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Deane KD. Rheumatoid arthritis: prediction of future clinically-apparent disease, and prevention. Curr Opin Rheumatol 2024; 36:225-234. [PMID: 38441488 PMCID: PMC10959682 DOI: 10.1097/bor.0000000000001013] [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] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW This review discusses updates in the prediction and prevention of future rheumatoid arthritis (RA). RECENT FINDINGS In individuals with musculoskeletal symptoms and elevated antibodies to citrullinated proteins (ACPA) without clinical inflammatory arthritis (IA), a 'simple' score has a positive predictive value (PPV) of ∼28% for clinical IA/RA within 1 year, and a comprehensive score (including ultrasound) has a PPV of ∼71% for clinical RA within 5 years. Controlled clinical trials in individuals at-risk for future RA have been performed using corticosteroids, rituximab, atorvastatin, methotrexate, hydroxychloroquine and abatacept. Abatacept modestly reduced rates of incident clinical RA and imaging inflammation within the trials, rituximab delayed clinical IA, and methotrexate improved function, symptoms and imaging inflammation. Vitamin D with or without omega 3 fatty acids reduced incidence of autoimmune diseases, including RA. While not proven in controlled clinical trials, observational studies suggest exercise, weight loss and smoking cessation may reduce progression to clinical RA. SUMMARY Prediction and prevention of RA is advancing although there are no currently approved interventions for prevention. Future studies should include deeper evaluation of the pathophysiology of RA development to improve prediction and identify key pathways to target in future clinical trials, as well as develop infrastructure to support prevention-related research.
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Affiliation(s)
- Kevin D Deane
- University of Colorado Anschutz Medical Campus, 1775 Aurora Court, Mail Stop B-115, Aurora, Colorado USA
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2
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Lamacchia C, Aymon R, Hattel BC, Aeby S, Kebbi-Beghdadi C C, Gilbert B, Studer O, Norris JM, Nolers MV, Demoruelle MK, Feser ML, Moss L, Courvoisier DS, Lauper K, Deane KD, Greub G G, Finckh A. A potential role for chlamydial infection in rheumatoid arthritis development. Rheumatology (Oxford) 2023:kead682. [PMID: 38092030 DOI: 10.1093/rheumatology/kead682] [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: 07/04/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVES To assess the relationship between self-reported and serologic evidence of prior chlamydial infection, rheumatoid arthritis (RA)-related autoantibodies and risk of RA-development. METHODS This is a nested study within a prospective Swiss-based cohort including all first-degree relatives of RA patients (RA-FDR) who answered a question on past chlamydial infections. Primary outcome was systemic autoimmunity associated with RA (RA-autoimmunity) defined as positivity for anti-citrullinated peptide antibodies (ACPA) and/or rheumatoid factor (RF). Secondary outcomes were high levels of RA-autoimmunity, RA-associated symptoms and RA-autoimmunity, and subsequent seropositive RA diagnosis. We conducted a nested case-control analysis by measuring the serological status against Chlamydia trachomatis' major outer membrane protein. We replicated our analysis in an independent United States-based RA-FDR cohort. RESULTS Among 1231 RA-FDRs, 168 (13.6%) developed RA-autoimmunity. Prevalence of self-reported chlamydial infection was significantly higher in individuals with RA-autoimmunity compared with controls (17.9% vs 9.8%, OR = 2.00, 95%CI: 1.27-3.09, p < 0.01). This association remained significant after adjustments (OR = 1.91, 95%CI: 1.20-2.95). Stronger effect sizes were observed in later stages of RA development. There was a similar trend between a positive C. trachomatis serology and high levels of RA-autoimmunity (OR = 3.05, 95% CI: 1.10-8.46, p= 0.032). In the replication cohort, there were significant associations between chlamydial infection and RF positivity and incident RA, but not anti-CCP positivity. CONCLUSIONS Self-reported chlamydial infections are associated with elevated RA-autoimmunity in at risk individuals. The differing association of chlamydial infections and ACPA/RF between cohorts will need to be explored in future studies but is consistent with a role of mucosal origin of RA-related autoimmunity.
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Affiliation(s)
- Celine Lamacchia
- Division of Rheumatology, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Romain Aymon
- Division of Rheumatology, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Brian C Hattel
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sebastien Aeby
- Institute of Microbiology, University of Lausanne & University Hospital Center, Lausanne, Switzerland
| | - Carole Kebbi-Beghdadi C
- Institute of Microbiology, University of Lausanne & University Hospital Center, Lausanne, Switzerland
| | - Benoit Gilbert
- Division of Rheumatology, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivia Studer
- Division of Rheumatology, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jill M Norris
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael V Nolers
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marie L Feser
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - LauraKay Moss
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Delphine S Courvoisier
- Division of Rheumatology, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kim Lauper
- Division of Rheumatology, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gilbert Greub G
- Institute of Microbiology, University of Lausanne & University Hospital Center, Lausanne, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Geneva Center for Inflammation Research (GCIR), University of Geneva, Geneva, Switzerland
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3
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Buckner JH. Translational immunology: Applying fundamental discoveries to human health and autoimmune diseases. Eur J Immunol 2023; 53:e2250197. [PMID: 37101346 PMCID: PMC10600327 DOI: 10.1002/eji.202250197] [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: 01/04/2023] [Revised: 03/10/2023] [Accepted: 04/25/2023] [Indexed: 04/28/2023]
Abstract
Studying the human immune system is challenging. These challenges stem from the complexity of the immune system itself, the heterogeneity of the immune system between individuals, and the many factors that lead to this heterogeneity including the influence of genetics, environment, and immune experience. Studies of the human immune system in the context of disease are increased in complexity as multiple combinations and variations in immune pathways can lead to a single disease. Thus, although individuals with a disease may share clinical features, the underlying disease mechanisms and resulting pathophysiology can be diverse among individuals with the same disease diagnosis. This has consequences for the treatment of diseases, as no single therapy will work for everyone, therapeutic efficacy varies among patients, and targeting a single immune pathway is rarely 100% effective. This review discusses how to address these challenges by identifying and managing the sources of variation, improving access to high-quality, well-curated biological samples by building cohorts, applying new technologies such as single-cell omics and imaging technologies to interrogate samples, and bringing to bear computational expertise in conjunction with immunologists and clinicians to interpret those results. The review has a focus on autoimmune diseases, including rheumatoid arthritis, MS, systemic lupus erythematosus, and type 1 diabetes, but its recommendations are also applicable to studies of other immune-mediated diseases.
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Affiliation(s)
- Jane H Buckner
- Center for Translational Immunology, Benaroya Research Institute, Virginia Mason Hospital, Seattle, WA, USA
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James EA, Holers VM, Iyer R, Prideaux EB, Rao NL, Rims C, Muir VS, Posso SE, Bloom MS, Zia A, Elliott SE, Adamska JZ, Ai R, Brewer RC, Seifert JA, Moss L, Barzideh S, Demoruelle MK, Striebich CC, Okamoto Y, Sainbayar E, Crook AA, Peterson RA, Vanderlinden LA, Wang W, Boyle DL, Robinson WH, Buckner JH, Firestein GS, Deane KD. Multifaceted immune dysregulation characterizes individuals at-risk for rheumatoid arthritis. Nat Commun 2023; 14:7637. [PMID: 37993439 PMCID: PMC10665556 DOI: 10.1038/s41467-023-43091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
Molecular markers of autoimmunity, such as antibodies to citrullinated protein antigens (ACPA), are detectable prior to inflammatory arthritis (IA) in rheumatoid arthritis (RA) and may define a state that is 'at-risk' for future RA. Here we present a cross-sectional comparative analysis among three groups that include ACPA positive individuals without IA (At-Risk), ACPA negative individuals and individuals with early, ACPA positive clinical RA (Early RA). Differential methylation analysis among the groups identifies non-specific dysregulation in peripheral B, memory and naïve T cells in At-Risk participants, with more specific immunological pathway abnormalities in Early RA. Tetramer studies show increased abundance of T cells recognizing citrullinated (cit) epitopes in At-Risk participants, including expansion of T cells reactive to citrullinated cartilage intermediate layer protein I (cit-CILP); these T cells have Th1, Th17, and T stem cell memory-like phenotypes. Antibody-antigen array analyses show that antibodies targeting cit-clusterin, cit-fibrinogen and cit-histone H4 are elevated in At-Risk and Early RA participants, with the highest levels of antibodies detected in those with Early RA. These findings indicate that an ACPA positive at-risk state is associated with multifaceted immune dysregulation that may represent a potential opportunity for targeted intervention.
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Affiliation(s)
- Eddie A James
- Benaroya Research Institute, Seattle, WA, 98101, USA
| | - V Michael Holers
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Radhika Iyer
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - E Barton Prideaux
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Navin L Rao
- Janssen Research and Development, Spring House, PA, 19477, USA
| | - Cliff Rims
- Benaroya Research Institute, Seattle, WA, 98101, USA
| | | | | | - Michelle S Bloom
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Amin Zia
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Serra E Elliott
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Julia Z Adamska
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Rizi Ai
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
| | - R Camille Brewer
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | - Jennifer A Seifert
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - LauraKay Moss
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Saman Barzideh
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Christopher C Striebich
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Yuko Okamoto
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Enkhtsogt Sainbayar
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Alexandra A Crook
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Lauren A Vanderlinden
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Wei Wang
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, 92093, USA
- Department of Cellular and Molecular Medicine, University of California, San Diego, La Jolla, CA, 92093, USA
| | - David L Boyle
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - William H Robinson
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, 94304, USA
- VA Palo Alto Health Care System, Palo Alto, CA, 94550, USA
| | | | - Gary S Firestein
- Division of Rheumatology, Allergy and Immunology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
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Arleevskaya MI, Larionova RV, Shagimardanova EI, Gogoleva NE, Kravtsova OA, Novikov AA, Kazarian GG, Carlé C, Renaudineau Y. Predictive risk factors before the onset of familial rheumatoid arthritis: the Tatarstan cohort study. Front Med (Lausanne) 2023; 10:1227786. [PMID: 37877020 PMCID: PMC10593450 DOI: 10.3389/fmed.2023.1227786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/14/2023] [Indexed: 10/26/2023] Open
Abstract
Background A familial history of rheumatoid arthritis (RA) predisposes an individual to develop RA. This study aimed at investigating factors associated with this conversion from the Tatarstan cohort. Methods A total of 144 individuals, referred to as pre-RA and at risk for familial RA, were selected 2 years (range: 2-21 years) before conversion to RA and compared to non-converted 328 first-degree relatives (FDR) from RA as assessed after ≥2 years follow-up, and 355 healthy controls were also selected (HC). Preclinical parameters and socio-demographic/individual/HLA genetic factors were analyzed when data were available at the time of enrollment. Results As compared to FDR and HC groups, pre-RA individuals were characterized before conversion to RA by the presence of arthralgia, severe morning symptoms, a lower educational level, and rural location. An association with the HLA-DRB1 SE risk factor was also retrieved with symmetrical arthralgia and passive smoking. On the contrary, alcohol consumption and childlessness in women were protective and associated with the HLA-DRB1*07:01 locus. Conclusion Before RA onset, a combination of individual and genetic factors characterized those who are at risk of progressing to RA among those with familial RA relatives.
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Affiliation(s)
- Marina I. Arleevskaya
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
| | - Regina V. Larionova
- Central Research Laboratory, Kazan State Medical Academy, Kazan, Russia
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
| | - Elena I. Shagimardanova
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
| | - Natalia E. Gogoleva
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
| | - Olga A. Kravtsova
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Russia
| | - Andrej A. Novikov
- Innovation Department, Sobolev Institute of Mathematics, Siberian Brunch of Russian Academy of Science, Novosibirsk, Russia
- Immunology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, Toulouse, France
- INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | | | - Caroline Carlé
- Immunology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, Toulouse, France
- INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | - Yves Renaudineau
- Immunology Department Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, Toulouse, France
- INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
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6
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Wells I, Simons G, Kanacherril JP, Mallen CD, Raza K, Falahee M. Stakeholder perceptions of preventive approaches to rheumatoid arthritis: qualitative study of healthcare professionals' perspectives on predictive and preventive strategies. BMC Rheumatol 2023; 7:35. [PMID: 37789489 PMCID: PMC10548722 DOI: 10.1186/s41927-023-00361-8] [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: 02/21/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND There is increasing research interest in the development of preventive treatment for individuals at risk of rheumatoid arthritis (RA). Previous studies have explored the perceptions of at-risk groups and patients about predictive and preventive strategies for RA, but little is known about health care professionals' (HCPs) perspectives. METHODS One-to-one semi-structured qualitative interviews were conducted (face-to-face or by telephone) with HCPs. Audio recordings of the interviews were transcribed, and the data were analysed by thematic analysis. RESULTS Nineteen HCPs (11 female) were interviewed, including ten GPs, six rheumatologists and three rheumatology nurse specialists. The thematic analysis identified four organising themes: 1) Attributes of predictive and preventive approaches; 2) Ethical and psychological concerns; 3) Implementation issues and 4) Learning from management of other conditions. Theme 1 described necessary attributes of predictive and preventive approaches, including the type and performance of predictive tools, the need for a sound evidence base and consideration of risks and benefits associated with preventive treatment. Theme 2 described the ethical and psycho-social concerns that interviewees raised, including the potential negative economic, financial and psychological effects of risk disclosure for 'at-risk' individuals, uncertainty around the development of RA and the potential for benefit associated with the treatments being considered. Theme 3 describes the implementation issues considered, including knowledge and training needs, costs and resource implications of implementing predictive and preventive approaches, the role of different types of HCPs, guidelines and tools needed, and patient characteristics relating to the appropriateness of preventive treatments. Theme 4 describes lessons that could be learned from interviewees' experiences of prediction and prevention in other disease areas, including how preventive treatment is prescribed, existing guidelines and tools for other diseases and issues relating to risk communication. CONCLUSIONS For successful implementation of predictive and preventative approaches in RA, HCPs need appropriate training about use and interpretation of predictive tools, communication of results to at-risk individuals, and options for intervention. Evidence of cost-efficiency, appropriate resource allocation, adaptation of official guidelines and careful consideration of the at-risk individuals' psycho-social needs are also needed.
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Affiliation(s)
- Imogen Wells
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK
| | | | | | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and the Research into Inflammatory Arthritis Centre Versus Arthritis, University of Birmingham, Birmingham, UK
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2WB, UK.
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.
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Duquenne L, Hensor EM, Wilson M, Garcia-Montoya L, Nam JL, Wu J, Harnden K, Anioke IC, Di Matteo A, Chowdhury R, Sidhu N, Ponchel F, Mankia K, Emery P. Predicting Inflammatory Arthritis in At-Risk Persons: Development of Scores for Risk Stratification. Ann Intern Med 2023; 176:1027-1036. [PMID: 37523695 DOI: 10.7326/m23-0272] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Inflammatory arthritis (IA) is an immune-related condition defined by the presence of clinical synovitis. Its most common form is rheumatoid arthritis. OBJECTIVE To develop scores for predicting IA in at-risk persons using multidimensional biomarkers. DESIGN Prospective observational cohort study. SETTING Single-center, Leeds, United Kingdom. PARTICIPANTS Persons with new musculoskeletal symptoms, a positive test result for anticitrullinated protein antibodies, and no clinical synovitis and followed for 48 weeks or more or until IA occurred. MEASUREMENTS A simple score was developed using logistic regression, and a comprehensive score was developed using the least absolute shrinkage and selection operator Cox proportional hazards regression. Internal validation with bootstrapping was estimated, and a decision curve analysis was done. RESULTS Of 455 participants, 32.5% (148 of 455) developed IA, and 15.4% (70 of 455) developed it within 1 year. The simple score identified 249 low-risk participants with a false negative rate of 5% (and 206 high-risk participants with a false-positive rate of 72%). The comprehensive score identified 119 high-risk participants with a false-positive rate of 29% (and 336 low-risk participants with a false-negative rate of 19%); 40% of high-risk participants developed IA within 1 year and 71% within 5 years. LIMITATIONS External validation is required. Recruitment occurred over 13 years, with lower rates of IA in later years. There was geographic variation in laboratory testing and recruitment availability. CONCLUSION The simple score identified persons at low risk for IA who were less likely to need secondary care. The comprehensive score identified high-risk persons who could benefit from risk stratification and preventive measures. Both scores may be useful in clinical care and should also be useful in clinical trials. PRIMARY FUNDING SOURCE National Institute for Health and Care Research Leeds Biomedical Research Centre.
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Affiliation(s)
- Laurence Duquenne
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Elizabeth M Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Michelle Wilson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Leticia Garcia-Montoya
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Jacqueline L Nam
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, Leeds, and Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom (J.W.)
| | - Kate Harnden
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Innocent Chidi Anioke
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, and Department of Medical Laboratory Sciences, University of Nigeria, Nigeria (I.C.A.)
| | - Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Rahaymin Chowdhury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Navkiran Sidhu
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Frederique Ponchel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom (F.P.)
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.)
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Inamo J, Keegan J, Griffith A, Ghosh T, Horisberger A, Howard K, Pulford J, Murzin E, Hancock B, Jonsson AH, Seifert J, Feser ML, Norris JM, Cao Y, Apruzzese W, Louis Bridges S, Bykerk V, Goodman S, Donlin L, Firestein GS, Perlman H, Bathon JM, Hughes LB, Tabechian D, Filer A, Pitzalis C, Anolik JH, Moreland L, Guthridge JM, James JA, Brenner MB, Raychaudhuri S, Sparks JA, Michael Holers V, Deane KD, Lederer JA, Rao DA, Zhang F. Deep immunophenotyping reveals circulating activated lymphocytes in individuals at risk for rheumatoid arthritis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.03.547507. [PMID: 37461737 PMCID: PMC10349983 DOI: 10.1101/2023.07.03.547507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease with currently no universally highly effective prevention strategies. Identifying pathogenic immune phenotypes in 'At-Risk' populations prior to clinical disease onset is crucial to establishing effective prevention strategies. Here, we applied mass cytometry to deeply characterize the immunophenotypes in blood from At-Risk individuals identified through the presence of serum antibodies to citrullinated protein antigens (ACPA) and/or first-degree relative (FDR) status (n=52), as compared to established RA (n=67), and healthy controls (n=48). We identified significant cell expansions in At-Risk individuals compared with controls, including CCR2+CD4+ T cells, T peripheral helper (Tph) cells, type 1 T helper cells, and CXCR5+CD8+ T cells. We also found that CD15+ classical monocytes were specifically expanded in ACPA-negative FDRs, and an activated PAX5 low naïve B cell population was expanded in ACPA-positive FDRs. Further, we developed an "RA immunophenotype score" classification method based on the degree of enrichment of cell states relevant to established RA patients. This score significantly distinguished At-Risk individuals from controls. In all, we systematically identified activated lymphocyte phenotypes in At-Risk individuals, along with immunophenotypic differences among both ACPA+ and ACPA-FDR At-Risk subpopulations. Our classification model provides a promising approach for understanding RA pathogenesis with the goal to further improve prevention strategies and identify novel therapeutic targets.
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9
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Wells I, Zemedikun DT, Simons G, Stack RJ, Mallen CD, Raza K, Falahee M. Predictors of the likelihood that patients with rheumatoid arthritis will communicate information about rheumatoid arthritis risk to relatives: A quantitative assessment. PATIENT EDUCATION AND COUNSELING 2023; 112:107713. [PMID: 37003160 DOI: 10.1016/j.pec.2023.107713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/10/2023] [Accepted: 03/17/2023] [Indexed: 05/09/2023]
Abstract
First-degree relatives (FDRs) of people with rheumatoid arthritis (RA) are increasingly recruited to prediction and prevention studies. Access to FDRs is usually via their proband with RA. Quantitative data on predictors of family risk communication are lacking. RA patients completed a questionnaire assessing likelihood of communicating RA risk information to their FDRs, demographic variables, disease impact, illness perceptions, autonomy preferences, interest in FDRs taking a predictive test for RA, dispositional openness, family functioning, and attitudes towards predictive testing. Ordinal regression examined associations between patients' characteristics and their median likelihood of communicating RA risk to FDRs. Questionnaires were completed by 482 patients. The majority (75.1%) were likely/extremely likely to communicate RA risk information to FDRs, especially their children. Decision-making preferences, interest in FDRs taking a predictive test, and beliefs that risk knowledge would increase people's empowerment over their health increased patients' odds of being likely to communicate RA risk information to FDRs. Beliefs that risk information would cause stress to their relatives decreased odds that patients would be likely to communicate RA risk. These findings will inform the development of resources to support family communication about RA risk.
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Affiliation(s)
- Imogen Wells
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Dawit T Zemedikun
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rebecca J Stack
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, United Kingdom
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom; Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and the Research into Inflammatory Arthritis Centre Versus Arthritis, University of Birmingham, Birmingham, United Kingdom
| | - Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
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10
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Seifert JA, Bemis EA, Ramsden K, Lowell C, Polinski K, Feser M, Fleischer C, Demoruelle MK, Buckner J, Gregersen PK, Keating RM, Mikuls TR, O’Dell JR, Weisman MH, Deane KD, Norris JM, Steere AC, Holers VM. Association of Antibodies to Prevotella copri in Anti-Cyclic Citrullinated Peptide-Positive Individuals At Risk of Developing Rheumatoid Arthritis and in Patients With Early or Established Rheumatoid Arthritis. Arthritis Rheumatol 2023; 75:507-516. [PMID: 36259174 PMCID: PMC10065886 DOI: 10.1002/art.42370] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/20/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Prevotella copri (P copri), a gut commensal, has been reported to be an immune-relevant organism in individuals with rheumatoid arthritis (RA). This study sought to evaluate anti-P copri (anti-Pc) antibody responses in our participant cohorts and to determine when in the natural history of RA such responses develop. METHODS We analyzed serum levels of immunoglobulin A (IgA) and IgG antibodies from a 27-kd protein of P copri (anti-Pc-p27), an immunogenic P copri protein, in study participants at risk of developing RA, participants who transitioned to RA, participants with early RA (<1 year of disease), and participants with established RA, with comparisons made to their matched controls. We also evaluated anti-Pc-p27 antibody levels in individuals stratified by RA-related autoantibody status. RESULTS Overall, participants with RA had significantly higher IgA anti-Pc-p27 antibody levels and trended toward higher IgG anti-Pc-p27 antibody levels compared with matched controls. When stratified by early versus established RA, participants with early RA had median IgG anti-Pc-p27 antibody levels that were overall higher, whereas median IgA anti-Pc-p27 antibody levels were statistically significantly higher in participants with established RA compared with their matched controls. In the autoantibody-specific analyses, the at-risk population with anti-cyclic citrullinated peptide (anti-CCP) antibodies, but not rheumatoid factor (RF), trended toward increased levels of IgG anti-Pc-p27. Additionally, RA participants who were seropositive for both CCP and RF had significantly increased levels of IgA anti-Pc-p27 antibodies and trended toward higher levels of IgG anti-Pc-p27 antibodies compared with matched controls. CONCLUSION Our findings support a potential etiologic role for P copri in both RA preclinical evolution and the subsequent pathogenesis of synovitis.
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Affiliation(s)
| | | | - Kristina Ramsden
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cassidy Lowell
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Marie Feser
- University of Colorado Denver, Aurora, Colorado
| | | | | | - Jane Buckner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Peter K. Gregersen
- Feinstein Institutes for Medical Research and North Shore-Long Island Jewish Health System, Manhasset, New York
| | | | - Ted R. Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska
| | - James R. O’Dell
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska
| | | | | | | | - Allen C. Steere
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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11
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Ponchel F, Duquenne L, Xie X, Corscadden D, Shuweihdi F, Mankia K, Trouw LA, Emery P. Added value of multiple autoantibody testing for predicting progression to inflammatory arthritis in at-risk individuals. RMD Open 2022; 8:rmdopen-2022-002512. [PMID: 36535711 PMCID: PMC9764647 DOI: 10.1136/rmdopen-2022-002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Predicting progression to clinical arthritis in individuals at-risk of developing rheumatoid arthritis is a prerequisite to developing stratification groups for prevention strategies. Selecting accurate predictive criteria is the critical step to define the population at-risk. While positivity for anti-citrullinated protein antibodies (ACPA) remains the main recruitment biomarker, positivity for other autoantibodies (AutoAbs) identified before the onset of symptoms, may provide additional predictive accuracy for stratification. OBJECTIVE To perform a multiple AutoAbs analysis for both the prediction and the time of progression to inflammatory arthritis (IA). METHODS 392 individuals were recruited based on a new musculoskeletal complaint and positivity for ACPA or rheumatoid factor (RF). ELISAs were performed for ACPA, RF, anti-nuclear Ab, anti-carbamylated protein (anti-CarP) and anti-collagen AutoAbs. Logistic and COX regression were used for analysis. RESULTS Progression to IA was observed in 125/392 (32%) of cases, of which 78 progressed within 12 months. The AutoAbs ACPA, RF, anti-CarP were individually associated with progression (p<0.0001) and improved prediction when combined with demographic/clinical data (Accuracy >77%; area under the curve (AUC) >0.789), compared with prediction using only demographic/clinical data (72.9%, AUC=0.760). Multiple AutoAbs testing provided added value, with +6.4% accuracy for number of positive AutoAbs (AUC=0.852); +5.4% accuracy for AutoAbs levels (ACPA/anti-CarP, AUC=0.832); and +6.2% accuracy for risk-groups based on high/low levels (ACPA/RF/anti-CarP, AUC=0.837). Time to imminent progression was best predicted using ACPA/anti-CarP levels (AUC=0.779), while the number of positive AutoAbs was/status/risk were as good (AUC=0.778). CONCLUSION We confirm added value of multiple AutoAbs testing for identifying progressors to clinical disease, allowing more specific stratification for intervention studies.
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Affiliation(s)
- Frederique Ponchel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Laurence Duquenne
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Xuanxiao Xie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Diane Corscadden
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, Faculty of Medicine, University of Leeds, Leeds, UK
| | - K Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - L A Trouw
- Department of Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK,Leeds NIHR Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
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12
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Chriswell ME, Lefferts AR, Clay MR, Hsu AR, Seifert J, Feser ML, Rims C, Bloom MS, Bemis EA, Liu S, Maerz MD, Frank DN, Demoruelle MK, Deane KD, James EA, Buckner JH, Robinson WH, Holers VM, Kuhn KA. Clonal IgA and IgG autoantibodies from individuals at risk for rheumatoid arthritis identify an arthritogenic strain of Subdoligranulum. Sci Transl Med 2022; 14. [PMID: 36288282 PMCID: PMC9804515 DOI: 10.1126/scitranslmed.abn5166 10.1126/scitranslmed.abn5166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The mucosal origins hypothesis of rheumatoid arthritis (RA) proposes a central role for mucosal immune responses in the initiation or perpetuation of the systemic autoimmunity that occurs with disease. However, the connection between the mucosa and systemic autoimmunity in RA remains unclear. Using dual immunoglobulin A (IgA) and IgG family plasmablast-derived monoclonal autoantibodies obtained from peripheral blood of individuals at risk for RA, we identified cross-reactivity between RA-relevant autoantigens and bacterial taxa in the closely related families Lachnospiraceae and Ruminococcaceae. After generating bacterial isolates within the Lachnospiraceae/Ruminococcaceae genus Subdoligranulum from the feces of an individual, we confirmed monoclonal antibody binding and CD4+ T cell activation in individuals with RA compared to control individuals. In addition, when Subdoligranulum isolate 7 but not isolate 1 colonized germ-free mice, it stimulated TH17 cell expansion, serum RA-relevant IgG autoantibodies, and joint swelling reminiscent of early RA, with histopathology characterized by antibody deposition and complement activation. Systemic immune responses were likely due to mucosal invasion along with the generation of colon-isolated lymphoid follicles driving increased fecal and serum IgA by isolate 7, because B and CD4+ T cell depletion not only halted intestinal immune responses but also eliminated detectable clinical disease. In aggregate, these findings demonstrate a mechanism of RA pathogenesis through which a specific intestinal strain of bacteria can drive systemic autoantibody generation and joint-centered antibody deposition and immune activation.
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Affiliation(s)
- Meagan E. Chriswell
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Adam R. Lefferts
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Michael R. Clay
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Alex Ren Hsu
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Jennifer Seifert
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Marie L. Feser
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Cliff Rims
- Benaroya Research Institute, Seattle, WA 98101
| | - Michelle S. Bloom
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Elizabeth A. Bemis
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Sucai Liu
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | | | - Daniel N. Frank
- Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - M. Kristen Demoruelle
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Kevin D. Deane
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | | | | | - William H. Robinson
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - V. Michael Holers
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Kristine A. Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045,Corresponding Author:
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13
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Chriswell ME, Lefferts AR, Clay MR, Hsu AR, Seifert J, Feser ML, Rims C, Bloom MS, Bemis EA, Liu S, Maerz MD, Frank DN, Demoruelle MK, Deane KD, James EA, Buckner JH, Robinson WH, Holers VM, Kuhn KA. Clonal IgA and IgG autoantibodies from individuals at risk for rheumatoid arthritis identify an arthritogenic strain of Subdoligranulum. Sci Transl Med 2022; 14:eabn5166. [PMID: 36288282 PMCID: PMC9804515 DOI: 10.1126/scitranslmed.abn5166] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The mucosal origins hypothesis of rheumatoid arthritis (RA) proposes a central role for mucosal immune responses in the initiation or perpetuation of the systemic autoimmunity that occurs with disease. However, the connection between the mucosa and systemic autoimmunity in RA remains unclear. Using dual immunoglobulin A (IgA) and IgG family plasmablast-derived monoclonal autoantibodies obtained from peripheral blood of individuals at risk for RA, we identified cross-reactivity between RA-relevant autoantigens and bacterial taxa in the closely related families Lachnospiraceae and Ruminococcaceae. After generating bacterial isolates within the Lachnospiraceae/Ruminococcaceae genus Subdoligranulum from the feces of an individual, we confirmed monoclonal antibody binding and CD4+ T cell activation in individuals with RA compared to control individuals. In addition, when Subdoligranulum isolate 7 but not isolate 1 colonized germ-free mice, it stimulated TH17 cell expansion, serum RA-relevant IgG autoantibodies, and joint swelling reminiscent of early RA, with histopathology characterized by antibody deposition and complement activation. Systemic immune responses were likely due to mucosal invasion along with the generation of colon-isolated lymphoid follicles driving increased fecal and serum IgA by isolate 7, because B and CD4+ T cell depletion not only halted intestinal immune responses but also eliminated detectable clinical disease. In aggregate, these findings demonstrate a mechanism of RA pathogenesis through which a specific intestinal strain of bacteria can drive systemic autoantibody generation and joint-centered antibody deposition and immune activation.
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Affiliation(s)
- Meagan E. Chriswell
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Adam R. Lefferts
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Michael R. Clay
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Alex Ren Hsu
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Jennifer Seifert
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Marie L. Feser
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Cliff Rims
- Benaroya Research Institute, Seattle, WA 98101
| | - Michelle S. Bloom
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Elizabeth A. Bemis
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Sucai Liu
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | | | - Daniel N. Frank
- Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - M. Kristen Demoruelle
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Kevin D. Deane
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | | | | | - William H. Robinson
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - V. Michael Holers
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Kristine A. Kuhn
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045,Corresponding Author:
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14
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Wells I, Zemedikun DT, Simons G, Stack RJ, Mallen CD, Raza K, Falahee M. Predictors of interest in predictive testing for rheumatoid arthritis among first degree relatives of rheumatoid arthritis patients. Rheumatology (Oxford) 2022; 61:3223-3233. [PMID: 34850849 PMCID: PMC9348622 DOI: 10.1093/rheumatology/keab890] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/05/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES There is increasing interest in prediction and prevention of RA. It is important to understand the views of those at risk to inform the development of effective approaches. First-degree relatives (FDRs) of RA patients are at increased risk of RA. This study assessed predictors of their interest in predictive testing for RA. METHODS Questionnaires were completed by RA patients (provided with their questionnaire by a healthcare professional) and their FDRs (provided with their questionnaire by their RA proband). FDR surveys assessed interest in taking a predictive test, demographic variables, perceived RA risk, attitudes about predictive testing, autonomy preferences, illness perceptions, avoidance coping and health anxiety. Patient surveys included demographic variables, disease impact, RA duration and treatment. Ordinal logistic regression examined the association between FDRs' characteristics and their interest in predictive testing. Generalized estimating equations assessed associations between patient characteristics and FDRs' interest in predictive testing. RESULTS Three hundred and ninety-six FDRs responded. Paired data from the RA proband were available for 292. The proportion of FDRs interested in predictive testing was 91.3%. Information-seeking preferences, beliefs that predictive testing can increase empowerment over health and positive attitudes about risk knowledge were associated with increased interest. Beliefs that predictive testing could cause psychological harm predicted lower interest. Patient characteristics of the proband were not associated with FDRs' interest. CONCLUSIONS FDRs' interest in predictive testing for RA was high, and factors associated with interest were identified. These findings will inform the development of predictive strategies and informational resources for those at risk.
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Affiliation(s)
- Imogen Wells
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences
| | | | - Gwenda Simons
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences
| | - Rebecca J Stack
- Institute of Clinical Sciences, University of Birmingham, Birmingham
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele
| | - Karim Raza
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences.,NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and the Research into Inflammatory Arthritis Centre Versus Arthritis, University of Birmingham, Birmingham, UK
| | - Marie Falahee
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences
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15
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Bergstedt DT, Tarter WJ, Peterson RA, Feser ML, Parish MC, Striebich CC, Demoruelle MK, Moss L, Bemis EA, Norris JM, Holers VM, Edison JD, Thiele GM, Mikuls TR, Deane KD. Antibodies to Citrullinated Protein Antigens, Rheumatoid Factor Isotypes and the Shared Epitope and the Near-Term Development of Clinically-Apparent Rheumatoid Arthritis. Front Immunol 2022; 13:916277. [PMID: 35812446 PMCID: PMC9265214 DOI: 10.3389/fimmu.2022.916277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background/Purpose In rheumatoid arthritis (RA) autoantibodies including antibodies to citrullinated protein antigens (ACPA) and rheumatoid factor (RF) can be predictive of incident clinical RA. However, there is limited understanding of how antibody changes over time impact prediction of the likelihood and timing of future clinical RA. Materials and Methods We evaluated relationships between ACPA, the shared epitope (SE), RF isotypes and incident RA in a prospective cohort of 90 ACPA(+) individuals without baseline arthritis identified through health-fair testing (i.e. Healthfair). We also evaluated ACPA and RF isotypes and time-to-diagnosis of RA in a retrospective cohort of 215 individuals with RA from the Department of Defense Serum Repository (DoDSR). Results Twenty-six of 90 (29%) of ACPA(+) Healthfair participants developed incident RA. Baseline or incident dual RF-IgA and RF-IgM positivity was associated with increased risk for incident RA (HR 3.09; 95% CI 1.15 to 8.29) although RFs were negative in ~50% of individuals with incident RA. SE was associated with increased risk of RA (HR 2.87, 95% CI 1.22-6.76). In the DoDSR cohort, triple positivity for ACPA, RF-IgA and RF-IgM was present a median of 1-2 years prior to RA diagnosis, with some sex-specific differences. Conclusion These findings can be used to counsel individuals at-risk for future RA and to design clinical trials for RA prevention. The findings also suggest that RF could be a surrogate outcome as a success of an immunologic intervention in RA prevention. Additional studies are needed to understand the biologic of different patterns of autoantibody elevations in RA evolution.
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Affiliation(s)
- Dylan T. Bergstedt
- Department of Medicine, St. Joseph’s Hospital, SCL Health, Denver, CO, United States
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Wyatt J. Tarter
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan A. Peterson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Marie L. Feser
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Mark C. Parish
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher C. Striebich
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - M. Kristen Demoruelle
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - LauraKay Moss
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Elizabeth A. Bemis
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Jill M. Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - V. Michael Holers
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Jess D. Edison
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Geoffrey M. Thiele
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Ted R. Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Kevin D. Deane
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
- *Correspondence: Kevin D. Deane,
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16
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Vanderlinden LA, Bemis EA, Seifert J, Guthridge JM, Young KA, Demoruelle MK, Feser M, DeJager W, Macwana S, Mikuls TR, O'Dell JR, Weisman MH, Buckner J, Keating RM, Gaffney PM, Kelly JA, Langefeld CD, Deane KD, James JA, Holers VM, Norris JM. Relationship Between a Vitamin D Genetic Risk Score and Autoantibodies Among First-Degree Relatives of Probands With Rheumatoid Arthritis and Systemic Lupus Erythematosus. Front Immunol 2022; 13:881332. [PMID: 35720397 PMCID: PMC9205604 DOI: 10.3389/fimmu.2022.881332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/09/2022] [Indexed: 12/28/2022] Open
Abstract
Objective Higher 25-hydroxyvitamin D (25(OH)D) levels have been associated with reduced risk for autoimmune diseases and are influenced by vitamin D metabolism genes. We estimated genetically-determined vitamin D levels by calculating a genetic risk score (GRS) and investigated whether the vitamin D GRS was associated with the presence of autoantibodies related to rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in those at increased risk for developing RA and SLE, respectively. Methods In this cross-sectional study, we selected autoantibody positive (aAb+) and autoantibody negative (aAb-) individuals from the Studies of the Etiologies of Rheumatoid Arthritis (SERA), a cohort study of first-degree relatives (FDRs) of individuals with RA (189 RA aAb+, 181 RA aAb-), and the Lupus Family Registry and Repository (LFRR), a cohort study of FDRs of individuals with SLE (157 SLE aAb+, 185 SLE aAb-). Five SNPs known to be associated with serum 25(OH)D levels were analyzed individually as well as in a GRS: rs4588 (GC), rs12785878 (NADSYN1), rs10741657 (CYP2R1), rs6538691 (AMDHD1), and rs8018720 (SEC23A). Results Both cohorts had similar demographic characteristics, with significantly older and a higher proportion of males in the aAb+ FDRs. The vitamin D GRS was inversely associated with RA aAb+ (OR = 0.85, 95% CI = 0.74-0.99), suggesting a possible protective factor for RA aAb positivity in FDRs of RA probands. The vitamin D GRS was not associated with SLE aAb+ in the LFRR (OR = 1.09, 95% CI = 0.94-1.27). The SEC23A SNP was associated with RA aAb+ in SERA (OR = 0.65, 95% CI = 0.43-0.99); this SNP was not associated with SLE aAb+ in LFRR (OR = 1.41, 95% CI = 0.90 - 2.19). Conclusion Genes associated with vitamin D levels may play a protective role in the development of RA aAbs in FDRs of RA probands, perhaps through affecting lifelong vitamin D status. The GRS and the SEC23A SNP may be of interest for future investigation in pre-clinical RA. In contrast, these results do not support a similar association in SLE FDRs, suggesting other mechanisms involved in the relationship between vitamin D and SLE aAbs not assessed in this study.
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Affiliation(s)
- Lauren A Vanderlinden
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elizabeth A Bemis
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer Seifert
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Joel M Guthridge
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Kendra A Young
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Mary Kristen Demoruelle
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Marie Feser
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Wade DeJager
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Susan Macwana
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Ted R Mikuls
- Division of Rheumatology and Immunology, University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - James R O'Dell
- Division of Rheumatology and Immunology, University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jane Buckner
- Center for Translational Immunology, Benaroya Research Institute (BRI) at Virginia Mason, Seattle, WA, United States
| | - Richard M Keating
- Division of Rheumatology, Scripps Health, La Jolla, CA, United States
| | - Patrick M Gaffney
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Jennifer A Kelly
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, United States.,Center for Precision Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Kevin D Deane
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Judith A James
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Vernon Michael Holers
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jill M Norris
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Kowalski EN, Qian G, Vanni KMM, Sparks JA. A Roadmap for Investigating Preclinical Autoimmunity Using Patient-Oriented and Epidemiologic Study Designs: Example of Rheumatoid Arthritis. Front Immunol 2022; 13:890996. [PMID: 35693829 PMCID: PMC9175569 DOI: 10.3389/fimmu.2022.890996] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background & Aims Rheumatoid arthritis (RA) is a prototypic autoimmune disease causing inflammatory polyarthritis that affects nearly 1% of the population. RA can lead to joint destruction and disability along with increased morbidity and mortality. Similar to other autoimmune diseases, RA has distinct preclinical phases corresponding to genetic risk, lifestyle risk factors, autoantibody development, and non-specific symptoms prior to clinical diagnosis. This narrative review will detail observational studies for RA risk and clinical trials for RA prevention as a roadmap to investigating preclinical autoimmunity that could be applied to other diseases. Methods In this narrative review, we summarized previous and ongoing research studies investigating RA risk and prevention, categorizing them related to their design and preclinical phases. Results We detailed the following types of studies investigating RA risk and prevention: retrospective population-based and administrative datasets; prospective studies (case-control and cohort; some enrolling based on genetics, first-degree relative status, elevated biomarkers, or early symptoms/arthritis); and randomized clinical trials. These correspond to all preclinical RA phases (genetic, lifestyle, autoimmunity, early signs/symptoms). Previous and ongoing randomized controlled trials have enrolled individuals at very elevated risk for RA based on biomarkers, symptoms, imaging abnormalities, or early signs/symptoms. Conclusion We detailed the rich variety of study designs that is necessary to investigate distinct preclinical phases of an autoimmune disease such as RA. However, further progress is needed to fully elucidate the pathogenesis of RA that may ultimately lead to prevention or delay of disease onset.
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Affiliation(s)
- Emily N Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Kathleen M M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
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18
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Tsaltskan V, Nguyen K, Eaglin C, Holers VM, Deane KD, Firestein GS. Comparison of Web-Based Advertising and a Social Media Platform as Recruitment Tools for Underserved and Hard-to-Reach Populations in Rheumatology Clinical Research. ACR Open Rheumatol 2022; 4:623-630. [PMID: 35536990 PMCID: PMC9274346 DOI: 10.1002/acr2.11448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 01/03/2023] Open
Abstract
Objective Traditional nondigital methods of participant recruitment for clinical research studies in rheumatology can be costly and inefficient, particularly for recruitment of underserved populations. We aimed to address this need by evaluating two methods of online recruitment to an observational cohort of individuals at risk for rheumatoid arthritis, namely web and Facebook advertisements. Methods A 3‐month countywide web‐based recruitment campaign was conducted consisting of text and image‐based advertisements. Similar advertisements were subsequently displayed on Facebook, initially in English for 5 months and later in Spanish for an additional 3 months. Individuals who clicked on advertisements were directed to a website landing page containing study information and could contact study personnel to schedule testing for anti‐cyclic citrullinated peptide‐3 (CCP3). The primary outcome measure for each campaign was the click‐through rate. Results During the web campaign, 413,289 advertisement impressions were displayed, resulting in 428 clicks (click‐through rate 0.10%) and only one screened participant. During the English Facebook campaign, 724,815 advertisements were displayed with 6765 clicks (click‐through rate 0.93%) and 43 screened participants, significantly greater than the web campaign (P < 0.001). During the Spanish advertisement campaign, 255,730 Spanish advertisements were displayed, resulting in a click‐through rate of 2.09% and 24 screened participants, a significantly higher rate than English advertisements. Of participants recruited through social media, 94% were female and 29.8% were Spanish speakers. Conclusion Facebook advertisements were superior to web advertisements for participant recruitment. Spanish Facebook advertisements had a greater click‐through rate than English Facebook advertisements. Facebook was an effective recruitment method, particularly for Spanish speakers.
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Abstract
Rheumatoid arthritis (RA) is currently diagnosed and treated once an individual displays the clinical findings of inflammatory arthritis (IA). However, growing evidence supports that there is a 'pre-RA' stage that can be identified through factors such as autoantibodies in absence of clinically apparent IA. In particular, biomarkers, including antibodies to citrullinated protein antigens (ACPA), demonstrate a high risk for future IA/RA, and multiple clinical trials have been developed to intervene in individuals in pre-RA to prevent or delay clinically apparent disease. Herein, we will discuss in more depth what is currently known about the natural history of RA, and the emerging possibility that early 'diagnosis' of RA-related autoimmunity followed by an intervention can lead to the delay or prevention of the first onset of clinically apparent RA.
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20
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Lundgren D, Widbom L, Hultdin J, Karling P. Preclinical Markers in Inflammatory Bowel Disease. A Nested Case-Control Study. CROHN'S & COLITIS 360 2021; 3:otab072. [PMID: 36777274 PMCID: PMC9802044 DOI: 10.1093/crocol/otab072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Indexed: 12/15/2022] Open
Abstract
Background Our objective was to determine if patients who later develop inflammatory bowel disease (IBD) show signs of increased inflammatory activity in plasma measured with high sensitivity C-reactive protein (CRP), calprotectin, and albumin before the clinical onset of IBD. Methods We identified 96 subjects who later developed IBD (70 ulcerative colitis [UC] and 26 Crohn's disease [CD]). High sensitivity CRP, calprotectin, and albumin were analyzed in frozen plasma, donated from cases and sex-age matched controls 1-15 years before diagnosis. Results We found that subjects who later developed UC had lower albumin levels, and subjects who later developed CD had higher CRP levels than controls. Multivariable conditional logistic regression with albumin, calprotectin, and CRP showed a lower risk for developing IBD and UC with higher albumin levels (odds ratio [OR] 0.79, confidence interval [CI] 0.69-0.90; respective OR 0.77, CI 0.66-0.91). Higher CRP levels were associated with an increased risk of developing CD (OR 1.314, CI 1.060-1.630). When adjusting for body mass index or smoking in the logistic regression model, similar results were found. Plasma calprotectin levels in the preclinical period among patients with IBD did not differ from controls. Conclusions In this nested case-control study, subjects who later developed IBD had signs of low-grade systemic inflammation, indicated by significantly higher CRP plasma levels in CD and lower albumin plasma levels in UC, before the onset of clinical disease.
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Affiliation(s)
- David Lundgren
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Lovisa Widbom
- Department of Medical Biosciences, Division of Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Johan Hultdin
- Department of Medical Biosciences, Division of Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Pontus Karling
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden,Address correspondence to: Pontus Karling, MD, PhD, Department of Public Health and Clinical Medicine, Umeå University, S90187 Umeå, Sweden ()
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21
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Mankia K, Siddle HJ, Kerschbaumer A, Alpizar Rodriguez D, Catrina AI, Cañete JD, Cope AP, Daien CI, Deane KD, El Gabalawy H, Finckh A, Holers VM, Koloumas M, Ometto F, Raza K, Zabalan C, van der Helm-van Mil A, van Schaardenburg D, Aletaha D, Emery P. EULAR points to consider for conducting clinical trials and observational studies in individuals at risk of rheumatoid arthritis. Ann Rheum Dis 2021; 80:1286-1298. [PMID: 34362746 PMCID: PMC8458095 DOI: 10.1136/annrheumdis-2021-220884] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/24/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite growing interest, there is no guidance or consensus on how to conduct clinical trials and observational studies in populations at risk of rheumatoid arthritis (RA). METHODS An European League Against Rheumatism (EULAR) task force formulated four research questions to be addressed by systematic literature review (SLR). The SLR results informed consensus statements. One overarching principle, 10 points to consider (PTC) and a research agenda were proposed. Task force members rated their level of agreement (1-10) for each PTC. RESULTS Epidemiological and demographic characteristics should be measured in all clinical trials and studies in at-risk individuals. Different at-risk populations, identified according to clinical presentation, were defined: asymptomatic, musculoskeletal symptoms without arthritis and early clinical arthritis. Study end-points should include the development of subclinical inflammation on imaging, clinical arthritis, RA and subsequent achievement of arthritis remission. Risk factors should be assessed at baseline and re-evaluated where appropriate; they include genetic markers and autoantibody profiling and additionally clinical symptoms and subclinical inflammation on imaging in those with symptoms and/or clinical arthritis. Trials should address the effect of the intervention on risk factors, as well as progression to clinical arthritis or RA. In patients with early clinical arthritis, pharmacological intervention has the potential to prevent RA development. Participants' knowledge of their RA risk may inform their decision to participate; information should be provided using an individually tailored approach. CONCLUSION These consensus statements provide data-driven guidance for rheumatologists, health professionals and investigators conducting clinical trials and observational studies in individuals at risk of RA.
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Affiliation(s)
- Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds, UK
| | - Andreas Kerschbaumer
- Department of Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | | | - Juan D Cañete
- Department of Rheumatology, Arthritis Unit, Hospital Clinic and IDIBAPS, Barcelona, Spain
| | - Andrew P Cope
- Faculty of Life Sciences and Medicine, Centre for Rheumatic Diseases, King's College London, London, UK
| | - Claire Immediato Daien
- Department of Rheumatology, CHU de Montpellier, University of Montpellier, PhyMedExp, INSERM, CNRS UMR, Montpellier, France
| | - Kevin D Deane
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hani El Gabalawy
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Axel Finckh
- Division of Rheumatology, University of Geneva, Geneva, Switzerland
| | - V Michael Holers
- Division of Rheumatology, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Francesca Ometto
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Karim Raza
- Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Annette van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dirkjan van Schaardenburg
- Department of Rheumatology, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Rheumatology, Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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22
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Hughes-Austin JM, Ix JH, Ward SR, Weisman MH, ODell JR, Mikuls TR, Buckner JH, Gregersen PK, Keating RM, Demoruelle MK, Deane KD, Holers VM, Norris JM. Evaluating associations of joint swelling, joint stiffness and joint pain with physical activity in first-degree relatives of patients with rheumatoid arthritis: Studies of the Aetiology of Rheumatoid Arthritis (SERA), a prospective cohort study. BMJ Open 2021; 11:e050883. [PMID: 34521672 PMCID: PMC8442039 DOI: 10.1136/bmjopen-2021-050883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Physical activity (PA) in preclinical rheumatoid arthritis (RA) is associated with lower RA risk and disease severity. As joint signs and symptoms of inflammatory arthritis serve as a barrier to PA in RA, it is important to consider whether they affect PA in the time prior to RA. Therefore, we investigated whether joint swelling, stiffness or pain were associated with PA in first-degree relatives (FDRs) of patients with RA, a population at higher risk for future RA. DESIGN Prospective study design. SETTING We recruited FDRs of patients with RA from academic centres, Veterans' hospitals and rheumatology clinics or through responses to advertising from six sites across the USA. PARTICIPANTS We evaluated associations of joint stiffness, joint swelling and joint pain with PA time in 268 FDRs with ≥2 visits over an average 1.2 years. Clinicians confirmed joint swelling. Participants self-reported joint stiffness and/or pain. PRIMARY OUTCOME MEASURES PA during a typical 24-hour day was quantified via questionnaire, weighted to reflect metabolic expenditure, where 24 hours was the minimum PA time. Linear mixed models evaluated associations between symptoms and change in PA over time, adjusting for age, sex, race, body mass index, smoking and RA-related autoantibodies. RESULTS Average weighted PA time was 37±7 hours. In the cross-sectional analysis, PA time was 1.3±0.9 hours higher in FDRs reporting joint pain (p=0.15); and 0.8±1.6 and 0.4±1 hours lower in FDRs with joint swelling (p=0.60) and stiffness (p=0.69), respectively. Longitudinally, adjusting for baseline PA time, baseline symptoms were not significantly associated with changes in PA time. However, on average over time, joint stiffness and pain were associated with lower PA time (pinteraction=0.0002, pinteraction=0.002), and joint swelling was associated with higher PA time (pinteraction <0.0001). CONCLUSION Baseline symptoms did not predict future PA time, but on average over time, joint symptoms influenced PA time.
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Affiliation(s)
- Jan M Hughes-Austin
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, USA
| | - Joachim H Ix
- Department of Medicine, Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, USA
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Michael H Weisman
- School of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - James R ODell
- College of Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ted R Mikuls
- College of Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jane H Buckner
- Translational Research Institute, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Peter K Gregersen
- Roberts S Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Richard M Keating
- Division of Rheumatology, Scripps Green Hospital, La Jolla, California, USA
| | - M Kristen Demoruelle
- School of Medicine, Department of Rheumatology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kevin D Deane
- School of Medicine, Department of Rheumatology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - V Michael Holers
- School of Medicine, Department of Rheumatology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
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23
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Okamoto Y, Devoe S, Seto N, Minarchick V, Wilson T, Rothfuss HM, Mohning MP, Arbet J, Kroehl M, Visser A, August J, Thomas SM, Lenis Charry L, Fleischer C, Feser ML, Frazer-Abel AA, Norris JM, Cherrington BD, Janssen WJ, Kaplan MJ, Deane KD, Holers VM, Demoruelle MK. Sputum Neutrophil Extracellular Trap Subsets Associate with IgA Anti-Citrullinated Protein Antibodies in Subjects At-Risk for Rheumatoid Arthritis. Arthritis Rheumatol 2021; 74:38-48. [PMID: 34369110 PMCID: PMC8712364 DOI: 10.1002/art.41948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/03/2021] [Indexed: 11/06/2022]
Abstract
Objective Mechanisms leading to anti–citrullinated protein antibody (ACPA) generation in rheumatoid arthritis (RA) are hypothesized to originate in the lung. We undertook this study to understand associations between neutrophil extracellular trap (NET) formation in the lung and local ACPA generation in subjects at risk of developing RA. Methods Induced sputum was collected from 49 subjects at risk of developing RA, 12 patients with RA, and 18 controls. Sputum neutrophils were tested for ex vivo NET formation, and sputum‐induced NET formation of control neutrophils was measured using immunofluorescence imaging. Sputum macrophages were tested for ex vivo endocytosis of apoptotic and opsonized cells. Levels of ACPA, NET remnants, and inflammatory proteins were quantified in sputum supernatant. Results Spontaneous citrullinated histone H3 (Cit‐H3)–expressing NET formation was higher in sputum neutrophils from at‐risk subjects and RA patients compared to controls (median 12%, 22%, and 0%, respectively; P < 0.01). In at‐risk subjects, sputum IgA ACPA correlated with the percentage of neutrophils that underwent Cit‐H3+ NET formation (r = 0.49, P = 0.002) and levels of Cit‐H3+ NET remnants (r = 0.70, P < 0.001). Reduced endocytic capacity of sputum macrophages was found in at‐risk subjects and RA patients compared to controls. Using a mediation model, we found that sputum inflammatory proteins were associated with sputum IgA ACPA through a pathway mediated by Cit‐H3+ NET remnants. Sputum‐induced Cit‐H3+ NET formation also correlated with sputum levels of interleukin‐1β (IL‐1β), IL‐6, and tumor necrosis factor in at‐risk subjects, suggesting a causal relationship. Conclusion These data support a potential mechanism for mucosal ACPA generation in subjects at risk of developing RA, whereby inflammation leads to increased citrullinated protein–expressing NETs that promote local ACPA generation.
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Affiliation(s)
- Yuko Okamoto
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA.,Tokyo Women's Medical University School of Medicine, Department of Rheumatology, Tokyo, Japan
| | - Stephanie Devoe
- University of Colorado Denver, Department of Immunology, Aurora, CO, USA
| | - Nickie Seto
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda
| | - Valerie Minarchick
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Timothy Wilson
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Heather M Rothfuss
- University of Wyoming, Department of Zoology and Physiology, Laramie, WY, USA
| | - Michael P Mohning
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, USA
| | - Jaron Arbet
- University of Colorado Denver, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - Miranda Kroehl
- University of Colorado Denver, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - Ashley Visser
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Justin August
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Stacey M Thomas
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, USA
| | - Laura Lenis Charry
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Chelsie Fleischer
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Marie L Feser
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | | | - Jill M Norris
- Colorado School of Public Health, Department of Epidemiology, Aurora, CO, USA
| | - Brian D Cherrington
- University of Wyoming, Department of Zoology and Physiology, Laramie, WY, USA
| | - William J Janssen
- National Jewish Health, Division of Pulmonary, Critical Care and Sleep Medicine, Denver, CO, USA
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda
| | - Kevin D Deane
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - V Michael Holers
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
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Gilbert BTP, Lamacchia C, Mongin D, Lauper K, Trunk E, Studer O, Courvoisier DS, Rubbert-Roth A, Kyburz D, Moeller B, Finckh A. Cohort profile: SCREEN-RA: design, methods and perspectives of a Swiss cohort study of first-degree relatives of patients with rheumatoid arthritis. BMJ Open 2021; 11:e048409. [PMID: 34261688 PMCID: PMC8280908 DOI: 10.1136/bmjopen-2020-048409] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Rheumatoid arthritis (RA) is an insidious autoimmune disease, with an immunological onset years before diagnosis. Early interventions in preclinical stages could prevent or minimise the progression towards irreversible joint damage. The SCREEN-RA cohort (Evaluation of a SCREENing strategy for Rheumatoid Arthritis) aims to characterise the preclinical stages of the disease, to identify environmental risk factors, and to discover or validate novel biomarkers predictive for RA development. PARTICIPANTS SCREEN-RA includes an at-risk population for RA, namely first-degree relatives of patients with established RA. FINDINGS TO DATE The cohort started in 2009 is composed of mostly asymptomatic healthy individuals (total n=1458, 7262 person-years), with a mean age of 44 years at enrolment, 74% female and 91% Caucasian ethnicity. During the study period, 16 participants have developed RA. All participants provide baseline serum, DNA and RNA samples, and in a subset, stool samples and oral examination are performed for microbiota assessment. At enrolment, 10% of participants had asymptomatic autoimmunity associated with RA (n=147), 10% presented 'clinically suspect arthralgias' (n=143) and 3% reported arthralgias in conjunction with autoimmunity or high genetic risk (n=51). Studies with this cohort have uncovered risk factors for RA development, such as female hormonal factors, poor oral health or intestinal dysbiosis. FUTURE PLANS Future directions include immunological and 'multiomics' approaches to discover new biological markers of progression towards RA, as well as testing preventive interventions in 'high-risk' population.
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Affiliation(s)
| | - Céline Lamacchia
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
| | - Denis Mongin
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
| | - Kim Lauper
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, England
| | - Eric Trunk
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
| | - Olivia Studer
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
| | | | | | - Diego Kyburz
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Burkhard Moeller
- Department of Rheumatology, Clinical Immunology and Allergology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Geneva University Hospitals (HUG), Geneve, Switzerland
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Demoruelle MK, Wang H, Davis RL, Visser A, Hoang J, Norris JM, Holers VM, Deane KD, Darrah E. Anti-peptidylarginine deiminase-4 antibodies at mucosal sites can activate peptidylarginine deiminase-4 enzyme activity in rheumatoid arthritis. Arthritis Res Ther 2021; 23:163. [PMID: 34092252 PMCID: PMC8182933 DOI: 10.1186/s13075-021-02528-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/10/2021] [Indexed: 01/23/2023] Open
Abstract
Background Mucosal sites are hypothesized to play a role in the development of rheumatoid arthritis (RA). Since serum anti-peptidylarginine deiminase (PAD)4 antibodies, including a subset that cross-react with PAD3 (PAD3/4), are specific for RA and associate with severe disease, we sought to examine whether anti-PAD4 and anti-PAD3/4 antibodies were present in the lung and oral mucosa of subjects with RA and “at-risk” for RA. Methods We included 37 RA, 25 healthy control, and 46 subjects “at-risk” for RA based on familial RA and/or serum anti-citrullinated protein antibody (ACPA) positivity. Paired serum, sputum, and saliva were evaluated for anti-PAD4 and anti-PAD3/4 using immunoprecipitation and ACPA using ELISA. Immunoglobulins (Ig) were purified from representative samples, and their effect on citrullination of histone H3 by recombinant human PAD4 was measured by anti-citH3 immunoblot. Results Anti-PAD4 antibodies were detected in the serum of 6/37 (16.2%), sputum of 3/37 (8.1%), and saliva of 3/33 (9.1%) RA subjects and in the serum and sputum of 1/46 (2.2%) at-risk subjects. None of the healthy controls had anti-PAD4 antibodies at any site. Serum, sputum, and salivary anti-PAD4 antibodies were more prevalent in RA subjects with RA duration >2 years. Purified antibodies from representative anti-PAD4-positive and anti-PAD3/4-positive sputum were primarily of the IgA isotype and able to increase PAD4 enzymatic activity. Conclusions Anti-PAD4 antibodies are present in the sputum and saliva of a portion of RA patients and are infrequent in at-risk subjects. Importantly, the ability of anti-PAD4, and particularly anti-PAD3/4, antibodies in the sputum to enhance PAD4 enzymatic activity suggests that anti-PAD4 may play an active role in the RA lung.
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Affiliation(s)
- M Kristen Demoruelle
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, 1775 Aurora Court, Mail Stop B-115, Aurora, CO, 80045, USA.
| | - Hong Wang
- Division of Rheumatology, The Johns Hopkins University, 5200 Eastern Ave. Suite 5300, Baltimore, MD, 21224, USA
| | - Ryan L Davis
- Division of Rheumatology, The Johns Hopkins University, 5200 Eastern Ave. Suite 5300, Baltimore, MD, 21224, USA
| | - Ashley Visser
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, 1775 Aurora Court, Mail Stop B-115, Aurora, CO, 80045, USA
| | - Johnny Hoang
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, 1775 Aurora Court, Mail Stop B-115, Aurora, CO, 80045, USA
| | | | - V Michael Holers
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, 1775 Aurora Court, Mail Stop B-115, Aurora, CO, 80045, USA
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado Anschutz Medical Campus, 1775 Aurora Court, Mail Stop B-115, Aurora, CO, 80045, USA
| | - Erika Darrah
- Division of Rheumatology, The Johns Hopkins University, 5200 Eastern Ave. Suite 5300, Baltimore, MD, 21224, USA.
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Mangalea MR, Paez-Espino D, Kieft K, Chatterjee A, Chriswell ME, Seifert JA, Feser ML, Demoruelle MK, Sakatos A, Anantharaman K, Deane KD, Kuhn KA, Holers VM, Duerkop BA. Individuals at risk for rheumatoid arthritis harbor differential intestinal bacteriophage communities with distinct metabolic potential. Cell Host Microbe 2021; 29:726-739.e5. [PMID: 33957082 PMCID: PMC8186507 DOI: 10.1016/j.chom.2021.03.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023]
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized in seropositive individuals by the presence of anti-cyclic citrullinated protein (CCP) antibodies. RA is linked to the intestinal microbiota, yet the association of microbes with CCP serology and their contribution to RA is unclear. We describe intestinal phage communities of individuals at risk for developing RA, with or without anti-CCP antibodies, whose first-degree relatives have been diagnosed with RA. We show that at-risk individuals harbor intestinal phage compositions that diverge based on CCP serology, are dominated by Streptococcaceae, Bacteroidaceae, and Lachnospiraceae phages, and may originate from disparate ecosystems. These phages encode unique repertoires of auxiliary metabolic genes, which associate with anti-CCP status, suggesting that these phages directly influence the metabolic and immunomodulatory capability of the microbiota. This work sets the stage for the use of phages as preclinical biomarkers and provides insight into a possible microbial-based causation of RA disease development.
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Affiliation(s)
- Mihnea R Mangalea
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Kristopher Kieft
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Anushila Chatterjee
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Meagan E Chriswell
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Jennifer A Seifert
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Marie L Feser
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Karthik Anantharaman
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Kevin D Deane
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Kristine A Kuhn
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - V Michael Holers
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Breck A Duerkop
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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27
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Falahee M, Simons G, DiSantostefano RL, Valor Méndez L, Radawski C, Englbrecht M, Schölin Bywall K, Tcherny-Lessenot S, Kihlbom U, Hauber B, Veldwijk J, Raza K. Treatment preferences for preventive interventions for rheumatoid arthritis: protocol of a mixed methods case study for the Innovative Medicines Initiative PREFER project. BMJ Open 2021; 11:e045851. [PMID: 36916312 PMCID: PMC8039213 DOI: 10.1136/bmjopen-2020-045851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/09/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Amidst growing consensus that stakeholder decision-making during drug development should be informed by an understanding of patient preferences, the Innovative Medicines Initiative project 'Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle' (PREFER) is developing evidence-based recommendations about how and when patient preferences should be integrated into the drug life cycle. This protocol describes a PREFER clinical case study which compares two preference elicitation methodologies across several populations and provides information about benefit-risk trade-offs by those at risk of rheumatoid arthritis (RA) for preventive interventions. METHODS AND ANALYSIS This mixed methods study will be conducted in three countries (UK, Germany, Romania) to assess preferences of (1) first-degree relatives (FDRs) of patients with RA and (2) members of the public. Focus groups using nominal group techniques (UK) and ranking surveys (Germany and Romania) will identify and rank key treatment attributes. Focus group transcripts will be analysed thematically using the framework method and average rank orders calculated. These results will inform the treatment attributes to be assessed in a survey including a discrete choice experiment (DCE) and a probabilistic threshold technique (PTT). The survey will also include measures of sociodemographic variables, health literacy, numeracy, illness perceptions and beliefs about medicines. The survey will be administered to (1) 400 FDRs of patients with RA (UK); (2) 100 FDRs of patients with RA (Germany); and (3) 1000 members of the public in each of UK, Germany and Romania. Logit-based approaches will be used to analyse the DCE and imputation and interval regression for the PTT. ETHICS AND DISSEMINATION This study has been approved by the London-Hampstead Research Ethics Committee (19/LO/0407) and the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg (92_17 B). The protocol has been approved by the PREFER expert review board. The results will be disseminated widely and will inform the PREFER recommendations.
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Affiliation(s)
- Marie Falahee
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gwenda Simons
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Larissa Valor Méndez
- Department of Internal Medicine and Institute for Clinical Immunology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | | | | | | | | | - Ulrik Kihlbom
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
| | - Brett Hauber
- Health Preference Assessment, RTI Health Solutions, Research Triangle Park, North Carolina, USA
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington School of Pharmacy, Seattle, Washington, USA
| | - Jorien Veldwijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Policy & Management and Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research and Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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28
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Silverman GJ. Could Compensatory Autoantibody Production Affect Rheumatoid Arthritis Etiopathogenesis? Arthritis Rheumatol 2021; 73:728-730. [PMID: 33538128 DOI: 10.1002/art.41673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/28/2021] [Indexed: 11/10/2022]
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Okamato Y, Ghosh T, Okamoto T, Schuyler RP, Seifert J, Charry LL, Visser A, Feser M, Fleischer C, Pedrick C, August J, Moss L, Bemis EA, Norris JM, Kuhn KA, Demoruelle MK, Deane KD, Ghosh D, Holers VM, Hsieh EWY. Subjects at-risk for future development of rheumatoid arthritis demonstrate a PAD4-and TLR-dependent enhanced histone H3 citrullination and proinflammatory cytokine production in CD14 hi monocytes. J Autoimmun 2021; 117:102581. [PMID: 33310262 PMCID: PMC7855988 DOI: 10.1016/j.jaut.2020.102581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
The presence of anti-citrullinated protein/peptide antibodies (ACPA) and epitope spreading across the target autoantigens is a unique feature of rheumatoid arthritis (RA). ACPA are present in the peripheral blood for several years prior to the onset of arthritis and clinical classification of RA. ACPA recognize multiple citrullinated proteins, including histone H3 (H3). Intracellular citrullination of H3 in neutrophils and T cells is known to regulate immune cell function by promoting neutrophil extracellular trap formation and citrullinated autoantigen release as well as regulating the Th2/Th17 T cell phenotypic balance. However, the roles of H3 citrullination in other immune cells are not fully elucidated. We aimed to explore H3 citrullination and cytokine/metabolomic signatures in peripheral blood immune cells from subjects prior to and after the onset of RA, at baseline and in response to ex vivo toll-like receptor (TLR) stimulation. Here, we analyzed 13 ACPA (+) subjects without arthritis but at-risk for future development of RA, 14 early RA patients, and 13 healthy controls. We found significantly elevated H3 citrullination in CD14hi monocytes, as well as CD1c+ dendritic cells and CD66+ granulocytes. Unsupervised analysis identified two distinct subsets in CD14hi monocytes characterized by H3 modification and unique cytokine/metabolomic signatures. CD14hi monocytes with elevated TLR-stimulated H3 citrullination were significantly increased in ACPA (+) at-risk subjects. These cells were skewed to produce TNFα, MIP1β, IFNα, and partially IL-12. Additionally, they demonstrate peptidyl arginine deiminase 4 (PAD4) mediated upregulation of the glycolytic enzyme PFKFB3. These CD14hi monocytes with elevated H3 citrullination morphologically formed monocyte extracellular traps (METs). Taken together, dysregulated PAD4-driven cytokine production as well as MET formation in CD14hi monocytes in ACPA (+) at-risk subjects likely plays an important role in the development of RA via promoting and perpetuating inflammation and generation of citrullinated autoantigens.
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Affiliation(s)
- Yuko Okamato
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA; Tokyo Women's Medical University School of Medicine, Department of Rheumatology, Tokyo, Japan.
| | - Tusharkanti Ghosh
- Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - Tsukasa Okamoto
- University of Colorado Denver, Department of Medicine, Aurora, CO, USA
| | - Ronald P Schuyler
- University of Colorado School of Medicine, Department of Immunology and Microbiology, Aurora, CO, USA
| | - Jennifer Seifert
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Laura Lenis Charry
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Ashley Visser
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Marie Feser
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Chelsie Fleischer
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Chong Pedrick
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Justin August
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Laurakay Moss
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Elizabeth A Bemis
- Colorado School of Public Health, Department of Epidemiology, Aurora, CO, USA
| | - Jill M Norris
- Colorado School of Public Health, Department of Epidemiology, Aurora, CO, USA
| | - Kristine A Kuhn
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | | | - Kevin D Deane
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Debashis Ghosh
- Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO, USA
| | - V Michael Holers
- University of Colorado Denver, Division of Rheumatology, Aurora, CO, USA
| | - Elena W Y Hsieh
- University of Colorado School of Medicine, Department of Immunology and Microbiology, Aurora, CO, USA; University of Colorado School of Medicine, Children's Hospital Colorado, Department of Pediatrics, Section of Allergy & Immunology, Aurora, CO, USA
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Deane KD, Holers VM. Rheumatoid Arthritis Pathogenesis, Prediction, and Prevention: An Emerging Paradigm Shift. Arthritis Rheumatol 2021; 73:181-193. [PMID: 32602263 PMCID: PMC7772259 DOI: 10.1002/art.41417] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022]
Abstract
Rheumatoid arthritis (RA) is currently diagnosed and treated when an individual presents with signs and symptoms of inflammatory arthritis (IA) as well as other features, such as autoantibodies and/or imaging findings, that provide sufficient confidence that the individual has RA-like IA (e.g., meeting established classification criteria) that warrants therapeutic intervention. However, it is now known that there is a stage of seropositive RA during which circulating biomarkers and other factors (e.g., joint symptoms) can be used to predict if and when an individual who does not currently have IA may develop future clinically apparent IA and classifiable RA. Indeed, the discovery of the "pre-RA" stage of seropositive disease has led to the development of several clinical trials in which individuals are studied to identify ways to delay or prevent the onset of clinically apparent IA/RA. This review focuses on several issues pertinent to understanding the prevention of RA. These include discussion of the pathogenesis of pre-RA development, prediction of the likelihood and timing of future classifiable RA, and a review of completed and ongoing clinical trials in RA prevention. Furthermore, this review discusses challenges and opportunities to be addressed to effect a paradigm shift in RA, where in the near future, proactive risk assessment focused on prevention of RA will become a public health strategy in much the same manner as cardiovascular disease is managed today.
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Affiliation(s)
- Kevin D. Deane
- Division of Rheumatology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - V. Michael Holers
- Division of Rheumatology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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31
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Bemis EA, Demoruelle MK, Seifert JA, Polinski KJ, Weisman MH, Buckner JH, Gregersen PK, Mikuls TR, ODell JR, Keating RM, Deane KD, Holers VM, Norris JM. Factors associated with progression to inflammatory arthritis in first-degree relatives of individuals with RA following autoantibody positive screening in a non-clinical setting. Ann Rheum Dis 2021; 80:154-161. [PMID: 32928740 PMCID: PMC7855648 DOI: 10.1136/annrheumdis-2020-217066] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Little is known about the likelihood of developing inflammatory arthritis (IA) in individuals who screen autoantibody positive (aAb+) in a non-clinical research setting. METHODS We screened for serum cyclic citrullinated peptide antibody (anti-CCP) and rheumatoid factor isotype aAbs in subjects who were at increased risk for rheumatoid arthritis (RA) because they are a first-degree relative of an individual with classified RA (n=1780). We evaluated combinations of aAbs and high titre aAbs, as defined by 2-times (2 x) the standard cut-off and an optimal cut-off, as predictors of our two outcomes, aAb+ persistence and incident IA. RESULTS 304 subjects (17.1%) tested aAb+; of those, 131 were IA-free and had at least one follow-up visit. Sixty-four per cent of these tested aAb+ again on their next visit. Anti-CCP+ at levels ≥2 x the standard cut-off was associated with 13-fold higher likelihood of aAb +persistence. During a median of 4.4 years (IQR: 2.2-7.2), 20 subjects (15.3%) developed IA. Among subjects that screened anti-CCP+ at ≥ 2 x or ≥an optimal cut-off, 32% and 26% had developed IA within 5 years, respectively. Both anti-CCP cut-offs conferred an approximate fourfold increased risk of future IA (HR 4.09 and HR 3.95, p<0.01). CONCLUSIONS These findings support that aAb screening in a non-clinical setting can identify RA-related aAb+ individuals, as well as levels and combinations of aAbs that are associated with higher risk for future IA. Monitoring for the development of IA in aAb+ individuals and similar aAb testing approaches in at-risk populations may identify candidates for prevention studies in RA.
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Affiliation(s)
- Elizabeth A Bemis
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Jennifer A Seifert
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Kristen J Polinski
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Michael H Weisman
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jane H Buckner
- Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Peter K Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York, USA
| | - Ted R Mikuls
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Division of Rheumatology, Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - James R ODell
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Division of Rheumatology, Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA
| | - Richard M Keating
- Division of Rheumatology, Scripps Clinic/Scripps Green Hospital, San Diego, California, USA
| | - Kevin D Deane
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - V Michael Holers
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
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Polinski KJ, Bemis EA, Yang F, Crume T, Demoruelle MK, Feser M, Seifert J, O'Dell JR, Mikuls TR, Weisman MH, Gregersen PK, Keating RM, Buckner J, Reisdorph N, Deane KD, Clare-Salzler M, Holers VM, Norris JM. Association of Lipid Mediators With Development of Future Incident Inflammatory Arthritis in an Anti-Citrullinated Protein Antibody-Positive Population. Arthritis Rheumatol 2021; 73:955-962. [PMID: 33381911 DOI: 10.1002/art.41631] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/23/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the association of polyunsaturated fatty acid (PUFA)-derived lipid mediators with progression from rheumatoid arthritis (RA)-related autoimmunity to inflammatory arthritis (IA). METHODS We conducted a prospective cohort study using data from the Studies of the Etiology of Rheumatoid Arthritis (SERA). SERA enrolled first-degree relatives (FDRs) of individuals with RA (FDR cohort) and individuals who screened positive for RA-related autoantibodies at health fairs (screened cohort). We followed up 133 anti-cyclic citrullinated peptide 3.1 (anti-CCP3.1)-positive participants, 29 of whom developed IA. Lipid mediators selected a priori were quantified from stored plasma samples using liquid chromatography tandem mass spectrometry. We fit multivariable Cox proportional hazards models for each lipid mediator as a time-varying variable. For lipid mediators found to be significantly associated with IA, we then examined interleukin-1β (IL-1β), IL-6, IL-8, and tumor necrosis factor (TNF) as potential statistical mediators. RESULTS For every 1 natural log pg/ml increase in the circulating plasma levels of proinflammatory 5-HETE, the risk of developing IA increased by 241% (hazard ratio 2.41 [95% confidence interval 1.43-4.07]) after adjusting for age at baseline, cohort (FDR or screened), and shared epitope status. The models examining 15-HETE and 17-HDHA had the same trend but did not reach significance. We did not find evidence that the association between 5-HETE and IA risk was influenced by the proinflammatory cytokines tested. CONCLUSION In a prospective cohort of anti-CCP-positive individuals, higher levels of 5-HETE, an important precursor to proinflammatory leukotrienes, is associated with subsequent IA. Our findings highlight the potential significance of these PUFA metabolites in pre-RA populations.
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Affiliation(s)
| | | | - Fan Yang
- Colorado School of Public Health, Aurora
| | | | | | - Marie Feser
- University of Colorado School of Medicine, Aurora
| | | | | | | | | | | | | | - Jane Buckner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Nichole Reisdorph
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora
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Polinski KJ, Bemis EA, Feser M, Seifert J, Demoruelle MK, Striebich CC, Brake S, O'Dell JR, Mikuls TR, Weisman MH, Gregersen PK, Keating RM, Buckner J, Nicassio P, Holers VM, Deane KD, Norris JM. Perceived Stress and Inflammatory Arthritis: A Prospective Investigation in the Studies of the Etiologies of Rheumatoid Arthritis Cohort. Arthritis Care Res (Hoboken) 2020; 72:1766-1771. [PMID: 31600025 DOI: 10.1002/acr.24085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/01/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of this study was to determine the association of perceived stress with incident inflammatory arthritis (IA) defined as having at least 1 joint consistent with rheumatoid arthritis (RA)-like synovitis based on examination. METHODS We conducted a prospective cohort study in the Studies of the Etiologies of Rheumatoid Arthritis cohort. Participants without IA were recruited if they were a first-degree relative of an RA proband or screened positive for anti-citrullinated protein antibody. Perceived stress was measured using the Perceived Stress Scale-14 (PSS-14), in which scores can range from 0 to 56, and a higher score indicates greater perceived stress. The total PSS-14 score, as well as 2 subscores indicative of perceived distress and self-efficacy, were averaged across all study visits until development of IA or the last follow-up. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) of IA associated with average PSS-14 scores were obtained using Cox proportional hazards models. RESULTS The mean total PSS-14 score was 20.4. We found that a 1-point increase in the perceived distress score was significantly associated with a 10-percent increase in the risk of IA (adjusted HR 1.10 [95% CI 1.02-1.19]). Total PSS-14 and self-efficacy were not associated with IA risk (adjusted HR 1.05 [95% CI 0.99-1.10] and 1.04 [95% CI 0.91-1.18], respectively). CONCLUSION An association between perceived distress and incident IA was observed in this at-risk cohort. Replication of this finding in other preclinical and at-risk RA populations is needed.
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Affiliation(s)
| | | | - Marie Feser
- University of Colorado School of Medicine, Aurora
| | | | | | | | | | | | | | | | - Peter K Gregersen
- Feinstein Institutes for Medical Research and North Shore-Long Island Jewish Health System, Manhasset, New York
| | | | - Jane Buckner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington
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Chila-Moreno L, Rodríguez LS, Bautista-Molano W, Bello-Gualtero JM, Ramos-Casallas A, Romero-Sánchez C. Anti-carbamylated protein and peptide antibodies as potential inflammatory joint biomarkers in the relatives of rheumatoid arthritis patients. Int J Rheum Dis 2020; 23:1698-1706. [PMID: 33146469 DOI: 10.1111/1756-185x.13977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Antibodies against carbamylated proteins/peptide (CarP) have been associated with severity in rheumatoid arthritis (RA) patients. However, their role in risk groups, specific targets and relation with periodontal disease (PD) is uncertain yet. The aim of this study was evaluated the association between the levels of anti-CarP with clinical manifestation, human leukocyte antigen (HLA) alleles, periodontal activity markers, PD diagnosis, PD severity, and presence of Porphyromonas gingivalis (P gingivalis) in relatives of patients with RA. METHODS One hundred and twenty-four individuals with a family history of RA in first-degree relatives (FDR) and 124 healthy individuals gender- and age-matched, RA activity was assessed. Antibodies against carbamylated protein anti-FCS-Carp and 2 carbamylated peptides of fibrinogen were selected (anti-Ca-Fib2, anti-Ca-Fib3). RESULTS Anti-FCS-Carp-positive, anti-Ca-Fib2 and anti-Ca-Fib3 were more frequent in FDR than controls (25.0% vs 14.5%, 34.7% vs 15.3% and 33.1% vs 11.3%, respectively). Anti-FCS-CarP were associated with the HLA-DRB1-SE* 1402 allele (P = .035) and highly sensitive C-reactive protein levels (P = .016), the anti-Ca-Fib2 antibodies were associated with the HLA-DRB1-SE* 1501 allele (P = .03), with non-SE* 0901 allele (P = .01), the anti-Ca-Fib3 was associated with positive rheumatoid factor (P = .0012). The FDR condition was associated with the presence of anti-Ca-Fib3 (odds ratio [OR] =4.7; 95% CI = 1.8-11.7; P = .001) and painful joints (OR = 2.2; 95% CI = 1.01-4.68; P = .045); we also detected an important trend toward the presence of P gingivalis (OR = 1.9; 95% CI = 0.9-3.7; P = .062). CONCLUSION The presence of anti-FCS-Carp, anti-Ca-Fib3 and anti-Ca-Fib2 antibodies may have a role for these antibodies as early biomarkers in the development of RA, probably including additional mechanisms related with other non-SE alleles; the anti-peptide antibodies proposed in the present study may represent a simpler way to identify antibodies directed to a specific target.
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Affiliation(s)
- Lorena Chila-Moreno
- School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Bogotá, Colombia.,School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Luz-Stella Rodríguez
- Facultad de Medicina, Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Wilson Bautista-Molano
- School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Bogotá, Colombia.,School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Juan-Manuel Bello-Gualtero
- School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada, Bogotá, Colombia.,Rheumatology and Immunology Department, Clinical Immunology Group, Hospital Militar Central, Bogotá, Colombia
| | - Alejandro Ramos-Casallas
- School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Bogotá, Colombia
| | - Consuelo Romero-Sánchez
- School of Dentistry, Cellular and Molecular Immunology Group/INMUBO, Universidad El Bosque, Bogotá, Colombia.,School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada, Bogotá, Colombia.,Rheumatology and Immunology Department, Clinical Immunology Group, Hospital Militar Central, Bogotá, Colombia
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Pérez-Barbosa L, Garza-Elizondo MA, Vega-Morales D, Esquivel-Valerio JA, Peláez-Ballestas I, Vázquez-Fuentes BR, Galarza-Delgado DÁ. High frequency of rheumatic regional pain syndromes in first-degree relatives of patients with rheumatoid arthritis. Clin Rheumatol 2020; 39:3303-3307. [PMID: 32388744 DOI: 10.1007/s10067-020-05029-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/20/2020] [Accepted: 03/05/2020] [Indexed: 01/08/2023]
Abstract
First-degree relatives (FDR) of patients with rheumatoid arthritis (RA) have a higher risk for the development of RA. In the stages prior to the development of arthritis, nonspecific musculoskeletal (MSK) manifestations may occur. The aim of the study is to describe the frequency of rheumatic regional pain syndromes (RRPS) in FDR of RA patients. A cross-sectional study was carried out from July 2016 to September 2018. Parents, offspring, and siblings of RA patients completed the Community Oriented Program in the Rheumatic Diseases (COPCORD) questionnaire. Rheumatoid factor (RF) IgG, IgM, and IgA; anticitrullinated peptide antibodies (ACPAs); C-reactive protein (CRP); and erythrocyte sedimentation rate (ESR) were determined. All subjects with a positive COPCORD (defined by the presence of musculoskeletal pain) were evaluated and classified. Three hundred thirty-five FDRs participated, 75.8% were female, mean age of 44.15 years; 138 (41.2%) were diagnosed with at least one RRPS; 72 (21.5%) had rotator cuff tendinitis, 51 (15.2%) pes anserine bursitis, and 39 (11.6) lateral epicondylitis; RA was diagnosed in 24 (7.16%) subjects, undifferentiated arthritis (UA) in 30 (8.9%) and inflammatory arthralgia (AI) in 104 (31%). We found anti-CCP positivity in 6.8%, RF IgA in 22.3%, RF IgM in 48.6%, and RF IgG in 8.9%. The presence of RRPS was higher in this RA-FDR group compared to general population. Clinical evaluation of this risk group should include screening for RRPS.
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Affiliation(s)
- Lorena Pérez-Barbosa
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Mario Alberto Garza-Elizondo
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico.
| | - David Vega-Morales
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Ingris Peláez-Ballestas
- Rheumatology Unit, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148, Doctores, 06720, México City, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Dionicio Ángel Galarza-Delgado
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
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Wysocki T, Olesińska M, Paradowska-Gorycka A. Current Understanding of an Emerging Role of HLA-DRB1 Gene in Rheumatoid Arthritis-From Research to Clinical Practice. Cells 2020; 9:cells9051127. [PMID: 32370106 PMCID: PMC7291248 DOI: 10.3390/cells9051127] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 12/22/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease with an unclear pathogenic mechanism. However, it has been proven that the key underlying risk factor is a genetic predisposition. Association studies of the HLA-DRB1 gene clearly indicate its importance in RA morbidity. This review presents the current state of knowledge on the impact of HLA-DRB1 gene, functioning both as a component of the patient’s genome and as an environmental risk factor. The impact of known HLA-DRB1 risk variants on the specific structure of the polymorphic HLA-DR molecule, and epitope binding affinity, is presented. The issues of the potential influence of HLA-DRB1 on the occurrence of non-articular disease manifestations and response to treatment are also discussed. A deeper understanding of the role of the HLA-DRB1 gene is essential to explore the complex nature of RA, which is a result of multiple contributing factors, including genetic, epigenetic and environmental factors. It also creates new opportunities to develop modern and personalized forms of therapy.
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Affiliation(s)
- Tomasz Wysocki
- Department of Systemic Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland; or
- Correspondence:
| | - Marzena Olesińska
- Department of Systemic Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland; or
| | - Agnieszka Paradowska-Gorycka
- Department of Molecular Biology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland; or
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Ayyappan P, Harms RZ, Seifert JA, Bemis EA, Feser ML, Deane KD, Demoruelle MK, Mikuls TR, Holers VM, Sarvetnick NE. Heightened Levels of Antimicrobial Response Factors in Patients With Rheumatoid Arthritis. Front Immunol 2020; 11:427. [PMID: 32265916 PMCID: PMC7100537 DOI: 10.3389/fimmu.2020.00427] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/25/2020] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic progressive autoimmune disease leading to considerable disability over time. The disease can be characterized by the presence of multiple autoantibodies in the serum and synovial fluid. Microbial dysbiosis is proposed to play a role in the pathogenesis of RA. Increased systemic bacterial exposure leads to elevated levels of antimicrobial response factors (ARFs) in the circulation. In the present study, we tested whether RA patients have increased levels of ARFs by analyzing the levels of multiple ARFs in serum from RA patients and healthy age and sex-matched controls. The levels of soluble CD14 (sCD14), lysozyme, and CXCL16 were significantly elevated in RA patients compared to healthy controls. Lipopolysaccharide binding protein (LBP) levels remained unchanged in RA patients compared to healthy controls. A positive correlation of LBP with rheumatoid factor (RF) was also found in RA subjects. Interestingly, the levels of anti-endotoxin core antibodies (EndoCAb) IgM, total IgM, EndoCAb IgA, and total IgA were significantly elevated in RA patients compared to healthy controls. No significant changes in the levels of EndoCAb IgG and total IgG were observed in RA patients compared to healthy controls. Furthermore, lysozyme and CXCL16 levels were positively correlated with disease severity among RA subjects. Increases in the levels of several ARFs and their correlations with clinical indices suggest systemic microbial exposure in the RA cohort. Modulation of microbial exposure may play an important role in disease pathogenesis in individuals with RA.
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Affiliation(s)
- Prathapan Ayyappan
- Department of Surgery-Transplant, University of Nebraska Medical Center, Omaha, NE, United States
| | - Robert Z. Harms
- Department of Surgery-Transplant, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jennifer A. Seifert
- Division of Rheumatology, University of Colorado-Denver, Aurora, CO, United States
| | - Elizabeth A. Bemis
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Marie L. Feser
- Division of Rheumatology, University of Colorado-Denver, Aurora, CO, United States
| | - Kevin D. Deane
- Division of Rheumatology, University of Colorado-Denver, Aurora, CO, United States
| | | | - Ted R. Mikuls
- Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
| | - V. Michael Holers
- Division of Rheumatology, University of Colorado-Denver, Aurora, CO, United States
| | - Nora E. Sarvetnick
- Department of Surgery-Transplant, University of Nebraska Medical Center, Omaha, NE, United States
- Mary and Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, United States
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38
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Davis JM, Crowson CS, Knutson KL, Achenbach SJ, Strausbauch MA, Therneau TM, Matteson EL, Gabriel SE, Wettstein PJ. Longitudinal relationships between rheumatoid factor and cytokine expression by immunostimulated peripheral blood lymphocytes from patients with rheumatoid arthritis: New insights into B-cell activation. Clin Immunol 2020; 211:108342. [PMID: 31926330 DOI: 10.1016/j.clim.2020.108342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 01/16/2023]
Abstract
To identify associations between immunostimulated cytokine production and disease characteristics, peripheral blood lymphocytes were collected from 155 adult patients with rheumatoid arthritis (RA) before and after a 5-year interval. The lymphocytes were activated in vitro with T-cell stimulants, cytosine-phosphate-guanine (CpG) oligonucleotide, and medium alone (negative control). Expression of 17 cytokines was evaluated with immunoassays, and factor analysis was used to reduce data complexity and identify cytokine combinations indicative of cell types preferentially activated by each immunostimulant. The findings showed that the highest numbers of correlations were between cytokine levels and rheumatoid factor (RF) positivity and between cytokine levels and disease duration. Scores for cytokines driven by CpG and medium alone were negatively associated with RF positivity and disease duration at baseline but positively associated with both at 5 years. Our findings suggest that RF expression sustained over time increases activation of B cells and monocytes without requirements for T-cell functions.
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Affiliation(s)
- John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America.
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Keith L Knutson
- Department of Immunology, Mayo Clinic, Jacksonville, FL, United States of America
| | - Sara J Achenbach
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Michael A Strausbauch
- Immunochemical Core Laboratory, Mayo Clinic, Rochester, MN, United States of America
| | - Terry M Therneau
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States of America
| | - Sherine E Gabriel
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Peter J Wettstein
- Department of Surgery, Mayo Clinic, Rochester, MN, United States of America
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39
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Rheumatoid arthritis and the mucosal origins hypothesis: protection turns to destruction. Nat Rev Rheumatol 2019; 14:542-557. [PMID: 30111803 DOI: 10.1038/s41584-018-0070-0] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Individuals at high risk of developing seropositive rheumatoid arthritis (RA) can be identified for translational research and disease prevention studies through the presence of highly informative and predictive patterns of RA-related autoantibodies, especially anti-citrullinated protein antibodies (ACPAs), in the serum. In serologically positive individuals without arthritis, designated ACPA positive at risk, the presence of mucosal inflammatory processes associated with the presence of local ACPA production has been demonstrated. In other at-risk populations, local RA-related autoantibody production is present even in the absence of serum autoantibodies. Additionally, a proportion of at-risk individuals exhibit local mucosal ACPA production in the lung, as well as radiographic small-airway disease, sputum hypercellularity and increased neutrophil extracellular trap formation. Other mucosal sites in at-risk individuals also exhibit autoantibody production, inflammation and/or evidence of dysbiosis. As the proportion of individuals who exhibit such localized inflammation-associated ACPA production is substantially higher than the likelihood of an individual developing future RA, this finding raises the hypothesis that mucosal ACPAs have biologically relevant protective roles. Identifying the mechanisms that drive both the generation and loss of externally focused mucosal ACPA production and promote systemic autoantibody expression and ultimately arthritis development should provide insights into new therapeutic approaches to prevent RA.
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40
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Bemis EA, Norris JM, Seifert J, Frazer-Abel A, Okamoto Y, Feser ML, Demoruelle MK, Deane KD, Banda NK, Holers VM. Complement and its environmental determinants in the progression of human rheumatoid arthritis. Mol Immunol 2019; 112:256-265. [PMID: 31207549 PMCID: PMC7712508 DOI: 10.1016/j.molimm.2019.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/26/2019] [Accepted: 05/29/2019] [Indexed: 12/28/2022]
Abstract
Rheumatoid arthritis (RA) is a complex autoimmune disease with an etiology that is not yet well understood, disproportionally affects women and also varies in incidence and prevalence by population. The presence of anti-citrullinated protein antibodies (ACPA) is a highly specific biomarker for the diagnosis of clinically apparent RA. ACPA are also present in the serum for an average of 3-5 years prior to the onset of RA during an asymptomatic period characterized by mucosal inflammation and local ACPA production at these sites. We hypothesized that systemic complement activation products might be generated during the pre-clinical initiation of RA and/or provide a second hit that promotes subsequent arthritis development in the joints. In addition, we evaluated which demographic and genetic features and environmental exposures could influence the complement activation process. We analyzed plasma from healthy subjects, subjects at-risk for the development of RA based on serum ACPA positivity in absence of inflammatory arthritis (IA), and ACPA positive RA subjects by Multiplex Assay and ELISA for eighteen complement system components, factors and activation products belonging to the classical, lectin and alternative pathways. By using regression models, associations between complement proteins and various demographic, genetic, and environmental factors previously found to be associated with RA, including sex, smoking, shared epitope, and oral contraceptive use, were examined. We found no evidence of systemic complement activation in ACPA positive subjects without IA, but in contrast found evidence of systemic involvement of the both classical and alternative pathways during the stage of the disease where classified RA is present, (i.e. during joint inflammation and damage). With regard to the demographic, genetic, and environmental variables, females who reported current or past oral contraceptive use and subjects with current tobacco exposure demonstrated alterations of the alternative pathway of complement. Furthermore, RA subjects with established disease who have a body mass index categorized as obese demonstrated higher levels of C2 compared to RA subjects who are not considered obese. In sum, the complement system may be involved in the pathogenesis of RA, with only localized mucosal effects during the preclinical period in those at-risk for RA but in the joint as well as systemically in those who have developed clinically apparent arthritis.
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Affiliation(s)
- Elizabeth A Bemis
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Jennifer Seifert
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Ashley Frazer-Abel
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Yuko Okamoto
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Marie L Feser
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - M Kristen Demoruelle
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Kevin D Deane
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Nirmal K Banda
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States.
| | - V Michael Holers
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States
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Genetic Risk for Rheumatoid Arthritis is Associated with Increased Striatal Volume in Healthy Young Adults. Sci Rep 2019; 9:10994. [PMID: 31358859 PMCID: PMC6662838 DOI: 10.1038/s41598-019-47505-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/24/2019] [Indexed: 01/11/2023] Open
Abstract
Rheumatoid arthritis (RA), an autoimmune disease, has recently been associated with increased striatal volume and decreased intracranial volume (ICV) in longstanding patients. As inflammation has been shown to precede the clinical diagnosis of RA and it is a known moderator of neuro- and gliogenesis, we were interested in testing whether these brain morphological changes appear before the clinical onset of disease in healthy young adult volunteers, as a function of relative genetic risk for RA. Genetic and structural MRI data were available for 516 healthy non-Hispanic Caucasian university students (275 women, mean age 19.78 ± 1.24 years). Polygenic risk scores were computed for each individual based on a genome-wide association study of RA, so that higher scores indicated higher risk. Striatal volume (sum of caudate, putamen, and nucleus accumbens volumes) and ICV were derived for each individual from high-resolution T1-weighted images. After controlling for sex, age, genetic components of ethnicity, socioeconomic status, and depressive symptoms, we found that higher RA polygenic risk scores were associated with increased striatal volume, but not decreased ICV. Our findings suggest that increased striatal volume may be linked to processes that precede disease onset, such as inflammation, while decreased ICV may relate to disease progression.
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Falahee M, Finckh A, Raza K, Harrison M. Preferences of Patients and At-risk Individuals for Preventive Approaches to Rheumatoid Arthritis. Clin Ther 2019; 41:1346-1354. [PMID: 31196645 DOI: 10.1016/j.clinthera.2019.04.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
Abstract
Effective treatments for rheumatoid arthritis (RA) are available and can lead to remission for some patients, but most patients remain on potentially toxic and expensive medications in the long term. Interest is increasingly turning to the disease phases preceding the development of RA that represent opportunities for preventive interventions. At-risk target populations include individuals with genetic and environmental risk factors, those who have developed systemic autoimmunity, and those who have developed clinically suspect symptoms (eg, arthralgias without synovitis, or an early arthritis). Ongoing prospective studies will inform the development of increasingly accurate predictive tools to identify individuals at risk of developing RA. Furthermore, a range of preventive approaches has been suggested, including lifestyle modification (eg, smoking cessation) and pharmacologic interventions (eg, hydroxychloroquine, methotrexate, abatacept, rituximab) that are currently the subject of randomized controlled trials. As prediction and prevention of RA evolve, it is increasingly likely that individuals at risk (including asymptomatic individuals) may be faced with complex decisions about whether to accept assessment of their risk status or to take a preventive intervention associated with risk of serious adverse events and uncertain benefit. Acceptance of preventive medication in other contexts can be low. For example, <25% of women at high risk of breast cancer are willing to take preventive hormonal treatments. Actual uptake is lower still. Patients' beliefs and preferences predict treatment uptake and adherence. Before the dream of preventing RA can become reality, health care providers need to understand the perspectives of individuals in the target population and to identify barriers and facilitators for this approach. This commentary reviews what is currently known about the perspectives of patients and individuals at risk about predictive and preventive approaches for RA and identifies gaps to be addressed to inform the development of efficient preventive strategies.
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Affiliation(s)
- Marie Falahee
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Axel Finckh
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Karim Raza
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence, MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research, NIHR Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
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Berens HM, Polinski KJ, Mikuls TR, Khatter S, August J, Visser A, Mahler M, Weisman MH, O'Dell JR, Keating RM, Buckner JH, Gregersen PK, Norris JM, Holers VM, Deane KD, Demoruelle MK. Anticyclic Citrullinated Peptide Antibodies 3.1 and Anti-CCP-IgA Are Associated with Increasing Age in Individuals Without Rheumatoid Arthritis. J Rheumatol 2019; 46:1556-1559. [PMID: 30988128 DOI: 10.3899/jrheum.180897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We investigated the association of age and anticyclic citrullinated peptide antibodies (anti-CCP) in subjects without rheumatoid arthritis (RA). METHODS Serum was tested for anti-CCP3.1 (IgG/IgA) in 678 first-degree relatives (FDR) of patients with RA and 330 patients with osteoarthritis (OA). Individual isotypes (anti-CCP-IgA and anti-CCP-IgG) were also tested in all FDR. RESULTS In FDR, increasing age was significantly associated with positivity for anti-CCP3.1 (per year, OR 1.03) and anti-CCP-IgA (per year, OR 1.05) but not anti-CCP-IgG. In FDR and OA subjects, anti-CCP3.1 prevalence was significantly increased after age 50 years. CONCLUSION Increasing age in individuals without RA should be considered in the interpretation of anti-CCP3.1 positivity.
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Affiliation(s)
- Heather M Berens
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Kristen J Polinski
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Ted R Mikuls
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Sonia Khatter
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Justin August
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Ashley Visser
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Michael Mahler
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Michael H Weisman
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - James R O'Dell
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Richard M Keating
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Jane H Buckner
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Peter K Gregersen
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Jill M Norris
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - V Michael Holers
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - Kevin D Deane
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus
| | - M Kristen Demoruelle
- From the Division of Rheumatology, University of Colorado Anschutz Medical Campus, Aurora; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Division of Rheumatology, University of Nebraska Medical Center, Omaha; Division of Rheumatology, Veterans Affairs (VA) Nebraska Western Iowa Health Care System, Omaha, Nebraska; Department of Research, Inova Diagnostics, San Diego; Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Division of Rheumatology, Scripps Green Hospital, La Jolla, California; Department of Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington; Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA. .,H.M. Berens, MD, PhD, Rheumatology Fellow, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.J. Polinski, BS, PhD student, Department of Epidemiology, Colorado School of Public Health; T.R. Mikuls, MD, MSPH, Professor of Medicine, Division of Rheumatology, University of Nebraska Medical Center, and Division of Rheumatology, VA Nebraska Western Iowa Health Care System; S. Khatter, MD, Resident, Division of Rheumatology, University of Colorado Anschutz Medical Campus; J. August, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; A. Visser, BS, Professional Research Assistant, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M. Mahler, PhD, Vice President of Research and Development, Department of Research, Inova Diagnostics; M.H. Weisman, MD, Professor of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center; J.R. O'Dell, MD, Professor and Vice Chair Internal Medicine, Chief of Rheumatology, Division of Rheumatology, University of Nebraska Medical Center; R.M. Keating, MD, Professor of Medicine, Division of Rheumatology, Scripps Green Hospital; J.H. Buckner, MD, President, Department of Immunology, Benaroya Research Institute at Virginia Mason; P.K. Gregersen, MD, Professor of Molecular Medicine, Center for Genomics and Human Genetics, Feinstein Institute for Medical Research; J.M. Norris, PhD, Professor and Chair of Epidemiology, Department of Epidemiology, Colorado School of Public Health; V.M. Holers, MD, Professor of Medicine, Chair of Rheumatology, Division of Rheumatology, University of Colorado Anschutz Medical Campus; K.D. Deane, MD, PhD, Associate Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus; M.K. Demoruelle, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Colorado Anschutz Medical Campus.
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James JA, Chen H, Young KA, Bemis EA, Seifert J, Bourn RL, Deane KD, Demoruelle MK, Feser M, O'Dell JR, Weisman MH, Keating RM, Gaffney PM, Kelly JA, Langefeld CD, Harley JB, Robinson W, Hafler DA, O'Connor KC, Buckner J, Guthridge JM, Norris JM, Holers VM. Latent autoimmunity across disease-specific boundaries in at-risk first-degree relatives of SLE and RA patients. EBioMedicine 2019; 42:76-85. [PMID: 30952617 PMCID: PMC6491794 DOI: 10.1016/j.ebiom.2019.03.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/15/2019] [Accepted: 03/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Autoimmune disease prevention requires tools to assess an individual's risk of developing a specific disease. One tool is disease-associated autoantibodies, which accumulate in an asymptomatic preclinical period. However, patients sometimes exhibit autoantibodies associated with a different disease classification. When and how these alternative autoantibodies first appear remain unknown. This cross-sectional study characterizes alternative autoimmunity, and associated genetic and environmental factors, in unaffected first-degree relatives (FDRs) of patients, who exhibit increased future risk for the same disease. METHODS Samples (n = 1321) from disease-specific autoantibody-positive (aAb+) systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and type 1 diabetes (T1D) patients; and unaffected aAb+ and autoantibody-negative (aAb-) SLE and RA FDRs were tested for SLE, RA, and T1D aAbs, as well as anti-tissue transglutaminase, anti-cardiolipin and anti-thyroperoxidase. FDR SLE and RA genetic risk scores (GRS) were calculated. FINDINGS Alternative autoimmunity occurred in SLE patients (56%) and FDRs (57·4%), RA patients (32·6%) and FDRs (34·8%), and T1D patients (43%). Expanded autoimmunity, defined as autoantibodies spanning at least two other diseases, occurred in 18·5% of SLE patients, 16·4% of SLE FDRs, 7·8% of RA patients, 5·3% of RA FDRs, and 10·8% of T1D patients. SLE FDRs were more likely to have alternative (odds ratio [OR] 2·44) and expanded (OR 3·27) autoimmunity than RA FDRs. Alternative and expanded autoimmunity were associated with several environmental exposures. Alternative autoimmunity was associated with a higher RA GRS in RA FDRs (OR 1·41), and a higher SLE GRS in aAb+ RA FDRs (OR 1·87), but not in SLE FDRs. INTERPRETATION Autoimmunity commonly crosses disease-specific boundaries in systemic (RA, SLE) and organ-specific (T1D) autoimmune diseases. Alternative autoimmunity is more common in SLE FDRs than RA FDRs, and is influenced by genetic and environmental factors. These findings have substantial implications for preclinical disease pathogenesis and autoimmune disease prevention studies. FUND: NIH U01AI101981, R01AR051394, U19AI082714, P30AR053483, P30GM103510, U54GM104938, U01AI101934, R01AI024717, U01AI130830, I01BX001834, & U01HG008666.
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Affiliation(s)
- Judith A James
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA; University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Hua Chen
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | | | | | - Rebecka L Bourn
- Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | | | | | | | | | | | | | | | | | - John B Harley
- Cincinnati Children's Hospital Medical Center, The University of Cincinnati College of Medicine, and Cincinnati US Department of Veterans Affairs VA Medical Center, Cincinnati, OH, USA
| | | | | | | | - Jane Buckner
- Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
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Young KA, Munroe ME, Guthridge JM, Kamen DL, Gilkensen GS, Harley JB, Weisman MH, Karp DR, Wallace DJ, James JA, Norris JM. Screening characteristics for enrichment of individuals at higher risk for transitioning to classified SLE. Lupus 2019; 28:597-606. [PMID: 30845880 DOI: 10.1177/0961203319834675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Further prospective study is needed to elucidate the etiology and natural history of systemic lupus erythematosus development. The clinical complexity of this heterogeneous disease makes study design challenging. Our objective was to ascertain useful screening factors for identifying at-risk individuals for follow-up rheumatologic assessment or inclusion in prospective studies. METHODS We attempted to re-contact 3823 subjects with a family history of systemic lupus erythematosus, who did not meet American College of Rheumatology systemic lupus erythematosus classification at a baseline study visit; 436 agreed to follow-up participation an average of 6.3 years after baseline. In total, 56 of these individuals had transitioned to classified systemic lupus erythematosus (≥ 4 cumulative American College of Rheumatology criteria, verified by medical record review) by the time of follow up. Generalized estimating equations assessed associations between our dichotomous outcome of transitioning to systemic lupus erythematosus with baseline characteristics, including ANA positivity, Connective Tissue Disease Screening questionnaire systemic lupus erythematosus score, and number of American College of Rheumatology criteria. We analyzed predictive accuracy of characteristics on transitioning. RESULTS ANA positivity, Connective Tissue Disease Screening questionnaire systemic lupus erythematosus score categorization of possible or probable systemic lupus erythematosus, and greater number of American College of Rheumatology criteria at baseline were each associated with transitioning to systemic lupus erythematosus classification. Being ANA positive and having confirmed immunologic criteria at baseline had the highest positive predictive value and specificity for transitioning to systemic lupus erythematosus. American College of Rheumatology Connective Tissue Disease Screening questionnaire systemic lupus erythematosus score categorization of possible or probable systemic lupus erythematosus had a better positive predictive value, negative predictive value, sensitivity, and specificity than ANA positivity. CONCLUSION Given limited resources, identifying individuals for follow up based on the systemic lupus erythematosus portion of the Connective Tissue Disease Screening questionnaire could be an efficient way to identify family members at highest risk of disease transition.
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Affiliation(s)
- K A Young
- 1 Department of Epidemiology, Colorado School of Public Health, Aurora, United States of America
| | - M E Munroe
- 2 Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, United States of America
| | - J M Guthridge
- 2 Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, United States of America
| | - D L Kamen
- 3 Division of Rheumatology, Medical University of South Carolina, Charleston, United States of America
| | - G S Gilkensen
- 3 Division of Rheumatology, Medical University of South Carolina, Charleston, United States of America
| | - J B Harley
- 4 Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America.,5 US Department of Veterans Affairs Medical Center, Cincinnati, United States of America
| | - M H Weisman
- 6 Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - D R Karp
- 7 Division of Rheumatic Diseases, University of Texas Southwestern, Dallas, United States of America
| | - D J Wallace
- 6 Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, United States of America
| | - J A James
- 2 Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, United States of America.,8 Departments of Medicine and Pathology, Oklahoma University Health Sciences Center, Oklahoma City, United States of America
| | - J M Norris
- 1 Department of Epidemiology, Colorado School of Public Health, Aurora, United States of America
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Stathopoulos P, Chastre A, Waters P, Irani S, Fichtner ML, Benotti ES, Guthridge JM, Seifert J, Nowak RJ, Buckner JH, Holers VM, James JA, Hafler DA, O'Connor KC. Autoantibodies against Neurologic Antigens in Nonneurologic Autoimmunity. THE JOURNAL OF IMMUNOLOGY 2019; 202:2210-2219. [PMID: 30824481 PMCID: PMC6452031 DOI: 10.4049/jimmunol.1801295] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/01/2019] [Indexed: 12/19/2022]
Abstract
The aim of this study was to test whether autoantibodies against neurologic surface Ags are found in nonneurologic autoimmune diseases, indicating a broader loss of tolerance. Patient and matched healthy donor (HD) sera were derived from four large cohorts: 1) rheumatoid arthritis (RA) (n = 194, HD n = 64), 2) type 1 diabetes (T1D) (n = 200, HD n = 200), 3) systemic lupus erythematosus (SLE) (n = 200, HD n = 67; neuro-SLE n = 49, HD n = 33), and 4) a control cohort of neurologic autoimmunity (relapsing-remitting multiple sclerosis [MS] n = 110, HD n = 110; primary progressive MS n = 9; secondary progressive MS n = 10; neuromyelitis optica spectrum disorders n = 15; and other neurologic disorders n = 26). Screening of 1287 unique serum samples against four neurologic surface Ags (myelin oligodendrocyte glycoprotein, aquaporin 4, acetylcholine receptor, and muscle-specific kinase) was performed with live cell–based immunofluorescence assays using flow cytometry. Positive samples identified in the screening were further validated using autoantibody titer quantification by serial dilutions or radioimmunoassay. Autoantibodies against neurologic surface Ags were not observed in RA and T1D patients, whereas SLE patients harbored such autoantibodies in rare cases (2/200, 1%). Within the CNS autoimmunity control cohort, autoantibodies against aquaporin 4 and high-titer Abs against myelin oligodendrocyte glycoprotein were, as expected, specific for neuromyelitis optica spectrum disorders. We conclude that neurologic autoantibodies do not cross disease barriers in RA and T1D. The finding of mildly increased neurologic autoantibodies in SLE may be consistent with a broader loss of B cell tolerance in this form of systemic autoimmunity.
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Affiliation(s)
- Panos Stathopoulos
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511.,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Anne Chastre
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511.,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Sarosh Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Miriam L Fichtner
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511.,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Erik S Benotti
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511.,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Joel M Guthridge
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104.,Oklahoma Clinical and Translational Science Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Jennifer Seifert
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045; and
| | - Richard J Nowak
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511
| | - Jane H Buckner
- Translational Research Program, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101
| | - V Michael Holers
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045; and
| | - Judith A James
- Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104.,Oklahoma Clinical and Translational Science Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - David A Hafler
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511; .,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
| | - Kevin C O'Connor
- Department of Neurology, Yale School of Medicine, New Haven, CT 06511; .,Department of Immunobiology, Yale School of Medicine, New Haven, CT 06511
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Alpizar-Rodriguez D, Lesker TR, Gronow A, Gilbert B, Raemy E, Lamacchia C, Gabay C, Finckh A, Strowig T. Prevotella copri in individuals at risk for rheumatoid arthritis. Ann Rheum Dis 2019; 78:590-593. [PMID: 30760471 DOI: 10.1136/annrheumdis-2018-214514] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) has been associated with a relative expansion of faecal Prevotellaceae. To determine the microbiome composition and prevalence of Prevotella spp. in a group of individuals at increased risk for RA, but prior to the development of the disease. METHODS In an ongoing cohort study of first-degree relatives (FDRs) of patients with RA, we identified 'FDR controls', asymptomatic and without autoantibodies, and individuals in pre-clinical RA stages, who had either developed anticitrullinated peptide antibodies or rheumatoid factor positivity and/or symptoms and signs associated with possible RA. Stool sampling and culture-independent microbiota analyses were performed followed by descriptive statistics and statistical analyses of community structures. RESULTS A total of 133 participants were included, of which 50 were categorised as 'FDR controls' and 83 in 'pre-clinical RA stages'. The microbiota of individuals in 'pre-clinical RA stages' was significantly altered compared with FDR controls. We found a significant enrichment of the bacterial family Prevotellaceae, particularly Prevotella spp., in the 'pre-clinical RA' group (p=0.04). CONCLUSIONS Prevotella spp. enrichment in individuals in pre-clinical stages of RA, before the onset of RA, suggests a role of intestinal dysbiosis in the development of RA.
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Affiliation(s)
| | - Till Robin Lesker
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Achim Gronow
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Benoît Gilbert
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Elena Raemy
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Celine Lamacchia
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Cem Gabay
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Axel Finckh
- Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Till Strowig
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany .,Hannover Medical School, Hannover, Germany
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Simons G, Stack RJ, Stoffer-Marx M, Englbrecht M, Mosor E, Buckley CD, Kumar K, Hansson M, Hueber A, Stamm T, Falahee M, Raza K. Perceptions of first-degree relatives of patients with rheumatoid arthritis about lifestyle modifications and pharmacological interventions to reduce the risk of rheumatoid arthritis development: a qualitative interview study. BMC Rheumatol 2018; 2:31. [PMID: 30886981 PMCID: PMC6390593 DOI: 10.1186/s41927-018-0038-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/24/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There is increasing interest in the identification of people at risk of rheumatoid arthritis (RA) to monitor the emergence of early symptoms (and thus allow early therapy), offer lifestyle advice to reduce the impact of environmental risk factors and potentially offer preventive pharmacological treatment for those at high risk. Close biological relatives of people with RA are at an increased risk of developing RA and are therefore potential candidates for research studies, screening initiatives and preventive interventions. To ensure the success of approaches of this kind, a greater understanding of the perceptions of this group relating to preventive measures is needed. METHODS Twenty-four first-degree relatives of patients with an existing diagnosis of RA from the UK, three from Germany and seven from Austria (age: 21-67 years) took part in semi-structured interviews exploring their perceptions of RA risk, preventive medicine and lifestyle changes to reduce RA risk. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Many first-degree relatives indicated that they anticipated being happy to make lifestyle changes such as losing weight or changing their diet to modify their risk of developing RA. Participants further indicated that in order to make any lifestyle changes it would be useful to know their personal risk of developing RA. Others implied they would not contemplate making lifestyle changes, including stopping smoking, unless this would significantly reduce or eliminate their risk of developing RA. Many first-degree relatives had more negative perceptions about taking preventive medication to reduce their risk of RA, and listed concerns about potential side effects as one of the reasons for not wanting to take preventive medicines. Others would be more willing to consider drug interventions although some indicated that they would wish to wait until symptoms developed. CONCLUSIONS Information targeted at those considered to be at risk of RA should contain information about RA, the extent to which risk can be quantified at an individual level and how risk levels may differ depending on whether early symptoms are present. The benefits (and risks) of lifestyle changes and pharmacological interventions as potential preventive measures should be clearly described.
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Affiliation(s)
- Gwenda Simons
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Rebecca J Stack
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- Department of Psychology, Nottingham Trent University, 50 Shakespeare St, Nottingham, NG1 4FQ UK
| | - Michaela Stoffer-Marx
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, BT88/E 031090 Vienna, Austria
- University of Applied Sciences FH Campus Wien, Vienna, 1100 Austria
| | - Matthias Englbrecht
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Internistisches Zentrum (INZ), Ulmenweg 18, 91054 Erlangen, Germany
| | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, BT88/E 031090 Vienna, Austria
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christopher D Buckley
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence, MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research and NIHR Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kanta Kumar
- The Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL UK
| | - Mats Hansson
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, SE-751 22 Uppsala, Sweden
| | - Axel Hueber
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Internistisches Zentrum (INZ), Ulmenweg 18, 91054 Erlangen, Germany
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, BT88/E 031090 Vienna, Austria
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marie Falahee
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Karim Raza
- Institute for Inflammation and Aging, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
- Arthritis Research UK Rheumatoid Arthritis Pathogenesis Centre of Excellence, MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research and NIHR Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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49
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Hughes-Austin JM, Deane KD, Giles JT, Derber LA, Zerbe GO, Dabelea DM, Sokolove J, Robinson WH, Holers VM, Norris JM. Plasma adiponectin levels are associated with circulating inflammatory cytokines in autoantibody positive first-degree relatives of rheumatoid arthritis patients. PLoS One 2018; 13:e0199578. [PMID: 29940013 PMCID: PMC6016921 DOI: 10.1371/journal.pone.0199578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/08/2018] [Indexed: 11/19/2022] Open
Abstract
Background Extra-articular manifestations of rheumatoid arthritis (RA), potentially due to systemic inflammation, include cardiovascular disease and sarcopenic obesity. Adiponectin, an adipose-derived cytokine, has been implicated in inflammatory processes in RA, but little is known regarding its association with inflammation in a pre-clinical period. Therefore, we investigated whether adiponectin was associated with inflammatory markers in individuals at risk for RA, and whether RA-related autoimmunity modifies these associations. Methods We analyzed samples from 144 first-degree relatives (FDRs) of RA probands, of whom 23 were positive for anti-cyclic citrullinated peptide antibody and/or ≥ 2 rheumatoid factor isotypes (IgM, IgG or IgA). We called this phenotype the ‘high risk autoantibody profile (HRP)’ as it has been shown in prior work to be >96% specific for future RA. We measured adiponectin, cytokines, and high-sensitivity C-reactive protein (hsCRP). Using linear mixed effects models, we evaluated interaction between HRP positivity and adiponectin on inflammatory markers, adjusting for age, sex, ethnicity, body mass index, pack-years smoking, and use of cholesterol-lowering medications. Results In everyone, adiponectin concentration was inversely associated with hsCRP and IL-1β in adjusted models, where a 1% higher adiponectin was associated with a 26% lower hsCRP (p = 0.04) and a 26% lower IL-1β (p = 0.04). Significant interactions between HRP and adiponectin for associations with GM-CSF, IL-6, and IL-9 were detected in fully adjusted models (p = 0.0006, p = 0.006, p = 0.01, respectively). In HRP positive FDRs but not HRP negative FDRs, a 1% higher adiponectin was associated with 97% higher GM-CSF, 73% higher IL-6, and 54% higher IL-9 concentrations. Conclusions Adiponectin associates with inflammatory markers, and these associations differ in individuals with a high-risk autoantibody profile compared with those without. The interaction between adiponectin and autoimmunity warrants further investigation into the potential systemic effects of RA-related autoantibodies and adiponectin on inflammation in the absence of clinically apparent RA.
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Affiliation(s)
- Jan M. Hughes-Austin
- Department of Orthopaedic Surgery, School of Medicine, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Kevin D. Deane
- Department of Rheumatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Jon T. Giles
- Division of Rheumatology, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Lezlie A. Derber
- Department of Rheumatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Gary O. Zerbe
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Dana M. Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Jeremy Sokolove
- VA Palo Alto Health Care System, Palo Alto, California and the Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, United States of America
| | - William H. Robinson
- VA Palo Alto Health Care System, Palo Alto, California and the Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, United States of America
| | - V. Michael Holers
- Department of Rheumatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Jill M. Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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50
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van Beers-Tas MH, Ter Wee MM, van Tuyl LH, Maat B, Hoogland W, Hensvold AH, Catrina AI, Mosor E, Stamm TA, Finckh A, Courvoisier DS, Filer A, Sahbudin I, Stack RJ, Raza K, van Schaardenburg D. Initial validation and results of the Symptoms in Persons At Risk of Rheumatoid Arthritis (SPARRA) questionnaire: a EULAR project. RMD Open 2018; 4:e000641. [PMID: 29862044 PMCID: PMC5976102 DOI: 10.1136/rmdopen-2017-000641] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 04/06/2018] [Accepted: 04/11/2018] [Indexed: 11/04/2022] Open
Abstract
Objectives To describe the development and assess the psychometric properties of the novel 'Symptoms in Persons At Risk of Rheumatoid Arthritis' (SPARRA) questionnaire in individuals at risk of rheumatoid arthritis (RA) and to quantify their symptoms. Methods The questionnaire items were derived from a qualitative study in patients with seropositive arthralgia. The questionnaire was administered to 219 individuals at risk of RA on the basis of symptoms or autoantibody positivity: 74% rheumatoid factor and/or anticitrullinated protein antibodies positive, 26% seronegative. Validity, reliability and responsiveness were assessed. Eighteen first degree relatives (FDR) of patients with RA were used for comparison. Results Face and content validity were high. The test-retest showed good agreement and reliability (1 week and 6 months). Overall, construct validity was low to moderate, with higher values for concurrent validity, suggesting that some questions reflect symptom content not captured with regular Visual Analogue Scale pain/well-being. Responsiveness was low (small subgroup). Finally, the burden of symptoms in both seronegative and seropositive at risk individuals was high, with pain, stiffness and fatigue being the most common ones with a major impact on daily functioning. The FDR cohort (mostly healthy individuals) showed a lower burden of symptoms; however, the distribution of symptoms was similar. Conclusions The SPARRA questionnaire has good psychometric properties and can add information to currently available clinical measures in individuals at risk of RA. The studied group had a high burden and impact of symptoms. Future studies should evaluate whether SPARRA data can improve the prediction of RA in at risk individuals.
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Affiliation(s)
- Marian H van Beers-Tas
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Marieke M Ter Wee
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Lilian H van Tuyl
- Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Bertha Maat
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | - Wijnanda Hoogland
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | | | - Erika Mosor
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Axel Finckh
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland.,Department of Medical Specialties, University of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland.,Department of Medical Specialties, University of Geneva, Geneva, Switzerland
| | - Andrew Filer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ilfita Sahbudin
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Rebecca J Stack
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Karim Raza
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center, Amsterdam Medical Center, Amsterdam, The Netherlands
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