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Shokrani A, Shokrani H, Munir MT, Kucinska-Lipka J, Yazdi MK, Saeb MR. Monitoring osteoarthritis: A simple mathematical model. BIOMEDICAL ENGINEERING ADVANCES 2022. [DOI: 10.1016/j.bea.2022.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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2
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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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Horta-Baas G, Sandoval-Cabrera A, Romero-Figueroa MDS. Modification of Gut Microbiota in Inflammatory Arthritis: Highlights and Future Challenges. Curr Rheumatol Rep 2021; 23:67. [PMID: 34218340 DOI: 10.1007/s11926-021-01031-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This Review evaluates the available information on the modification of the microbiota by diet, prebiotics, probiotics, or drugs and its association with the severity of arthritis in animals and humans and highlights how this modulation could have therapeutic applications in RA. RECENT FINDINGS The gut microbiota and microbiota-derived metabolites play a role in developing rheumatoid arthritis (RA) in animals and humans, making the intestinal microbiota an exciting novel approach to suppress autoimmunity. Studies in animal models of RA show that it is possible to modify the intestinal microbiota with drugs, natural products, diet, probiotics, and prebiotics. Furthermore, these changes showed beneficial effects on symptom relief in animal models of RA and that these effects were associated with modulation of the immune response. Therapies that modify the gut microbiota would significantly impact the preclinical stage of arthritis, based on the fact that dysbiosis occurs before clinical arthritis. The effects of interventions to modulate the microbiota could not reverse arthritis. Furthermore, the therapies modulating therapies in controlling symptoms were limited once arthritis developed. The results obtained in the study of acarbose, probiotics, and prebiotics suggest that these interventions may decrease the disease's incidence rather than treat or cure it.
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Affiliation(s)
- Gabriel Horta-Baas
- Servicio de Reumatología, Hospital General Regional número 1, Delegación Yucatán, Instituto Mexicano del Seguro Social, Calle 41 No. 439 x 34. Colonia Industrial, 97150, Mérida, Yucatán, Mexico.
| | - Antonio Sandoval-Cabrera
- Laboratorio de alta especialidad en Hemato-Oncología, Hospital para el Niño, IMIEM, Toluca, Mexico.,Facultad de Medicina, Campus Universitario Siglo XXl, Zinacantepec, State of Mexico, Mexico
| | - María Del Socorro Romero-Figueroa
- Facultad de Medicina, Campus Universitario Siglo XXl, Zinacantepec, State of Mexico, Mexico.,Centro de Investigación en Ciencias de la Salud, Campus Norte Huixquilucan, Universidad Anáhuac México, Mexico City, Mexico
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Zou M, Jiang D, Wu T, Zhang X, Zhao Y, Wu D, Sun W, Cui J, Moreland L, Li G. Post-GWAS functional studies reveal an RA-associated CD40-induced NF-kB signal transduction and transcriptional regulation network targeted by class II HDAC inhibitors. Hum Mol Genet 2021; 30:823-835. [PMID: 33517445 PMCID: PMC8161515 DOI: 10.1093/hmg/ddab032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 01/17/2023] Open
Abstract
Currently, it remains difficult to identify which single nucleotide polymorphisms (SNPs) identified by genome-wide association studies (GWAS) are functional and how various functional SNPs (fSNPs) interact and contribute to disease susceptibility. GWAS have identified a CD40 locus that is associated with rheumatoid arthritis (RA). We previously used two techniques developed in our laboratory, single nucleotide polymorphism-next-generation sequencing (SNP-seq) and flanking restriction enhanced DNA pulldown-mass spectrometry (FREP-MS), to determine that the RA risk gene RBPJ regulates CD40 expression via a fSNP at the RA-associated CD40 locus. In the present work, by applying the same approach, we report the identification of six proteins that regulate RBPJ expression via binding to two fSNPs on the RA-associated RBPJ locus. Using these findings, together with the published data, we constructed an RA-associated signal transduction and transcriptional regulation network (STTRN) that functionally connects multiple RA-associated risk genes via transcriptional regulation networks (TRNs) linked by CD40-induced nuclear factor kappa B (NF-kB) signaling. Remarkably, this STTRN provides insight into the potential mechanism of action for the histone deacetylase inhibitor givinostat, an approved therapy for systemic juvenile idiopathic arthritis. Thus, the generation of disease-associated STTRNs based on post-GWAS functional studies is demonstrated as a novel and effective approach to apply GWAS for mechanistic studies and target identification.
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Affiliation(s)
- Meijuan Zou
- Aging Institute, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Pharmacology, Nanjing Medical University, Nanjing 211166, China
| | - Danli Jiang
- Aging Institute, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Ting Wu
- Aging Institute, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Medicine, Xiangya School of Medicine, Central South University, Changsha 410083, China
| | - Xiaoyu Zhang
- Aging Institute, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Yihan Zhao
- Aging Institute, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Di Wu
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Wei Sun
- Department of Medicine, Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Jing Cui
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Larry Moreland
- Department of Medicine, Division of Rheumatology, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Gang Li
- Aging Institute, University of Pittsburgh, Pittsburgh, PA 15219, USA
- Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
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Berberine Delays Onset of Collagen-Induced Arthritis through T Cell Suppression. Int J Mol Sci 2021; 22:ijms22073522. [PMID: 33805383 PMCID: PMC8037694 DOI: 10.3390/ijms22073522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
There is evidence that berberine (BBR), a clinically relevant plant compound, ameliorates clinically apparent collagen-induced arthritis (CIA) in vivo. However, to date, there are no studies involving the use of BBR which explore its prophylactic potential in this model of rheumatoid arthritis (RA). The aim of this study was to determine if prophylactic BBR use during the preclinical phase of collagen-induced arthritis would delay arthritic symptom onset, and to characterize the cellular mechanism underlying such an effect. DBA/1J mice were injected with an emulsion of bovine type II collagen (CII) and complete Freund’s adjuvant (day 0) and a booster injection of CII in incomplete Freund’s adjuvant (day 18) to induce arthritis. Mice were then given i.p. injections of 1 mg/kg/day of BBR or PBS (vehicle with 0.01% DMSO) from days 0 to 28, were left untreated (CIA control), or were in a non-arthritic control group (n = 15 per group). Incidence of arthritis in BBR-treated mice was 50%, compared to 90% in both the CIA and PBS controls. Populations of B and T cells from the spleens and draining lymph nodes of mice were examined on day 14 (n = 5 per group) and day 28 (n = 10 per group). BBR-treated mice had significantly reduced populations of CD4+Th and CD4+CXCR5+ Tfh cells, and an increased proportion of Foxp3+ Treg at days 14 and 28, as well as reduced expression of co-stimulatory molecules CD28 and CD154 at both endpoints. The effect seen on T cell populations and co-stimulatory molecule expression in BBR-treated mice was not mirrored in CD19+ B cells. Additionally, BBR-treated mice experienced reduced anti-CII IgG2a and anti-CII total IgG serum concentrations. These results indicate a potential role for BBR as a prophylactic supplement for RA, and that its effect may be mediated specifically through T cell suppression. However, the cellular effector involved raises concern for BBR prophylactic use in the context of vaccine efficacy and other primary adaptive immune responses.
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Perez-Chada LM, Haberman RH, Chandran V, Rosen CF, Ritchlin C, Eder L, Mease P, Reddy S, Ogdie A, Merola JF, Scher JU. Consensus terminology for preclinical phases of psoriatic arthritis for use in research studies: results from a Delphi consensus study. Nat Rev Rheumatol 2021; 17:238-243. [PMID: 33589818 PMCID: PMC7997804 DOI: 10.1038/s41584-021-00578-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/21/2022]
Abstract
The concept of psoriatic arthritis (PsA) prevention is gaining increased interest owing to the physical limitation, poor quality of life and low remission rates that are achieved with current therapies for PsA. The psoriasis-to-PsA transition offers a unique opportunity to identify individuals at increased risk of developing PsA and to implement preventive strategies. However, identifying individuals at increased risk of developing PsA is challenging as there is no consensus on how this population should be defined. This Consensus Statement puts forward recommended terminology from the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN) for defining specific subgroups of individuals during the preclinical and early clinical phases of PsA to be used in research studies. Following a three-round Delphi process, consensus was reached for three terms and definitions: 'increased risk for PsA', 'psoriasis with asymptomatic synovio-entheseal imaging abnormalities' and 'psoriasis with musculoskeletal symptoms not explained by other diagnosis'. These terms and their definitions will enable improved identification and standardization of study populations in clinical research. In the future, as increasing evidence emerges regarding the molecular and clinical features of the psoriasis-to-PsA continuum, these terms and definitions will be further refined and updated.
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Affiliation(s)
- Lourdes M Perez-Chada
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rebecca H Haberman
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Vinod Chandran
- Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, ON, Canada.,Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Cheryl F Rosen
- Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Christopher Ritchlin
- Allergy, Immunology, and Rheumatology Division, University of Rochester Medical School, Rochester, NY, USA
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Philip Mease
- Seattle Rheumatology Associates, Swedish Medical Center and Providence St, Joseph Health, Seattle, WA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Soumya Reddy
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA
| | - Alexis Ogdie
- Department of Medicine, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph F Merola
- Department of Dermatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Medicine, Division of Rheumatology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology, New York University Langone Health, New York, NY, USA.
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7
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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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8
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Min HK, Kim KW, Lee SH, Kim HR. Roles of mast cells in rheumatoid arthritis. Korean J Intern Med 2020; 35:12-24. [PMID: 31722515 PMCID: PMC6960056 DOI: 10.3904/kjim.2019.271] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory arthritis, and the complex interaction and activation of innate and adaptive immune cells are involved in RA pathogenesis. Mast cells (MCs) are one of the tissue-resident innate immune cells, and they contribute to RA pathogenesis. In the present review, the evidence of the pathologic role of MC in RA is discussed based on human and animal data. In addition, the potential role of MC in RA pathogenesis and the research area that should be focused on in the future are suggested.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Kyoung-Woon Kim
- Conversant Research Consortium in Immunologic Disease, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
- Correspondence to Hae-Rim Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: +82-2-2030-7542, Fax: +82-2-2030-7728, E-mail:
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9
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Kelmenson LB, Wagner BD, McNair BK, Frazer-Abel A, Demoruelle MK, Bergstedt DT, Feser ML, Moss LK, Parish MC, Mewshaw EA, Mikuls TR, Edison JD, Holers VM, Deane KD. Timing of Elevations of Autoantibody Isotypes Prior to Diagnosis of Rheumatoid Arthritis. Arthritis Rheumatol 2019; 72:251-261. [PMID: 31464042 DOI: 10.1002/art.41091] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/22/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate patterns of elevations of isotypes of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs) pre-rheumatoid arthritis (RA) diagnosis and post-RA diagnosis. METHODS Using the Department of Defense Serum Repository we identified 214 RA cases and 210 matched controls. Up to 3 pre-RA diagnosis and 1 post-RA diagnosis serum samples per subject were tested for RF and for IgA, IgG, and IgM ACPAs. The timing and trajectories of elevations of autoantibodies were evaluated. RESULTS Autoantibody levels were elevated in cases versus controls a mean of 17.9 years before RA diagnosis for IgG ACPA, 14.2 years for IgA-RF, 7.2 years for IgM-RF, 6.2 years for IgA ACPA, and 5.0 years for both IgM ACPA and IgG-RF (P < 0.01 for all comparisons). There were similar relationships for positive or negative autoantibody status, with cases first showing positivity for IgG ACPA 1.9 years pre-RA and for IgA-RF 1.7 years pre-RA, followed by the other isotypes. Only IgA ACPA positivity was significantly increased in post-RA diagnosis samples (19% 0-2 years pre-RA versus 39% >2 years post-RA diagnosis; P = 0.04). All autoantibody levels demonstrated an early initial elevation, a period of stability, then an increase immediately before RA diagnosis. A pre-RA endotype of early elevation of autoantibodies was associated with increased use of biologic therapy, and a higher prevalence of sicca symptoms and lung disease post-RA diagnosis. CONCLUSION Differences in patterns of elevations of autoantibody isotypes have implications for understanding the pathophysiology of RA development. These include understanding what factors drive initial autoantibody elevations compared to what factors (including mucosal) drive later increases in autoantibody levels and a transition to clinically apparent RA, and how pre-RA endotypes may influence post-RA diagnosis phenotypes.
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Affiliation(s)
| | | | | | | | | | | | - Marie L Feser
- University of Colorado Denver Anschutz Medical Campus
| | - Laura K Moss
- University of Colorado Denver Anschutz Medical Campus
| | - Mark C Parish
- University of Colorado Denver Anschutz Medical Campus
| | | | | | - Jess D Edison
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Kevin D Deane
- University of Colorado Denver Anschutz Medical Campus
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10
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Rantapää Dahlqvist S, Andrade F. Individuals at risk of seropositive rheumatoid arthritis: the evolving story. J Intern Med 2019; 286:627-643. [PMID: 31562671 PMCID: PMC6878216 DOI: 10.1111/joim.12980] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aetiology of the autoimmune disease rheumatoid arthritis (RA) involves a complex interplay between genetic and environmental factors that initiate many years before the onset of clinical symptoms. These interactions likely include both protective and susceptibility factors which together determine the risk of developing RA. More than 100 susceptibility loci have been linked to RA. The strongest association is with HLA-DRB1 alleles encoding antigen presenting molecules containing a unique sequence in the peptide-binding grove called the 'shared epitope'. Female sex, infections during childhood, lifestyle habits (e.g. smoking and diet) and distinct microbial agents, amongst many others, are interacting risk factors thought to contribute to RA pathogenesis by dysregulating the immune system in individuals with genetic susceptibility. Interestingly, patients with RA develop autoantibodies many years before the clinical onset of disease, providing strong evidence that the lack of tolerance to arthritogenic antigens is amongst the earliest events in the initiation of seropositive RA. Here, we will discuss the clinical and mechanistic evidence surrounding the role of different environmental and genetic factors in the phases leading to the production of autoantibodies and the initiation of symptomatic RA. Understanding this complexity is critical in order to develop tools to identify drivers of disease initiation and propagation and to develop preventive therapeutics.
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Affiliation(s)
- S Rantapää Dahlqvist
- Institution of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - F Andrade
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Neagu MR, Weinreich MA, Doan TT, Hendrickson BA. Monitoring Drug Safety in Rheumatoid Arthritis Prevention Trials. Clin Ther 2019; 41:1366-1375. [DOI: 10.1016/j.clinthera.2019.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/08/2019] [Accepted: 04/09/2019] [Indexed: 12/18/2022]
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12
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Sharma L, Kwoh K, Lee JJ, Cauley J, Jackson R, Hochberg M, Chang AH, Eaton C, Nevitt M, Song J, Almagor O, Chmiel JS. Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis. Ann Rheum Dis 2019; 78:1412-1419. [PMID: 31243017 DOI: 10.1136/annrheumdis-2019-215353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. METHODS Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. RESULTS 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11%, varying 0%-29 % (derivation) and 2%-23 % (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95% CI 0.72 to 0.78 (derivation); 0.72, 95% CI 0.68 to 0.76 (validation)). CONCLUSIONS In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.
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Affiliation(s)
- Leena Sharma
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kent Kwoh
- University of Arizona, Tucson, Arizona, USA
| | - Jungwha Julia Lee
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane Cauley
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Marc Hochberg
- University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Alison H Chang
- Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles Eaton
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Michael Nevitt
- University of California San Francisco, San Francisco, California, USA
| | - Jing Song
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Orit Almagor
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joan S Chmiel
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Deane KD, Cheung TT. Rheumatoid Arthritis Prevention: Challenges and Opportunities to Change the Paradigm of Disease Management. Clin Ther 2019; 41:1235-1239. [PMID: 31196651 DOI: 10.1016/j.clinthera.2019.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Kevin D Deane
- Division of Rheumatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
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14
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Deane KD, Holers VM. The Natural History of Rheumatoid Arthritis. Clin Ther 2019; 41:1256-1269. [PMID: 31196652 DOI: 10.1016/j.clinthera.2019.04.028] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE This article reviews the phases of rheumatoid arthritis (RA) development in terms of the evolution of disease, with a focus on events that occur before the first appearance of clinically apparent inflammatory arthritis. This presynovitis period is defined in individuals who eventually develop classified RA as the pre-RA phase. We include additional discussion of the relevance of this model of RA development to the concept of disease prevention. METHODS The information provided in this review was identified through searches of the medical literature through MEDLINE and a review of references from published manuscripts as well as information obtained by the authors through attendance at various conferences and working groups related to pre-RA. FINDINGS It is now well established that RA develops in a series of phases. The first of these phases is believed to be the presence of genetic and/or environmental risk factors for RA in the absence of detectable systemic autoimmunity in the blood. After this phase, autoimmunity may be detectable through a variety of means (eg, autoantibodies, autoreactive cells) in peripheral blood; in addition, there is emerging evidence that perhaps initiation and early propagation of RA-related autoimmunity may occur at mucosal sites. The presence of autoimmunity detectable in the blood through serologic or other testing is followed in most individuals by a propagation phase that is characterized by an expansion of autoimmunity, inflammation, and symptoms. This transition may be associated with similar or different genetic and environmental factors that initially triggered autoimmunity, as well as continued mucosal inflammation and local RA-related autoantibody production. Eventually, clinically detectable inflammatory arthritis develops that can be classified as RA. IMPLICATIONS Understanding the phases of RA development are critical to the development of preventive strategies for this disease.
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Affiliation(s)
- Kevin D Deane
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
| | - V Michael Holers
- Division of Rheumatology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
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15
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Rheumatoid Arthritis. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fritzler MJ, Martinez-Prat L, Choi MY, Mahler M. The Utilization of Autoantibodies in Approaches to Precision Health. Front Immunol 2018; 9:2682. [PMID: 30505311 PMCID: PMC6250829 DOI: 10.3389/fimmu.2018.02682] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/30/2018] [Indexed: 12/12/2022] Open
Abstract
Precision health (PH) applied to autoimmune disease will need paradigm shifts in the use and application of autoantibodies and other biomarkers. For example, autoantibodies combined with other multi-analyte “omic” profiles will form the basis of disease prediction allowing for earlier intervention linked to disease prevention strategies, as well as earlier, effective and personalized interventions for established disease. As medical intervention moves to disease prediction and a model of “intent to PREVENT,” diagnostics will include an early symptom/risk-based, as opposed to a disease-based approach. Newer diagnostic platforms that utilize emerging megatrends such as deep learning and artificial intelligence and close the gaps in autoantibody diagnostics will benefit from paradigm shifts thereby facilitating the PH agenda.
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Affiliation(s)
- Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - May Y Choi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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17
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Abstract
IMPORTANCE Rheumatoid arthritis (RA) occurs in about 5 per 1000 people and can lead to severe joint damage and disability. Significant progress has been made over the past 2 decades regarding understanding of disease pathophysiology, optimal outcome measures, and effective treatment strategies, including the recognition of the importance of diagnosing and treating RA early. OBSERVATIONS Early diagnosis and treatment of RA can avert or substantially slow progression of joint damage in up to 90% of patients, thereby preventing irreversible disability. The development of novel instruments to measure disease activity and identify the presence or absence of remission have facilitated new treatment strategies to arrest RA before joints are damaged irreversibly. Outcomes have been improved by recognizing the benefits of early diagnosis and early therapy with disease-modifying antirheumatic drugs (DMARDs). The treatment target is remission or a state of at least low disease activity, which should be attained within 6 months. Methotrexate is first-line therapy and should be prescribed at an optimal dose of 25 mg weekly and in combination with glucocorticoids; 40% to 50% of patients reach remission or at least low disease activity with this regimen. If this treatment fails, sequential application of targeted therapies, such as biologic agents (eg, tumor necrosis factor [TNF] inhibitors) or Janus kinase inhibitors in combination with methotrexate, have allowed up to 75% of these patients to reach the treatment target over time. New therapies have been developed in response to new pathogenetic findings. The costs of some therapies are considerable, but these costs are decreasing with the advent of biosimilar drugs (drugs essentially identical to the original biologic drugs but usually available at lower cost). CONCLUSIONS AND RELEVANCE Scientific advances have improved therapies that prevent progression of irreversible joint damage in up to 90% of patients with RA. Early treatment with methotrexate plus glucocorticoids and subsequently with other DMARDs, such as inhibitors of TNF, IL-6, or Janus kinases, improves outcomes and prevents RA-related disability. A treat-to-target strategy aimed at reducing disease activity by at least 50% within 3 months and achieving remission or low disease activity within 6 months, with sequential drug treatment if needed, can prevent RA-related disability.
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Affiliation(s)
- Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
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18
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Verheul MK, Böhringer S, van Delft MAM, Jones JD, Rigby WFC, Gan RW, Holers VM, Edison JD, Deane KD, Janssen KMJ, Westra J, Brink M, Rantapää-Dahlqvist S, Huizinga TWJ, van der Helm-van Mil AHM, van der Woude D, Toes REM, Trouw LA. Triple Positivity for Anti-Citrullinated Protein Autoantibodies, Rheumatoid Factor, and Anti-Carbamylated Protein Antibodies Conferring High Specificity for Rheumatoid Arthritis: Implications for Very Early Identification of At-Risk Individuals. Arthritis Rheumatol 2018; 70:1721-1731. [PMID: 29781231 DOI: 10.1002/art.40562] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/15/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In rheumatoid arthritis (RA), anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF) are commonly used to aid in the diagnosis. Although these autoantibodies are mainly found in RA, their specificity is not optimal. It is therefore difficult to identify RA patients, especially in very early disease, based on the presence of ACPAs and RF alone. In addition, anti-carbamylated protein (anti-CarP) antibodies have diagnostic and prognostic value, since their presence is associated with joint damage in RA patients and also associated with the future development of RA in patients with arthralgia. Therefore, the aim of the present study was to investigate the value of combined antibody testing in relation to prediction and diagnosis of (early) RA. METHODS A literature search resulted in identification of 12 relevant studies, consisting of RA patients, pre-RA individuals, disease controls, healthy first-degree relatives of RA patients, and healthy control subjects, in which data on RF, ACPAs, and anti-CarP antibody status were available. Using these data, random effects meta-analyses were carried out for several antibody combinations. RESULTS The individual antibodies were highly prevalent in patients with RA (34-80%) compared to the control groups, but were also present in non-RA controls (0-23%). For the classification of most subjects correctly as having RA or as a non-RA control, the combination of ACPAs and/or RF often performed well (specificity 65-100%, sensitivity 59-88%). However, triple positivity for ACPAs, RF, and anti-CarP antibodies resulted in a higher specificity for RA (98-100%), accompanied by a lower sensitivity (11-39%). CONCLUSION As the rheumatology field is moving toward very early identification of RA and possible screening for individuals at maximum risk of RA in populations with a low pretest probability, an autoantibody profile of triple positivity for ACPAs, RF, and anti-CarP provides interesting information that might help identify individuals at risk of developing RA.
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Affiliation(s)
| | | | | | | | | | - Ryan W Gan
- Colorado School of Public Health, Aurora
| | | | - Jess D Edison
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Koen M J Janssen
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna Westra
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | | | | | - Rene E M Toes
- Leiden University Medical Center, Leiden, The Netherlands
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19
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Abstract
Rheumatoid arthritis (RA) is a chronic immunoinflammatory (autoimmune) disease manifested by progressive joint destruction, systemic inflammation of the internal organs, and a wide range of comorbidities associated with chronic inflammation and frequently with adverse drug reactions. However, despite the major advances in the early diagnosis and treatment of RA, which have led to the radical improvement of prognosis in many patients, the problem of pharmacotherapy for RA is far from being solved. This is determined by a lack of sensitive and specific diagnostic and prognostic biomarkers in the early stage of the disease and, most importantly, by the heterogeneity of immunopathogenesis mechanisms in both at the onset of RA and during its progression, which make the personalization of therapy difficult in the patients. Selective block of inflammatory mediators with innovative medicines is frequently associated with primary inefficiency, secondary drug resistance, the development of generalized immunosuppression, the paradoxical activation of an autoimmune process, and the aggravation of comorbidities. At the same time, it is difficult to search for new RA pharmacotherapy targets since the nature of immunopathological disorders in patients can be substantially different from the inflammatory process that takes place when simulating arthritis in laboratory animals. The paper discusses the novel drugs that are used in rheumatology to treat RA or tested in different phases of preclinical or clinical trials, such as tumor necrosis factor-α inhibitors, interleukin-6 (IL-6), IL-17, anti-B cell therapy, bispecific antibodies, blockers of JAK (and other signaling molecules), bioelectronic vagus nerve activation, dendritic cell-based immunotherapy, and other therapies, as well as approaches to secondary prevention of RA in patients with undifferentiated arthritis and clinically suspect arthralgia, who are at high risk for RA. Decoding the mechanisms underlying the pathogenesis of RA and a chronic inflammatory process as a whole has created preconditions for the design of novel medications for the prevention and treatment of this disease, the introduction of which into clinical practice should lead to a radical improvement of prognosis in this disease.
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Affiliation(s)
- E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
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