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Zhang N, Ji C, Bao X, Yuan C. Development and assessment of a predictive model for early diagnosis of rheumatoid arthritis in southwest China: A new nomogram. Medicine (Baltimore) 2023; 102:e33386. [PMID: 36961142 PMCID: PMC10036016 DOI: 10.1097/md.0000000000033386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
Rheumatoid arthritis (RA) is a disease complicated with inflammatory synovitis, which seriously affects the life quality of patients. Early diagnosis is important for prognosis of RA. Here, we aimed to develop and assess a model for early diagnosis of RA in southwest China. A nomogram including 44 patients with an early diagnosis of RA was developed. Variables were filtered by least absolute contraction selection operator and multiple logistic regression. The efficiency and clinical application range were evaluated. This nomogram showed that rheumatoid factor, erythrocyte sedimentation rate, RA33, facet joint and knee joint had high positive predictive value for RA. The area under curve was 0.920 [95% confidence interval (CI): 0.865-0.975]. In the validation model, area under curve was 0.942 (95% CI: 0.893-0.991). Calibration and decision curve suggested that this nomogram was helpful within the threshold probability range of 0.02 to 1.00. Using this nomogram will help clinicians in the early diagnosis of RA. Laboratory indicators such as rheumatoid factor, erythrocyte sedimentation rate, RA33, and clinical symptoms such as morning stiffness, facet joint and knee joint are very important, which deserves the attention of clinicians.
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Affiliation(s)
- Naidan Zhang
- Department of Clinical Laboratory, Peoples Hospital of Deyang City, Deyang, China
| | - Chaixia Ji
- Department of Clinical Laboratory, Peoples Hospital of Deyang City, Deyang, China
| | - Xiao Bao
- Department of Rheumatology, Peoples Hospital of Deyang City, Deyang, China
| | - Chengliang Yuan
- Department of Clinical Laboratory, Peoples Hospital of Deyang City, Deyang, China
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Jia Y, Zhang J, Mo L, Ju B, Hu N, Wang Y, Wang P, Zheng J, He L, Wang J. Low positivity rates for HBeAg and HBV DNA in rheumatoid arthritis patients: a case-control study. BMC Infect Dis 2022; 22:570. [PMID: 35751011 PMCID: PMC9229421 DOI: 10.1186/s12879-022-07536-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background The rates of hepatitis B virus (HBV) infection in rheumatoid arthritis (RA) patients are controversial when considering the reported outcomes. It was speculated that HBV infection status was altered after RA, and variations inn HBV infection rates became apparent. Methods To compare the positive proportions of hepatitis B e antigen (HBeAg) and HBV DNA, a retrospective case–control study was performed between 27 chronic hepatitis B (CHB) patients with RA and 108 age- and gender-matched CHB patients. In addition, the positivity rates of hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) were surveyed among the 892 RA patients. Results Compared to CHB patients, CHB patients with RA exhibited lower rates of HBeAg positivity (11.1% vs. 35.2%, P = 0.003), HBV DNA positivity (37.0% vs. 63.9%, P = 0.007) and ALT elevation (11.1% vs. 35.2%, P = 0.024). In the 892 RA patients, the prevalence of HBsAg (3.0%) was lower than that reported in the Chinese national data (7.2%), whereas the anti-HBc positivity rate of 44.6% was higher than that of 34.1%. Conclusion HBV infection status was altered after suffering from RA. Compared to the matched CHB patients, low positive proportions of HBeAg and HBV DNA were observed for CHB patients with RA.
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Affiliation(s)
- Yue Jia
- Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jingjing Zhang
- Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Lingfei Mo
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Bomiao Ju
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Nan Hu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Yanhua Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Pei Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China
| | - Jie Zheng
- Clinical Research Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Lan He
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China.
| | - Jing Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta Road (w), Xi'an, 710061, Shaanxi Province, China.
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Hepatitis B Virus Infection and Extra-Hepatic Manifestations: A Systemic Disease. Am J Gastroenterol 2022; 117:253-263. [PMID: 34913875 DOI: 10.14309/ajg.0000000000001575] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 11/11/2021] [Indexed: 12/11/2022]
Abstract
People living with hepatitis B virus (HBV) chronic infection are exposed to high rates of liver complications including end-stage liver disease and hepatocellular carcinoma. Extrahepatic manifestations of HBV infection have long been underestimated. Several of these extrahepatic syndromes have been well described, including systemic vasculitides, glomerulonephritis, and cutaneous manifestations. Other manifestations have been more recently described such as hematological malignancies and neurological diseases. These extrahepatic manifestations are associated with significant morbidity and mortality. Although not completely understood, underlying mechanisms include HBV-induced local and systemic inflammation. Suppression of HBV replication usually improves extrahepatic manifestations. This review will discuss how HBV induces inflammation and the extrahepatic manifestations of HBV infection to guide clinical management.
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Yerima A, Akintayo R, Adebajo A. Implications of a diagnosis of rheumatoid arthritis in resource-poor countries. Best Pract Res Clin Rheumatol 2021; 36:101725. [PMID: 34906416 DOI: 10.1016/j.berh.2021.101725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) is a multisystemic autoimmune disease that predominantly affects synovial joints. It causes marked disability, reduces health-related quality of life, and leads to high mortality. The diagnosis of RA is often made by standard criteria, and the management of this condition is usually undertaken according to the established guidelines. In resource-poor settings, the diagnosis and management of RA are hampered by diverse factors such as late presentation, inadequate trained personnel, poor healthcare infrastructure, low socioeconomic status, poor access to both conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics, and a high burden of infectious diseases such as tuberculosis, hepatitis, and human immunodeficiency virus. There is a need to establish registries in these settings to provide adequate information on the pattern, medication, and long-term outcome of RA in resource-poor countries in order to provide a practical and evidence-based management guide for rheumatologists, which is appropriate for these settings.
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Affiliation(s)
- Abubakar Yerima
- Department of Medicine, University of Maiduguri, PMB 1069, Maiduguri, Borno State, Nigeria.
| | - Richard Akintayo
- Dumfries and Galloway, Royal Infirmary, Cargenbridge, Dumfries DG2 8RX, United Kingdom.
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield S10 2RX, South Yorkshire, United Kingdom; Barnsley NHS Foundation Trust, Barnsley S75 2EP, South Yorkshire, United Kingdom.
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Stasi C, Tiengo G, Sadalla S, Zignego AL. Treatment or Prophylaxis against Hepatitis B Virus Infection in Patients with Rheumatic Disease Undergoing Immunosuppressive Therapy: An Update. J Clin Med 2021; 10:jcm10122564. [PMID: 34200522 PMCID: PMC8227638 DOI: 10.3390/jcm10122564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 12/20/2022] Open
Abstract
Chronic hepatitis B virus (HBV) flares or reactivations are serious causes of morbidity or mortality in rheumatologic patients undergoing immunosuppressive therapy. The recent insights in the pathogenesis of rheumatic diseases led to the use of new immunosuppressive therapies indicated in case of failure, partial response, or intolerance of conventional synthetic disease-modifying anti-rheumatic drugs. Based on these premises, this review examines and discusses the main rheumatologic treatments that could require the initiation of prophylactic treatment or close monitoring of occult HBV infection in patients beginning antiviral therapy at the first signs of HBV reactivation, or antiviral treatment in chronic HBV-infected patients. We searched for relevant studies published in the last five years. Studies suggested that the presence of HBV infection is common in rheumatic patients and HBV reactivation during these immunosuppressant treatments is quite frequent in these kinds of patients. Therefore, before starting an immunosuppressive therapy, patients should be screened for HBsAg, anti-HBs, and anti-HBc and, on the basis of markers positivity, they should be carefully characterized for HBV infection phases. In conclusion, screening of HBV infection in patients undergoing immunosuppressive therapy with subsequent HBV monitoring, prophylaxis or treatment consistently reduces the risk of clinical consequences.
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Affiliation(s)
- Cristina Stasi
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence and CRIA-MASVE Center for Research and Innovation, Careggi University Hospital, 50134 Florence, Italy; (G.T.); (A.L.Z.)
- Epidemiology Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy
- Correspondence:
| | - Giacomo Tiengo
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence and CRIA-MASVE Center for Research and Innovation, Careggi University Hospital, 50134 Florence, Italy; (G.T.); (A.L.Z.)
| | - Sinan Sadalla
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Anna Linda Zignego
- MASVE Interdepartmental Hepatology Center, Department of Experimental and Clinical Medicine, University of Florence and CRIA-MASVE Center for Research and Innovation, Careggi University Hospital, 50134 Florence, Italy; (G.T.); (A.L.Z.)
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ASAN A, AYAR K, TÜRK M, ONART O, DEMIRAY TD. Prevalence of Hepatitis B virus serological groups in rheumatoid arthritis and association of previous hepatitis B virus infection with demographic data and parenteral therapies. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.878533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Think autoimmunity, breath autoimmunity, and learn autoimmunity. Clin Rheumatol 2019; 38:1227-1230. [PMID: 30980191 DOI: 10.1007/s10067-019-04540-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
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