Features and Outcomes of Elderly Rheumatoid Arthritis: Does the Age of Onset Matter? A Comparative Study From a Single Center in China

Effects of oral contraceptives and menopausal hormone therapy on the risk of rheumatoid arthritis: a prospective cohort study

OBJECTIVES

Oral contraceptives (OC) and menopausal hormone therapy (MHT) contain exogenous sex hormones and are used by millions of women around the world. However, their effect on the development of rheumatoid arthritis (RA) is still debated and the current literature suggests that they may exert opposite effects on the risk of RA. The present study aimed to estimate the effects of exogenous hormones on the development of RA, both during the reproductive lifespan and later in life.

METHODS

The association between OC and RA, as well as between MHT and late-onset RA (LORA), was investigated using time-dependent Cox regression modelling in white British women from the UK Biobank (n = 236 602 and n = 102 466, respectively) and replicated in women from all ethnic groups.

RESULTS

OC use was associated with a decreased risk of RA in ever-users [hazard ratio (HR) = 0.89; 95% CI = 0.82-0.96], as well as in current (HR = 0.81; 0.73-0.91) and former users (HR = 0.92; 0.84 -1.00), compared with never-users. In contrast, MHT use was associated with an increased risk of LORA in ever-users (HR = 1.16; 1.06-1.26) as well as in former users (HR = 1.13; 1.03-1.24) compared with never-users.

CONCLUSION

OC use appears to protect against RA, while MHT may increase the risk of LORA. This study provides new insights into the possible inverse effect of exposure to different exogenous sex hormones on the risk of RA.

A Case of Painless Elderly-Onset Rheumatoid Arthritis

Rheumatoid arthritis (RA) has multiple manifestations. Patients present with a variety of symptoms and varying levels of severity. Elderly-onset rheumatoid arthritis (EORA) is described as RA with onset after 60 years of age. EORA can present with different clinical and laboratory findings compared to RA in a younger patient, making awareness of the condition important. Diagnosing inflammatory arthritis can be especially challenging in an elderly population where symptoms are poorly reported and communication is often difficult. We report the case of an elderly patient whose presentation with persistent tachycardia and raised inflammatory markers led to a diagnosis of EORA. This case details an atypical presentation of EORA with convincing diagnostic features for the disease without any joint symptoms reported. Clinicians should be aware of the differences in the typical presentation of EORA versus RA, the challenges of diagnosing inflammatory arthritis in elderly, isolated patients, and the importance of early diagnosis.

Depressive symptoms and associated factors among older patients with arthritis: evidence from a community-based study in eastern China

Introduction

Depressive symptoms are often experienced by patients with arthritis and are correlated with poor health outcomes. However, the association between depressive symptoms and multidimensional factors (sociodemographic characteristics, health conditions, health behaviors, and social support) among older patients with arthritis in China remains poorly understood. This study aimed to explore the prevalence of depressive symptoms in older patients with arthritis in eastern China and identify the associated factors.

Methods

We analyzed data of 1,081 older patients with arthritis using secondary data from 2014 to 2020 from a community-based ongoing study initiated in 2014 in eastern China. The prevalence of depressive symptoms was calculated, and univariate and multilevel logistic regression analyses were used to identify the associated factors.

Results

The mean age of older patients with arthritis was 69.16 ± 7.13 years; 42.92% were men and 57.08% were women. The prevalence of depressive symptoms in older patients with arthritis was 14.99% (95% confidence interval: 12.91-17.26%), about 1.8 times higher than that in older adults without arthritis (8.49%, p < 0.001). Multilevel logistic regression identified perception of poor economic status (odds ratio [OR] = 5.52, p < 0.001), multimorbidity (OR = 1.96, p = 0.001), limitations in activities of daily living (OR = 2.36, p = 0.004), and living alone (OR = 3.13, p = 0.026) as factors positively associated with depressive symptoms. Patients diagnosed with arthritis at an older age had lower odds of experiencing depressive symptoms (OR = 0.67, p = 0.046).

Conclusion

Screening for depressive symptoms is essential among older patients with arthritis, especially those who perceive themselves as having a poor economic status, are diagnosed at an earlier age, have multimorbidity, have limitations in activities of daily living, and live alone. The associations of age at arthritis diagnosis and dietary behaviors with depressive symptoms require further research.

Influences of advanced age in rheumatoid arthritis: A multicentre ultrasonography cohort study

OBJECTIVES

We aimed to evaluate the effects of age on clinical characteristics and outcomes in biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD)-naïve patients with rheumatoid arthritis (RA).

METHODS

We analysed the cases of 234 Japanese b/tsDMARD-naïve RA patients who underwent b/tsDMARD treatment in a multicentre ultrasound prospective observational cohort. We compared the clinical characteristics at baseline and outcomes at 12 months between those aged ≥60 years and those <60 years.

RESULTS

Compared to the <60-year-old group (n = 78), the ≥60-year-old group (n = 156) had higher inflammatory marker values and ultrasound combined scores, especially wrist joints, at baseline. Age at baseline positively correlated significantly with the ultrasound scores at baseline; however, age was not a significant variable by the multiple regression analysis. The patients treated with different MOAs in the ≥60-year-old group had comparable outcomes and multiple regression analysis revealed that mechanism of action (MOA) was not a significant contributor to the Clinical Disease Activity Index at 12 months.

CONCLUSIONS

RA patients with advanced age demonstrated distinctive clinical characteristics. The MOAs were not associated with clinical outcomes and ultrasound outcomes in RA patients with advanced age.

Seronegative Rheumatoid Arthritis in an Elderly Dialysis Patient With Multiple Comorbidities: A Case Report

The diagnosis of autoimmune diseases in elderly, immunocompromised patients undergoing dialysis poses significant challenges due to the diverse etiology of symptoms such as fever and systemic pain. This case study reports on a 79-year-old man undergoing hemodialysis with a history of multiple comorbidities, including diabetes, heart failure, and pure red cell aplasia. He presented with subacute polyarthritis and fever and was ultimately diagnosed with seronegative rheumatoid arthritis. The case illustrates the complexities of differential diagnosis in this population, emphasizing the need for a systematic approach to distinguish between possible infectious and autoimmune causes. Despite the absence of rheumatoid factor and anti-citrullinated protein antibody, the patient's clinical presentation and response to steroids supported the diagnosis of seronegative rheumatoid arthritis. Treatment with prednisolone resulted in significant improvement in symptoms and quality of life, demonstrating the effectiveness of steroids in managing autoimmune conditions in elderly, high-risk patients. However, such treatment necessitates careful monitoring due to potential adverse effects. This case underlines the importance of considering autoimmune diseases in differential diagnoses and customizing treatment strategies to accommodate the unique needs of elderly, immunocompromised patients on dialysis. Insights from this case contribute to better understanding and management of complex clinical scenarios in similar patient populations.

Translation, transcultural adaptation into Brazilian Portuguese and concurrent validity of the rheumatoid arthritis assessment scale (RAKAS-13/Brazil)

BACKGROUND

Knowledge of patients about Rheumatoid Arthritis (RA) is a necessary aspect to better approach self-management support in a patient-centered manner. The research instrument known as the Rheumatoid Arthritis Knowledge Assessment Scale (RAKAS), consisting of 13 items, is simple, reliable and reproducible, and can be applied in both clinical practice and research protocols.

OBJECTIVE

This study aimed to translate and culturally adapt the RAKAS vocabulary into Brazilian Portuguese and to evaluate its concurrent validity.

METHODS

The RAKAS was translated into Brazilian Portuguese and administered to 52 elderly women with RA recruited between May 2021 and May 2022. Concurrent validity was assessed using the Spearman's correlation coefficient between RAKAS and Patient Knowledge Questionnaire (PKQ).

RESULTS

The participants considered RAKAS-13/BRAZIL easy to understand and did not report any doubts in answering the final version. Concurrent validity of the RAKAS-13/BRAZIL was low compared to the PKQ (ρ = 0.283, p = 0.038).

CONCLUSION

The Brazilian Portuguese version of the RAKAS (RAKAS-13/BRASIL) proved to be a questionnaire that was easy and quick to administer to assess patient knowledge about Rheumatoid Arthritis, despite its low correlation with the PKQ in the present study.

Association of Hydroxychloroquine Use with a Dose-Dependent Decrease in Mortality Risk in Patients with Elderly-Onset Rheumatoid Arthritis

INTRODUCTION

Elderly-onset rheumatoid arthritis (EORA) is associated with an increased mortality risk; however, the effect of conventional synthetic, biologics or targeted synthetic disease-modifying anti-rheumatic drugs (csDMARDs, bDMARDs or tsDMARDs) on the EORA-specific mortality risk is unknown. In this study, we investigated the risk factors for all-cause mortality of patients with EORA.

METHODS

Data of EORA patients diagnosed with RA at age > 60 years between January 2007 and June 2021 were extracted from the electronic health record of Taichung Veterans General Hospital, Taiwan. Multivariable Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). The survival of patients with EORA was analyzed by Kaplan-Meier method.

RESULTS

Among the 980 EORA patients who were enrolled (survivors 852 and non-survivor 128), the significant mortality-associated risk factors [HR (95% CI)] included higher age (1.10 [1.07-1.12], p < 0.001), male sex (1.92 [1.22-3.00], p = 0.004), current smoker (2.31 [1.10-4.87], p = 0.027) and underlying malignancy (1.89 [1.20-2.97], p = 0.006). Hydroxychloroquine treatment conferred protection against mortality in patients with EORA (HR 0.30, 95% CI 0.14-0.64, p = 0.002). Patients with malignancy who did not receive hydroxychloroquine treatment had the highest mortality risk compared with their counterparts. Patients with a monthly cumulative dose of hydroxychloroquine dose < 1374.5 mg had the lowest survival rate compared to patients who received hydroxychloroquine 1374.5-5778.5 and ≥ 5778.5 mg.

CONCLUSION

Hydroxychloroquine treatment is associated with survival benefits in patients with EORA, and prospective studies are needed to validate the abovementioned findings.

Incidence and prevalence of interstitial lung diseases worldwide: a systematic literature review

Interstitial lung disease (ILD) is a collective term representing a diverse group of pulmonary fibrotic and inflammatory conditions. Due to the diversity of ILD conditions, paucity of guidance and updates to diagnostic criteria over time, it has been challenging to precisely determine ILD incidence and prevalence. This systematic review provides a synthesis of published data at a global level and highlights gaps in the current knowledge base. Medline and Embase databases were searched systematically for studies reporting incidence and prevalence of various ILDs. Randomised controlled trials, case reports and conference abstracts were excluded. 80 studies were included, the most described subgroup was autoimmune-related ILD, and the most studied conditions were rheumatoid arthritis (RA)-associated ILD, systemic sclerosis associated (SSc) ILD and idiopathic pulmonary fibrosis (IPF). The prevalence of IPF was mostly established using healthcare datasets, whereas the prevalence of autoimmune ILD tended to be reported in smaller autoimmune cohorts. The prevalence of IPF ranged from 7 to 1650 per 100 000 persons. Prevalence of SSc ILD and RA ILD ranged from 26.1% to 88.1% and 0.6% to 63.7%, respectively. Significant heterogeneity was observed in the reported incidence of various ILD subtypes. This review demonstrates the challenges in establishing trends over time across regions and highlights a need to standardise ILD diagnostic criteria.PROSPERO registration number: CRD42020203035.

Plateletcrit is a Useful Marker in the Quality of Life Assessment of Patients with Rheumatoid Arthritis: A Cross-Sectional Study from Erbil, Iraq

Background

In patients with rheumatoid arthritis (RA), hematological indices and ratios have been reported to be related to the severity of illness, and thus could potentially be useful determinants of quality of life (QoL).

Objective

To evaluate the association between hematological indices or ratios, which serve as biomarkers of disease activity, and the QoL of RA patients.

Materials and Methods

This study was carried out in the Rizgary Teaching Hospital in the Kurdistan region of Iraq between December 01, 2021, and March 31, 2022. All female patients with a confirmed diagnosis of RA and aged ≥18 years were included. Data relating to the disease activity score (DAS-28), biochemical measurements of the profile, and hematological indices and ratios were assessed. The QoL of each patient was assessed using the Quality of Life-Rheumatoid Arthritis II (QoL-RA II) and the World Health Organization-Quality of Life (WHOQOL-BREF) scales.

Results

A total of 81 participants were included, with a median disease duration of 9 years. The median values of the hematological indices were as follows: mean corpuscular volume, 80 fL; platelet count 282 × 103/mm3; mean platelet volume, 9.7 fL; neutrophil-to-lymphocyte ratio, 2.76; and platelet-to-lymphocyte ratio, 170.5. In six of the eight domains of the QoL-RA II scale, the median score was ≤5, indicating poor QoL. The transformed scores of WHOQOL-BREF domains were <50. Multivariate regression analysis showed significant inverse correlations between plateletcrit and the health domains. The area under the curve of the physical, psychological, and environmental domains was <0.5 at a cutoff value of plateletcrit of 0.25.

Conclusions

In RA patients, hematological indices and ratios could serve as a QoL assessment tool, particularly plateletcrit, as higher plateletcrit (≥0.25) were found to negatively impact the physical health, psychological, and environmental domains.

Rheumatic Immune-Related Adverse Events due to Immune Checkpoint Inhibitors—A 2023 Update

With the aging of the population, malignancies are becoming common complications in patients with rheumatoid arthritis (RA), particularly in elderly patients. Such malignancies often interfere with RA treatment. Among several therapeutic agents, immune checkpoint inhibitors (ICIs) which antagonize immunological brakes on T lymphocytes have emerged as a promising treatment option for a variety of malignancies. In parallel, evidence has accumulated that ICIs are associated with numerous immune-related adverse events (irAEs), such as hypophysitis, myocarditis, pneumonitis, and colitis. Moreover, ICIs not only exacerbate pre-existing autoimmune diseases, but also cause de novo rheumatic disease–like symptoms, such as arthritis, myositis, and vasculitis, which are currently termed rheumatic irAEs. Rheumatic irAEs differ from classical rheumatic diseases in multiple aspects, and treatment should be individualized based on the severity. Close collaboration with oncologists is critical for preventing irreversible organ damage. This review summarizes the current evidence regarding the mechanisms and management of rheumatic irAEs with focus on arthritis, myositis, and vasculitis. Based on these findings, potential therapeutic strategies against rheumatic irAEs are discussed.

Fighting age-related orthopedic diseases: focusing on ferroptosis

Ferroptosis, a unique type of cell death, is characterized by iron-dependent accumulation and lipid peroxidation. It is closely related to multiple biological processes, including iron metabolism, polyunsaturated fatty acid metabolism, and the biosynthesis of compounds with antioxidant activities, including glutathione. In the past 10 years, increasing evidence has indicated a potentially strong relationship between ferroptosis and the onset and progression of age-related orthopedic diseases, such as osteoporosis and osteoarthritis. Therefore, in-depth knowledge of the regulatory mechanisms of ferroptosis in age-related orthopedic diseases may help improve disease treatment and prevention. This review provides an overview of recent research on ferroptosis and its influences on bone and cartilage homeostasis. It begins with a brief overview of systemic iron metabolism and ferroptosis, particularly the potential mechanisms of ferroptosis. It presents a discussion on the role of ferroptosis in age-related orthopedic diseases, including promotion of bone loss and cartilage degradation and the inhibition of osteogenesis. Finally, it focuses on the future of targeting ferroptosis to treat age-related orthopedic diseases with the intention of inspiring further clinical research and the development of therapeutic strategies.

Differential associations of rheumatoid arthritis and periodontitis or tooth loss: A cross-sectional study

AIM

To study the association between periodontitis, tooth loss, and rheumatoid arthritis (RA) by using a large national dataset.

MATERIALS AND METHODS

An observational cross-sectional study was performed using the National Health and Nutrition Examination Survey cycles (2009-2014). RA status was detected using a questionnaire. Periodontal status was assigned on the basis of the clinical attachment level and periodontal pocket depth. Dentition status was assessed by the number of permanent teeth observed. We examined the association between RA as exposure and moderate/severe periodontitis and non-functional dentition as outcomes. We progressively adjusted our models for different sets of potential confounders.

RESULTS

Moderate/severe periodontitis was more prevalent in participants reporting RA (53% vs. 41.5%, p = .0003). Non-functional dentition was more prevalent in participants with RA (41% vs. 15.5%, p = .0001). The fully adjusted model showed that participants with RA had higher odds of having non-functional dentition (odds ratio 1.8, 95% confidence interval [CI] 1.3-2.3, p = .0001) but no association with moderate/severe periodontitis (prevalence ratio 1.01, 95% CI 0.9-1.1, p = .9).

CONCLUSION

RA was associated with a higher likelihood of having non-functional dentition but did not show any association with periodontitis after adjusting for the risk factors to control their confounding effect.

Efficacy and gastrointestinal tolerability of methotrexate in late-onset rheumatoid arthritis patients: a prospective cohort study

Background

The proportion of the late-onset forms of disease is growing in rheumatoid arthritis (RA) population. Concerns about comorbidities and drug adverse events lead to delay or ineffective treatment in these patients. The aim of this study is to analyze the tolerability and efficacy of methotrexate therapy in late-onset RA (LORA) patients and compare the baseline characteristics, efficacy, and gastrointestinal (GIT) adverse effects of methotrexate treatment between LORA and young-onset RA patients (YORA).

Results

Patients whose symptoms began after 65 years or older were classified as LORA. Baseline characteristics, rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) status, C-reactive proten (CRP) levels, disease activity scores, and radiographs of hands and feet were recorded. Patients were started to methotrexate therapy and followed for 6 months. Female gender was predominant in both LORA and YORA. LORA patients had less seropositivity (RF or anti-CCP), higher CRP levels, and higher DAS 28 scores. More than half of the patients (58%) had large joint involvement. Remission rates were higher in LORA patients, and total remission and low disease activity rates were similar. Methotrexate withdrawal due to gastrointestinal adverse events (nausea and vomiting) was lower than YORA patients. Logistic regression analysis demonstrated that DAS 28 score was the only predictor for disease remission (p: 0.000), and no predictive factor was found for methotrexate-related adverse events.

Conclusion

Methotrexate-related gastrointestinal adverse events do not increase in LORA patients, and nausea-vomiting is seen lower than YORA. Methotrexate is well tolerated and effective in LORA patients, and a large amount of patients achieve treatment targets after 6 months of treatment with MTX. Methotrexate should be started immediately in LORA without additional concerns on adverse effects.

L-shaped association between serum 25-hydroxyvitamin D and all-cause mortality of individuals with rheumatoid arthritis

OBJECTIVE

We aimed to examine the relationship between serum 25-hydroxyvitamin D and all-cause, cause-specific mortality of patients with RA.

METHODS

This cohort study included 1466 patients with RA from The National Health and Nutrition Examination Survey (NHANES) 2001-14. Mortality status was obtained according to death certificate records from the National Death Index. Cox proportional risk models were used to estimate hazard ratios (HR) and 95% CI for mortality. A generalized additive model, smooth curve fitting and 2-piecewise Cox proportional hazards models were established to address the nonlinearity between serum 25-hydroxyvitamin D and mortality.

RESULTS

A total of 1466 patients [mean (s.d.) 59.89 (14.14) years old; 58.94% female] were enrolled. The weighted mean level of 25-hydroxyvitamin D was 59.26 (24.99) nmol/l and 38.95% were found with deficient (or severe deficient) vitamin D (<50.00 nmol/l). During 10453 person-years of follow-up, 268 patients were documented for all-cause death, including 52 cardiovascular disease （CVD）deaths and 48 cancer deaths. Compared with patients with serum 25-hydroxyvitamin D <25.00 nmol/l, patients with higher serum 25-hydroxyvitamin D were more likely to have lower rate of all-cause mortality. Nonlinear and L-shaped association between serum 25-hydroxyvitamin D and all-cause mortality was found, and decreased serum 25-hydroxyvitamin D was significantly associated with increased risk of all-cause mortality in patients with serum 25-hydroxyvitamin D <37.30 nmol/l [HR 0.95 (0.92, 0.98); P < 0.01].

CONCLUSION

An L-shaped association between serum 25-hydroxyvitamin D and all-cause mortality was found among patients with RA, indicating that serum 25-hydroxyvitamin D should be improved to a certain level for the prevention of premature death.

Predictors of Remission and Low Disease Activity in Rheumatoid Arthritis Patients: Results From the Follow-up of a Real-World Peruvian Cohort

BACKGROUND

Clinical remission is the goal in rheumatoid arthritis (RA) management; however, this can be difficult to achieve in several parts of the world. Our objective was to determine predictors of remission and remission/low disease activity (LDA) in RA.

METHODS

A longitudinal real-setting RA cohort was followed up (January 2016-2020). Predictors examined were sex, age at diagnosis, disease duration, socioeconomic status, tobacco use, rheumatoid factor titer, comorbidities (Charlson index), Simple Disease Activity Index (SDAI) score, disability (Multidimensional Disease Health Assessment Questionnaire), health-related quality of life (Short Form-36 questionnaire), glucocorticoid dose, biological/target synthetic disease-modifying antirheumatic drugs, and conventional DMARD (c-DMARD) use. Univariable and multivariable generalized estimating equation models were done to determine predictors of remission (at a given visit) and sustained remission (2 consecutives visits), using the SDAI definition (0 or <3.3). Similarly, remission/LDA (SDAI <11) predictors were examined.

RESULTS

Five hundred thirty RA patients included the following: 160 patients (30.2%) achieved remission in at least 1 visit, and 126 patients (23.77%) achieved sustained remission. On the multivariable analysis glucocorticoid dose (odds ratio [OR], 1.060; 95% confidence interval [CI], 1.027-1.094; p = 0.004) and current (OR, 2.293; 95% CI, 1.811-2.903; p < 0.001) or past (OR, 1.383; 95% CI, 1.127-1.698; p = 0.002) use of c-DMARDs predicted remission/LDA in at least 1 visit, whereas the SDAI (OR, 0.951; 95% CI, 0.942-0.959; p < 0.001), Multidimensional Disease Health Assessment Questionnaire (OR, 0.648; 95% CI, 0.549-0.764; p < 0.001), and age at diagnosis (OR, 0.994; 95% CI, 0.990-0.998; p = 0.004) were negative predictors. As to sustained remission/LDA, current (OR, 2.012; 95% CI, 1.458-2.776: p < 0.001) or past (OR, 1.517; 95% CI, 1.155-1.993; p = 0.003) use of c-DMARDs, having a better Short Form-36 questionnaire physical component summary (OR, 1.022; 95% CI, 1.014-1.029; p < 0.001), and older age at diagnosis (OR, 1.013; 95% CI, 1.003-1.022; p = 0.008) predicted it, whereas SDAI (OR, 0.949; 95% CI, 0.933-0.965; p < 0.001) and medium low/low socioeconomic status (OR, 0.674; 95% CI, 0.500-0.909; p = 0.010) were negative predictors.

CONCLUSION

During follow-up of this real-world RA cohort, c-DMARD use predicted remission and remission/LDA. In contrast, disease activity was a negative predictor.

Incidence, Risk Factors, and Mortality of Clinical and Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Population-Based Cohort

OBJECTIVE

To identify the incidence, risk factors, and outcomes of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to assess time trends in the incidence and mortality in RA-ILD.

METHODS

We included adult residents of Olmsted County, Minnesota with incident RA between 1999 and 2014. Subjects were followed until death, emigration, or April 30, 2019. ILD was defined as the presence of a radiologist-defined pattern consistent with ILD on chest computed tomography (CT). When chest CT was absent, the combination of chest radiograph abnormalities compatible with ILD and restrictive pattern on pulmonary function testing was considered consistent with ILD. Potential risk factors included age, sex, smoking, obesity, seropositivity, extraarticular manifestations (EAMs), and medications. For survival analysis, we matched RA-ILD patients to RA-non-ILD comparators. The frequency and mortality from clinician-diagnosed RA-ILD from 1999 to 2014 was compared against a cohort from 1955 to 1994.

RESULTS

During the 1999-2014 time period, 645 individuals (70% women) had incident RA, were a median age of 55.3 years, and 53% never smoked. Twenty-two patients had ILD before RA, and 51 (67% women) developed ILD during follow-up. The 20-year cumulative incidence of RA-ILD was 15.3%. Ever-smoking (hazard ratio [HR] 1.92), age at RA onset (HR 1.89 per 10-year increase), and severe EAMs (HR 2.29) were associated with incident RA-ILD. The RA-ILD cases had higher mortality than their matched RA comparators (HR 2.42). Incidence of RA-ILD was non-significantly lower from 1999 to 2014 than from 1955 to1994, but mortality was improved.

CONCLUSIONS

RA-ILD occurs in nearly 1 in 6 patients with RA within 20 years and is associated with shorter survival. Lack of significant change in RA-ILD incidence over 6 decades deserves further investigation.

Inflammatory profile of incident cases of late-onset compared with young-onset rheumatoid arthritis: A nested cohort study

OBJECTIVES

To describe the characteristics of patients between late-onset rheumatoid arthritis (LORA) with young-onset (YORA), and analyze their association with cumulative inflammatory burden.

METHODS

We performed a nested cohort study in a prospective cohort comprising 110 patients with rheumatoid arthritis (RA) and 110 age- and sex-matched controls. The main variable was cumulative inflammatory activity according to the 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR). High activity was defined as DAS28 ≥ 3.2 and low activity as DAS28 < 3.2. The other variables recorded were inflammatory cytokines, physical function, and comorbid conditions. Two multivariate models were run to identify factors associated with cumulative inflammatory activity.

RESULTS

A total of 22/110 patients (20%) met the criteria for LORA (≥ 60 years). Patients with LORA more frequently had comorbid conditions than patients with YORA and controls. Compared with YORA patients, more LORA patients had cumulative high inflammatory activity from onset [13 (59%) vs. 28 (31%); p = 0.018] and high values for CRP (p = 0.039) and IL-6 (p = 0.045). Cumulative high inflammatory activity in patients with RA was associated with LORA [OR (95% CI) 4.69 (1.49-10.71); p = 0.008], smoking [OR (95% CI) 2.07 (1.13-3.78); p = 0.017], anti-citrullinated peptide antibody [OR (95% CI) 3.24 (1.15-9.13); p = 0.025], average Health Assessment Questionnaire (HAQ) score [OR (95% CI) 2.09 (1.03-14.23); p = 0.034], and physical activity [OR (95% CI) 0.99 (0.99-0.99); p = 0.010]. The second model revealed similar associations with inflammatory activity in patients with LORA.

CONCLUSION

Control of inflammation after diagnosis is poorer and comorbidity more frequent in patients with LORA than in YORA patients and healthy controls.

A Novel Ensemble-Based Technique for the Preemptive Diagnosis of Rheumatoid Arthritis Disease in the Eastern Province of Saudi Arabia Using Clinical Data

Rheumatoid arthritis (RA) is a chronic inflammatory disease caused by numerous genetic and environmental factors leading to musculoskeletal system pain. RA may damage other tissues and organs, causing complications that severely reduce patients' quality of life. According to the World Health Organization (WHO), over 1.71 billion individuals worldwide had musculoskeletal problems in 2021. Rheumatologists face challenges in the early detection of RA since its symptoms are similar to other illnesses, and there is no definitive test to diagnose the disease. Accordingly, it is preferable to profit from the power of computational intelligence techniques that can identify hidden patterns to diagnose RA early. Although multiple studies were conducted to diagnose RA early, they showed unsatisfactory performance, with the highest accuracy of 87.5% using imaging data. Yet, imaging data requires diagnostic tools that are challenging to collect and examine and are more costly. Recent studies indicated that neither a blood test nor a physical finding could early confirm the diagnosis. Therefore, this study proposes a novel ensemble technique for the preemptive prediction of RA and investigates the possibility of diagnosing the disease using clinical data before the symptoms appear. Two datasets were obtained from King Fahad University Hospital (KFUH), Dammam, Saudi Arabia, including 446 patients, with 251 positive cases of RA and 195 negative cases of RA. Two experiments were conducted where the former was developed without upsampling the dataset, and the latter was carried out using an upsampled dataset. Multiple machine learning (ML) algorithms were utilized to assemble the novel voting ensemble, including support vector machine (SVM), logistic regression (LR), and adaptive boosting (Adaboost). The results indicated that clinical laboratory tests fed to the proposed voting ensemble technique could accurately diagnose RA preemptively with an accuracy, recall, and precision of 94.03%, 96.00%, and 93.51%, respectively, with 30 clinical features when utilizing the original data and sequential forward feature selection (SFFS) technique. It is concluded that deploying the proposed model in local hospitals can contribute to introducing a method that aids medical specialists in preemptively diagnosing RA and stopping or delaying the course using clinical laboratory tests.

Evaluating the Role of Probiotics in the Prevention and Management of Age-Related Diseases

The human lifespan has been significantly increased due to scientific advancements in the management of disease; however, the health span of the aging population does not follow the same trend. Aging is the major risk factor for multimorbidity that is derived from the progressive loss of homeostasis, immunological and stem cell exhaustion, as well as exacerbated inflammation responses. Age-related diseases presenting with high frequencies include neurodegenerative, musculoskeletal, cardiovascular, metabolic diseases and cancer. These diseases can be co-morbid and are usually managed using a disease-specific approach that can eventually lead to polypharmacy, low medication adherence rates and undesired drug-drug interactions. Novel studies suggest targeting the shared biological basis of age-related diseases to retard the onset and manage their manifestations. Harvesting the anti-inflammatory and immunomodulatory capacity of probiotics to tackle the root cause of these diseases, could pose a viable alternative. In this article, a comprehensive review of the effects of probiotic supplementation on the molecular pathogenesis of age-related diseases, and the potential of probiotic treatments as preventative or alleviatory means is attempted. Furthermore, issues on the safety and efficiency of probiotic supplementation, as well as the pitfalls of current clinical studies are discussed, while new perspectives for systematic characterization of probiotic benefits on aged hosts are outlined.

Interplay Between Iron Overload and Osteoarthritis: Clinical Significance and Cellular Mechanisms

There are multiple diseases or conditions such as hereditary hemochromatosis, hemophilia, thalassemia, sickle cell disease, aging, and estrogen deficiency that can cause iron overload in the human body. These diseases or conditions are frequently associated with osteoarthritic phenotypes, such as progressive cartilage degradation, alterations in the microarchitecture and biomechanics of the subchondral bone, persistent joint inflammation, proliferative synovitis, and synovial pannus. Growing evidences suggest that the conditions of pathological iron overload are associated with these osteoarthritic phenotypes. Osteoarthritis (OA) is an important complication in patients suffering from iron overload-related diseases and conditions. This review aims to summarize the findings and observations made in the field of iron overload-related OA while conducting clinical and basic research works. OA is a whole-joint disease that affects the articular cartilage lining surfaces of bones, subchondral bones, and synovial tissues in the joint cavity. Chondrocytes, osteoclasts, osteoblasts, and synovial-derived cells are involved in the disease. In this review, we will elucidate the cellular and molecular mechanisms associated with iron overload and the negative influence that iron overload has on joint homeostasis. The promising value of interrupting the pathologic effects of iron overload is also well discussed for the development of improved therapeutics that can be used in the field of OA.

Incidence and severity of G6PI-induced arthritis are not increased in genetically distinct mouse strains upon aging

Background

The incidence of rheumatoid arthritis is correlated with age. In this study, we analyzed the association of the incidence and severity of glucose-6-phosphate isomerase (G6PI)-induced arthritis with age in two different mouse strains.

Methods

Young and very old mice from two different arthritis-susceptible wild-type mouse strains were analyzed after a single subcutaneous injection of G6PI s.c. The metabolism and the function of synoviocytes were analyzed in vitro, the production of bioactive lipid mediators by myeloid cells and synoviocytes was assessed in vitro and ex vivo by UPLC-MS-MS, and flow cytometry was used to verify age-related changes of immune cell composition and function.

Results

While the severity of arthritis was independent from age, the onset was delayed in old mice. Old mice showed common signs of immune aging like thymic atrophy associated with decreased CD4⁺ effector T cell numbers. Despite its decrease, the effector T helper (Th) cell compartment in old mice was reactive and functionally intact, and their Tregs exhibited unaltered suppressive capacities. In homeostasis, macrophages and synoviocytes from old mice produced higher amounts of pro-inflammatory cyclooxygenase (COX)-derived products. However, this functional difference did not remain upon challenge in vitro nor upon arthritis reactions ex vivo.

Conclusion

While old mice show a higher baseline of inflammatory functions, this does not result in increased reaction towards self-antigens in arthritis-susceptible mouse strains. Together, our data from two different mouse strains show that the susceptibility for G6PI-induced arthritis is not age-dependent.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-021-02596-7.