposal; MUS information was then added, based on German Ultrasound score, followed by a blank section for treatment re-consideration, if applicable. During a 6 months period, each vignette was concomitantly presented to six trainees and six senior rheumatologists (SR); three SR had ≥15 years of experience. Participants were blinded to colleagues' responses. Appropriated statistics were used.
RESULTS: Vignettes included data from female patients, who had a mean ± SD age of 43.3 ± 9 years, 7.6 ± 3.5 years of disease duration and comorbidities (68.8%). MUS induced treatment modification in 24% of evaluations, with similar percentage among SR and trainees. Within SR, more experienced rheumatologists (≥15 years) never translated MUS findings in a different treatment proposal, compared to 34% of those with lesser experience, p ≤ 0.0001. There were 60 clinical scenarios each, with remission and moderate disease activity, and 36 clinical scenarios each, with low and high disease activity. MUS-induced treatment modifications were more frequent in scenarios with low and moderate disease activity, compared to remission and high disease activity, p = 0.008.
CONCLUSIONS: Physician's experience and disease activity level affect the impact of MUS on the treatment decision in RA outpatients. RA patients with intermediate disease activity may benefit from MUS incorporation to standard assessments.
PMID: 30998570 [PubMed - indexed for MEDLINE]
Ultrasound as a Useful Tool in the Diagnosis of Rheumatoid Arthritis in Patients With Undifferentiated Arthritis.
J Clin Rheumatol. 2019 Aug;25(5):203-208
Authors: Gutierrez M, Bertolazzi C, Castillo E, Reyes-Long S, Clavijo-Cornejo D, Santos-Moreno P
BACKGROUND: Nowadays, rheumatologists face challenges in finding an effective method to classify and treat patients with undifferentiated arthritis (UA). There is a need for new tools that could ensure accurate characterization of inflammatory processes in these patients.
OBJECTIVE: The aim of this study was to investigate if a characterization of UA patients using ultrasound (US) may help to fulfill the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) classification criteria in a real-life cohort.
METHODS: We conducted a cross-sectional study in 2 rheumatology care clinics. Patients not fulfilling the 2010 ACR/EULAR RA criteria were included. On the examination day, all patients underwent a physical examination, radiography, and US. The 7-joint US score was adopted to scan all patients. The US was performed according to EULAR criteria and interpreted by Outcome Measures in Rheumatology definitions. Gray-scale and power Doppler synovitis and tenosynovitis were scored. Bone erosions were also evaluated during the US examination.
RESULTS: A total of 204 patients were included. The diagnosis was modified from UA to RA in 86 patients (42.1%). Also, the final score of the 2010 ACR/EULAR RA classification criteria changed from a mean of 4.6 to 6.5 after the US examination. In addition to synovitis, a wide range of tenosynovitis and bone erosions were detected by US. Synovitis was more frequently detected in second metacarpophalangeal joint followed by second metatarsophalangeal joint (MTPj) and fifth MTPj. The tendons of the wrist and second and third fingers were the most affected. In relation to bone erosions, second metacarpophalangeal joint and fifth MTPj were the joints with more proportion of anatomical damage.
CONCLUSIONS: The US demonstrated to be useful to help accurately classify as RA patients previously diagnosed with UA.
PMID: 30946286 [PubMed - indexed for MEDLINE]
Evolving Use of Molecular Imaging in Research and in Practice.
Arthritis Rheumatol. 2019 08;71(8):1207-1210
Authors: Tawakol A, Unizony S, Osborne MT, Massarotti E, Giles JT
PMID: 30835948 [PubMed - indexed for MEDLINE]
Pain and Catastrophizing in Patients With Rheumatoid Arthritis: An Observational Cohort Study.
J Clin Rheumatol. 2019 Aug;25(5):232-236
Authors: Cohen EM, Edwards RR, Bingham CO, Phillips K, Bolster MB, Moreland LW, Neogi T, Marder W, Wohlfahrt A, Clauw D, Lee YC
BACKGROUND: The aims of this study were to define changes in catastrophizing that occur with initiation of a new disease-modifying antirheumatic drug (DMARD) and to examine the relationship between changes in Clinical Disease Activity Index (CDAI) and changes in catastrophizing.
METHODS: Participants in an ongoing multisite, observational study completed the Pain Catastrophizing Scale (PCS) before and 12 weeks after DMARD initiation. We used multivariable linear regression models to examine the association between changes in CDAI as the exposure and change in pain catastrophizing as the outcome. We also assessed the relationship between changes in each component of CDAI and change in PCS, using multivariable linear regression models.
RESULTS: Among the 165 rheumatoid arthritis patients with data on CDAI at both time points, CDAI decreased from 22 to 11.5 on a 76-point scale (p < 0.0001) after 12 weeks. Pain intensity decreased from a median of 5 to 3 on a 10-point numeric rating scale (p < 0.0001), and catastrophizing decreased, from 16.0 to 12.0 on the 52-point PCS (p = 0.0005). Among the 163 with complete data for the regression analysis, changes in CDAI were positively correlated with changes in catastrophizing (standardized β = 0.19, p = 0.01). Of the components of the CDAI, change in assessor global score was most strongly associated with changes in catastrophizing (standardized β = 0.24, p = 0.003).
CONCLUSIONS: Pain catastrophizing decreases, in conjunction with disease activity, after initiation of a new DMARD. These findings provide support for catastrophizing as a dynamic construct that can be altered with treatment directed at decreasing inflammatory disease activity and pain.
PMID: 30035754 [PubMed - indexed for MEDLINE]
Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic Review.
J Clin Rheumatol. 2019 Aug;25(5):197-202
Authors: Liu L, Liu S, Wang C, Guan W, Zhang Y, Hu W, Zhang L, He Y, Lu J, Li T, Liu X, Xuan Y, Wang P
OBJECTIVE: To review the evidence for benefits and harms of folate (folic acid or folinic acid) supplementation on methotrexate (MTX) treatment for rheumatoid arthritis (RA), to assess whether or not folate supplementation would reduce MTX toxicity or reduce MTX benefits, and to decide whether a higher MTX dosage is essential.
METHODS: We performed a sensitive search strategy and searched systematically the Medline, Embase, Web of Science and Cochrane Library databases from inception to 2 June 2016. Abstracts from major rheumatology meetings and major trial registers were also searched to retrieve all randomized controlled trials that interested us.
RESULTS: Seven studies with 709 patients were included. No significant heterogeneity was found between these trials. For RA patients treated with MTX, those supplied with folate were less likely to have elevated transaminase (odds ratio [OR] 0.15; 95% confidence interval [95% CI] 0.10, 0.23 [p < 0.00001]) and gastrointestinal side-effects such as nausea and vomiting (OR 0.71; 95% CI 0.51, 0.99 [p = 0.04]). Folate appeared to promote compliance to MTX as it reduced patient withdrawal compared to placebo (OR 0.29; 95% CI 0.21, 0.42 [p < 0.00001]). There was no statistical difference for mouth sores between folate and placebo (OR 0.83; 95% CI 0.57, 1.22 [p = 0.35]). As the markers of disease activity in those trials were not consistent, it was impossible to decide whether folate supplementation reduced MTX efficacy. Besides, we compared high-dose folate (≥25 mg per week) and low-dose folate (≤10 mg per week) on MTX efficacy, finding no statistical difference (OR 2.07; 95% CI 0.81, 5.30 [p = 0.13]), nor on MTX toxicity (OR 1.56; 95% CI 0.80,3.04 [p = 0.19]).
CONCLUSION: Folate supplementation can reduce the incidence of hepatotoxicity and gastrointestinal side-effects of MTX in patients with RA. It can also reduce patient withdrawal from MTX treatment. Although it tended to reduce mouth sores, it had no statistical significance. No significant difference was found between high-dose folate and low-dose folate on MTX efficacy or toxicity.
PMID: 29975207 [PubMed - indexed for MEDLINE]