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Ishihara R, Watanabe R, Shiomi M, Katsushima M, Fukumoto K, Yamada S, Okano T, Hashimoto M. Exploring the Link between Varicella-Zoster Virus, Autoimmune Diseases, and the Role of Recombinant Zoster Vaccine. Biomolecules 2024; 14:739. [PMID: 39062454 PMCID: PMC11274381 DOI: 10.3390/biom14070739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
The varicella-zoster virus (VZV) is a human neurotropic herpes virus responsible for varicella and herpes zoster (HZ). Following primary infection in childhood, VZV manifests as varicella (chickenpox) and enters a period of latency within the dorsal root ganglion. A compromised cellular immune response due to aging or immunosuppression triggers viral reactivation and the development of HZ (shingles). Patients with autoimmune diseases have a higher risk of developing HZ owing to the immunodeficiency associated with the disease itself and/or the use of immunosuppressive agents. The introduction of new immunosuppressive agents with unique mechanisms has expanded the treatment options for autoimmune diseases but has also increased the risk of HZ. Specifically, Janus kinase (JAK) inhibitors and anifrolumab have raised concerns regarding HZ. Despite treatment advances, a substantial number of patients suffer from complications such as postherpetic neuralgia for prolonged periods. The adjuvanted recombinant zoster vaccine (RZV) is considered safe and effective even in immunocompromised patients. The widespread adoption of RZV may reduce the health and socioeconomic burdens of HZ patients. This review covers the link between VZV and autoimmune diseases, assesses the risk of HZ associated with immunosuppressant use, and discusses the benefits and risks of using RZV in patients with autoimmune diseases.
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Affiliation(s)
- Ryuhei Ishihara
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Ryu Watanabe
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Mayu Shiomi
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Masao Katsushima
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kazuo Fukumoto
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Shinsuke Yamada
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tadashi Okano
- Center for Senile Degenerative Disorders (CSDD), Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
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Chatterjee A, Jayaprakasan M, Chakrabarty AK, Lakkaniga NR, Bhatt BN, Banerjee D, Narwaria A, Katiyar CK, Dubey SK. Comprehensive insights into rheumatoid arthritis: Pathophysiology, current therapies and herbal alternatives for effective disease management. Phytother Res 2024; 38:2764-2799. [PMID: 38522945 DOI: 10.1002/ptr.8187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024]
Abstract
Rheumatoid arthritis is a chronic autoimmune inflammatory disease characterized by immune response overexpression, causing pain and swelling in the synovial joints. This condition is caused by auto-reactive antibodies that attack self-antigens due to their incapacity to distinguish between self and foreign molecules. Dysregulated activity within numerous signalling and immunological pathways supports the disease's development and progression, elevating its complexity. While current treatments provide some alleviation, their effectiveness is accompanied by a variety of adverse effects that are inherent in conventional medications. As a result, there is a deep-rooted necessity to investigate alternate therapeutic strategies capable of neutralizing these disadvantages. Medicinal herbs display a variety of potent bioactive phytochemicals that are effective in the complementary management of disease, thus generating an enormous potency for the researchers to delve deep into the development of novel phytomedicine against autoimmune diseases, although additional evidence and understanding are required in terms of their efficacy and pharmacodynamic mechanisms. This literature-based review highlights the dysregulation of immune tolerance in rheumatoid arthritis, analyses the pathophysiology, elucidates relevant signalling pathways involved, evaluates present and future therapy options and underscores the therapeutic attributes of a diverse array of medicinal herbs in addressing this severe disease.
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Affiliation(s)
- Amrita Chatterjee
- Department of Chemistry and Chemical Biology, Indian Institute of Technology (Indian School of Mines), Dhanbad, India
| | - Monisha Jayaprakasan
- Department of Chemistry and Chemical Biology, Indian Institute of Technology (Indian School of Mines), Dhanbad, India
| | | | - Naga Rajiv Lakkaniga
- Department of Chemistry and Chemical Biology, Indian Institute of Technology (Indian School of Mines), Dhanbad, India
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Takei H, Takanashi S, Otomo K, Hanaoka H, Kikuchi J, Yamaoka K, Yoshimoto K, Abe T, Takeuchi T, Kaneko Y. Clinical and immunological effects of hydroxychloroquine in patients with active rheumatoid arthritis despite antirheumatic treatment. Mod Rheumatol 2023; 34:50-59. [PMID: 36484525 DOI: 10.1093/mr/roac153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To investigate the efficacy and safety of hydroxychloroquine (HCQ) in patients with rheumatoid arthritis (RA). METHODS Patients with active RA, despite conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), were recruited. HCQ was administered for 24 weeks, in addition to prior treatment. The primary end-point was the proportion of patients achieving American College of Rheumatology (ACR) 20 at Week 24, compared to that of a propensity score-matched historical control group. RESULTS Sixty patients were enrolled and administered HCQ. We also identified 276 patients as candidates for the historical control group. Propensity score matching yielded 46 patients in each group. The proportion of patients achieving ACR20 at Week 24 was significantly higher in the HCQ group than in the control group (54.4% vs. 28.3%, P = .007). The proportion of patients achieving ACR50 and ACR70 at Week 24 were also higher in the HCQ group than in the control group (ACR50, 30.4% vs. 4.3%, P = .006; ACR70, 17.4% vs. 0%, P = .005). Neither HCQ retinopathy nor any new safety signal was observed during the study. CONCLUSION The addition of HCQ to csDMARDs was effective, with no new safety signal in patients with RA.
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Affiliation(s)
- Hiroshi Takei
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Takanashi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kotaro Otomo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Otomo Rheumatology Clinic, Tokyo, Japan
| | - Hironari Hanaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Jun Kikuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kunihiro Yamaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Keiko Yoshimoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Abe
- School of Data Science, Yokohama City University, Yokohama, Japan
- Biostatistics, Clinical and Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Saitama Medical University, Saitama, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Siddiqui B, Ahmed H, Haq IU, Rehman AU, Ahmed N. Development and validation of HPLC method for simultaneous determination of Leflunomide and folic acid in the nanoparticulate system by reversed-phase HPLC. Drug Dev Ind Pharm 2023; 49:497-507. [PMID: 37470519 DOI: 10.1080/03639045.2023.2239346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE The main objective of this study was to develop a highly sensitive, accurate, and reproducible analytical method for the simultaneous detection of LEF and FA in polymeric nanocarriers. SIGNIFICANCE Leflunomide (LEF), is widely employed in the treatment of rheumatoid arthritis (RA). However, long-term delivery of the drug is associated with systemic side effects. Therefore, folate (FA) conjugated LEF nanocarriers were fabricated for targeting the nanocarriers toward activated macrophages. HPLC is considered one of the most sensitive and precise analytical techniques for the simultaneous detection and estimation of different components in a particular sample. METHODS Analysis was performed on HPLC (Shimadzu 10 A), having a reversed-phase C-18 column (Beckmen, 250 X 4.6 mm, 5 µm) equipped with a photodiode detector set at a wavelength of 260 nm (LEF) and 285 nm (Folic acid). The isocratic mobile phase was composed of acetonitrile, water, and trimethylamine in a ratio of 65:35:0.5 at pH 4. Rapid analysis of both agents was performed, with a total run time of 10 min (FA = 2.1 ± 0.1 min, LEF = 5.9 ± 1 min) at a 1 mL/min flow rate. RESULTS The assay demonstrated good linearity of 0.9989 of 0.9997 for LEF and FA respectively with a recovery in the range of 95-100%. The method also depicted good specificity, and intra and inter-day precision based on relative standard deviation (RSD) values. CONCLUSIONS The study concludes, that the developed method was helpful in the detection and quantitation of lower values of both agents from polymeric nanocarriers.
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Affiliation(s)
- Bazla Siddiqui
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Haroon Ahmed
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Ihsan-Ul- Haq
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Asim Ur Rehman
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Naveed Ahmed
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Huang WN, Chuo CY, Lin CH, Chen YM, Lin WS, Tuckwell K, Jones NS, Galanter J, Lindsay L. Serious Infection Rates Among Patients with Select Autoimmune Conditions: A Claims-Based Retrospective Cohort Study from Taiwan and the USA. Rheumatol Ther 2023; 10:387-404. [PMID: 36572758 PMCID: PMC10011274 DOI: 10.1007/s40744-022-00525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Serious infections are an important concern for patients with autoimmune conditions. We sought to estimate serious infection rates among patients with select autoimmune conditions relative to the general population in Taiwan and the USA. METHODS This retrospective cohort study estimated setting-specific standardized serious infection incidence rates and ratios among patients with systemic lupus erythematosus, including extra-renal lupus and lupus nephritis, rheumatoid arthritis and primary membranous nephropathy, compared with the general population using insurance claims for hospitalizations between 2000 and 2013. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios for serious infections, adjusting for age, sex, index year, prior serious infection, comorbidities and medications. RESULTS In Taiwan, serious infection rates were 22.7, 28.7, 70.6, 43.4 and 215.3 per 1000 person-years among the general population and among cohorts of patients with primary membranous nephropathy, rheumatoid arthritis, extra-renal lupus and lupus nephritis, respectively. In the USA, serious infection rates were 2.6, 9.0, 15.6, 21.0 and 63.3 per 1000 person-years among the general population and among cohorts of patients with primary membranous nephropathy, rheumatoid arthritis, extra-renal lupus and lupus nephritis, respectively. Patients had significantly higher serious infection rates than the general population in both settings, largely driven by bacterial, respiratory, urinary tract and opportunistic infections. Patients with lupus nephritis had the highest burden of serious infections relative to the general population, with 7- to 25-fold higher adjusted hazard ratios in Taiwan and the USA, respectively. CONCLUSION This study identified a significant excess serious infection burden among patients with targeted autoimmune conditions compared with the general populations in Taiwan and the USA.
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Affiliation(s)
- Wen-Nan Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Business Administration, Ling-Tung University, Taichung, Taiwan
- College of Medicine National Chung Hsing University, Taichung, Taiwan
| | - Ching-Yi Chuo
- RWD Enabling Platform, Product Development Data Science, Genentech Inc, South San Francisco, CA, USA
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine National Chung Hsing University, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Szu Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Katie Tuckwell
- Early Clinical Development, Genentech Inc, South San Francisco, CA, USA
| | - Nicholas S Jones
- Early Clinical Development, Genentech Inc, South San Francisco, CA, USA
| | - Joshua Galanter
- Early Clinical Development, Genentech Inc, South San Francisco, CA, USA
- Product Development Safety, Genentech Inc, South San Francisco, CA, USA
| | - Lisa Lindsay
- RWD Enabling Platform, Product Development Data Science, Genentech Inc, South San Francisco, CA, USA.
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Li Z, Bai X, Fan Y, Jia Q, Zhang H, Hou H. Structure of type II collagen from sturgeon cartilage and its effect on adjuvant-induced rheumatoid arthritis in rats. Food Funct 2022; 13:6152-6165. [PMID: 35582851 DOI: 10.1039/d1fo03929f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this paper was to extract and characterize type II collagen of sturgeon cartilage (SC-CII), and to explore the effects of taking SC-CII orally on rheumatoid arthritis (RA) in rats. SC-CII showed a triple-helix structure (RPN = 0.12), with d1 of 11.82 Å and d2 of 4.08 Å, which was analyzed by FT-IR, CD, XRD, and MS. It was constructed of the repeating tripeptide unit Gly-X-Y, where X and Y are generally Pro or Hyp, proved by amino acid composition and peptide mass fingerprinting. Furthermore, the effects of SC-CII on RA were evaluated. Ankle thickness was significantly decreased in SC-CII groups, with changes in lymphocyte proliferation also observed. Compared with the model control group, there was an evident decrease in TNF-α, IL-1β, COX-2, MCP-1, and TLR-4 mRNA levels, but no remarkable differences in APF, MMP-3, and MyD88 mRNA levels in the SC-CII groups. In addition, TNF-α, IL-1β, RF, Anti-CII Ab were significantly reduced in the SC-CII groups, proved by ELISA. Therefore, SC-CII showed alleviating effects on RA through the TLR4/MyD88-NFκB pathway.
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Affiliation(s)
- Zhaoxia Li
- College of Food Science and Engineering, Ocean University of China, No. 5, YuShan Road, Qingdao, Shandong Province, 266003, P.R. China. .,Laboratory for Marine Drugs and Bioproducts, Qingdao National Laboratory for Marine Science and Technology, Qingdao, Shandong Province, 266071, P.R. China
| | - Xue Bai
- College of Food Science and Engineering, Ocean University of China, No. 5, YuShan Road, Qingdao, Shandong Province, 266003, P.R. China.
| | - Yan Fan
- College of Food Science and Engineering, Ocean University of China, No. 5, YuShan Road, Qingdao, Shandong Province, 266003, P.R. China.
| | - Qiannan Jia
- College of Food Science and Engineering, Ocean University of China, No. 5, YuShan Road, Qingdao, Shandong Province, 266003, P.R. China.
| | - Hongwei Zhang
- Technology Center of Qingdao Customs, No. 83, Xinyue Road, Qingdao, Shandong Province 266109, P.R. China
| | - Hu Hou
- College of Food Science and Engineering, Ocean University of China, No. 5, YuShan Road, Qingdao, Shandong Province, 266003, P.R. China. .,Laboratory for Marine Drugs and Bioproducts, Qingdao National Laboratory for Marine Science and Technology, Qingdao, Shandong Province, 266071, P.R. China
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A Review of Safety Outcomes from Clinical Trials of Baricitinib in Rheumatology, Dermatology and COVID-19. Adv Ther 2022; 39:4910-4960. [PMID: 36063279 PMCID: PMC9443639 DOI: 10.1007/s12325-022-02281-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2022] [Indexed: 01/30/2023]
Abstract
Baricitinib is an oral, selective inhibitor of Janus kinase (JAK)1/JAK2 that transiently and reversibly inhibits many proinflammatory cytokines. This mechanism is a key mediator in a number of chronic inflammatory diseases; accordingly, baricitinib has been studied and approved for the treatment of several rheumatological and dermatological disorders, as well as COVID-19. This narrative review summarises and discusses the safety profile of baricitinib across these diseases, with special focus on adverse events of special interest (AESI) for JAK inhibitors, using integrated safety data sets of clinical trial data, and puts findings into context with the underlying risk in the respective disease populations, using supporting literature. We show that rates of infection with baricitinib generally reflected the inherent risk of the disease populations being treated, with serious infections and herpes zoster being more frequent in rheumatic diseases than in dermatological disorders, and herpes simplex being reported particularly in atopic dermatitis. Similarly, rates of major adverse cardiovascular events (MACE), venous thromboembolism (VTE) and malignancies were generally within or below the ranges reported for the respective disease populations, thereby reflecting the underlying risk; these events were therefore more frequent in patients with rheumatic diseases than in those with dermatological disorders, the latter of whom generally had low absolute risk. AESI were usually more common in patients with risk factors specific for each event. When a population similar to that of ORAL Surveillance was considered, the incidence rate of MACE with baricitinib was numerically lower than that reported with tofacitinib and similar to that of tumour necrosis factor inhibitors. No safety concerns were observed in hospitalised patients with COVID-19 who received baricitinib for up to 14 days. Identifying the patterns and likelihoods of AEs that occur during treatment in large groups of patients with different diseases can help the physician and patient better contextualise the benefit-to-risk ratio for the individual patient.
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Chen HL, Lin SC, Li S, Tang KT, Lin CC. Alantolactone alleviates collagen-induced arthritis and inhibits Th17 cell differentiation through modulation of STAT3 signalling. PHARMACEUTICAL BIOLOGY 2021; 59:134-145. [PMID: 33556301 PMCID: PMC8871681 DOI: 10.1080/13880209.2021.1876102] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
CONTEXT Alantolactone, the bioactive component in Inula helenium L. (Asteraceae), exhibits multiple biological effects. OBJECTIVE We aimed to determine the anti-inflammatory effect of alantolactone in a collagen-induced arthritis (CIA) mouse model and its immunomodulatory effects on Th17 differentiation. MATERIALS AND METHODS A CIA mouse model was established with DBA/1 mice randomly divided into four groups (n = 6): healthy, vehicle and two alantolactone-treated groups (25 or 50 mg/kg), followed by oral administration of alantolactone to mice for 21 consecutive days after arthritis onset. The severity of CIA was evaluated by an arthritic scoring system and histopathological examination. Levels of cytokines and anti-CII antibodies as well as percentages of splenic Th17 and Th17 differentiation with or without alantolactone treatments (0.62, 1.2 or 2.5 μM) were detected with ELISA and flow cytometry, respectively. Western blot analysis was used to evaluate intracellular signalling in alantolactone-treated spleen cells. RESULTS In CIA mice, alantolactone at 50 mg/kg attenuated RA symptoms, including high arthritis scores, infiltrating inflammatory cells, synovial hyperplasia, bone erosion and levels of the proinflammatory cytokines TNF-α, IL-6 and IL-17A, but not IL-10 in paw tissues. Alantolactone also reduced the number of splenic Th17 cells and the capability of naïve CD4+ T cells to differentiate into the Th17 subset by downregulating STAT3/RORγt signalling by as early as 24 h of treatment. DISCUSSION AND CONCLUSIONS Alantolactone possesses an anti-inflammatory effect that suppresses murine CIA by inhibiting Th17 cell differentiation, suggesting alantolactone is an adjunctive therapeutic candidate to treat rheumatoid arthritis.
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MESH Headings
- Animals
- Anti-Inflammatory Agents/administration & dosage
- Anti-Inflammatory Agents/isolation & purification
- Anti-Inflammatory Agents/pharmacology
- Arthritis, Experimental/drug therapy
- Arthritis, Experimental/pathology
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/pathology
- Cell Differentiation/drug effects
- Cytokines
- Dose-Response Relationship, Drug
- Female
- Immunologic Factors/administration & dosage
- Immunologic Factors/isolation & purification
- Immunologic Factors/pharmacology
- Inula/chemistry
- Lactones/administration & dosage
- Lactones/isolation & purification
- Lactones/pharmacology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Inbred DBA
- STAT3 Transcription Factor/metabolism
- Sesquiterpenes, Eudesmane/administration & dosage
- Sesquiterpenes, Eudesmane/isolation & purification
- Sesquiterpenes, Eudesmane/pharmacology
- Signal Transduction/drug effects
- Th17 Cells/cytology
- Th17 Cells/drug effects
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Affiliation(s)
- Hsiang-Lai Chen
- Department of Surgery, Division of Urology, Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC
- Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Shih Chao Lin
- Bachelor Degree Program in Marine Biotechnology, College of Life Sciences, National Taiwan Ocean University, Keelung, Taiwan, ROC
| | - Shiming Li
- College of Chemistry & Chemical Engineering, Hubei Key Laboratory for Processing & Application of Catalytic Materials, Huanggang Normal University, Huanggang, PR China
| | - Kuo-Tung Tang
- Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- CONTACT Kuo-Tung Tang Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chi-Chien Lin
- Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
- Institute of Biomedical Science, The iEGG and Animal Biotechnology Center, National Chung-Hsing University, Taichung, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Chi-Chien Lin Institute of Biomedical Science, National Chung Hsing University, 145 Xingda Rd., South Dist., Taichung402, Taiwan, ROC
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Yousefghahari B, Navari S, Sadeghi M, Soleimaniamiri S, Soleimaniamiri M, Heidari B, Babaei M, Ghodrati K, Guran A, Gholinia H. Risk of COVID-19 infection in patients with rheumatic disease taking disease-modifying anti-rheumatic drugs. Clin Rheumatol 2021; 40:4309-4315. [PMID: 34052904 PMCID: PMC8164488 DOI: 10.1007/s10067-021-05779-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with rheumatic disease taking long-term disease-modifying anti-rheumatic drugs (DMARDs) are expected to have a higher risk of infection due to the alterations in cellular immunity associated with these medications. However, the potential risks associated with these drugs remain unclear. This study aimed to estimate the risk of COVID-19 infection in patients with rheumatic disease taking disease-modifying anti-rheumatic drugs. METHODS Patients with autoimmune rheumatic disease taking DMARDs with or without long-term (> 6 months) HCQ treatment prior to the COVID-19 outbreak were selected consecutively. The diagnosis of COVID-19 was made based on the history of symptoms suggestive of the disease and/or serum IgG positivity. During statistical analysis, the risk of COVID-19 infection was calculated in rheumatic patients taking DMARDs versus controls, as well as in patients taking HCQ versus those who are not. The ORs and 95% CIs were also calculated. The participants in the control group were selected from individuals without RD. RESULTS A total of 800 patients with RD and 449 controls were analyzed. COVID-19 infection was detected in 16.8% of rheumatic patients versus 17.6% of controls (OR 0.95; 95% CI 0.7-1.28). The proportions of COVID-19 infection in HCQ users versus non-users were 15.3% and 18.1%, respectively (OR 0.87; 95% CI 0.61-1.26). These results remained unchanged after adjusting for all covariates using logistic regression analysis. CONCLUSION These findings indicate that rheumatic patients taking DMARDs are not at a higher risk of COVID-19 infection, and that HCQ therapy has no influence on the risk of COVID-19 infection. Key points • The risk of COVID-19 infection is not higher in patients with RD on DMARD therapy. • The prevalence of COVID-19 infection in HCQ users has not significant difference relative to non-users. • Significant percent of RD patients taking DMARDs had asymptomatic infection. • There was a positive association between leflunamide therapy and the risk of COVID-19 infection.
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Affiliation(s)
- Behnaz Yousefghahari
- Clinical Research Development Unit of Rohani Hospital, Babol University of Medical Sciences, Ganjafrooz Ave, Babol, Iran.
| | - Sanaz Navari
- Babol University of Medical Sciences, Babol, Iran
| | - Mahmoud Sadeghi
- Clinical Research Development Unit of Rohani Hospital, Babol University of Medical Sciences, Ganjafrooz Ave, Babol, Iran
| | | | | | - Behzad Heidari
- Clinical Research Development Unit of Rohani Hospital, Babol University of Medical Sciences, Ganjafrooz Ave, Babol, Iran
| | - Mansour Babaei
- Clinical Research Development Unit of Rohani Hospital, Babol University of Medical Sciences, Ganjafrooz Ave, Babol, Iran
| | | | | | - Hemmat Gholinia
- Clinical Research Development Unit of Rohani Hospital, Babol University of Medical Sciences, Ganjafrooz Ave, Babol, Iran
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Abatacept is Efficacious in the Treatment of Older Patients with csDMARD-Refractory Rheumatoid Arthritis: A Prospective, Multicenter, Observational Study. Rheumatol Ther 2021; 8:1585-1601. [PMID: 34448173 PMCID: PMC8572263 DOI: 10.1007/s40744-021-00356-2] [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: 05/24/2021] [Accepted: 08/02/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Abatacept efficacy in older patients with rheumatoid arthritis (RA) has been primarily demonstrated via retrospective comparisons with younger patients. The objective of this study was to compare efficacy of abatacept in older vs. younger patients with RA, and efficacy of abatacept with that of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) in both age groups. METHODS This prospective, multicenter, observational study (UMIN000014913) enrolled csDMARD-refractory patients without previous biological DMARD treatment. Abatacept (A) or csDMARDs (C) were administered at the treating physician's discretion to older (O, ≥ 65 years) and younger (Y, 20-64 years) patients, producing AO, AY, CO, and CY groups. Clinical efficacy after 24 weeks was evaluated using European League Against Rheumatism (EULAR) erythrocyte sedimentation rate response criteria. RESULTS Overall, 202 patients were evaluated. Compared with the CO group, more patients in the AO group achieved a EULAR good or moderate response (p < 0.0001). Compared with the CY group, more patients in the AY group achieved a EULAR good or moderate response (p < 0.01). Similar proportions of patients in the AO and AY groups achieved a EULAR good response or a good or moderate response. Few adverse events were reported. CONCLUSIONS This prospective study demonstrated that abatacept is efficacious and safe in older patients with RA and a history of being refractory to csDMARDs. Abatacept was shown to be more efficacious than adding or switching to a new csDMARD in both younger and older csDMARD-refractory patients with RA. TRIAL REGISTRATION UMIN000014913.
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11
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Miri A, Sato AI, Sewell RK, Huang-Pacheco A. Pott's Puffy Tumor in an Inflammatory Bowel Disease Patient on Anti-TNF Therapy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929892. [PMID: 34032782 PMCID: PMC8165497 DOI: 10.12659/ajcr.929892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patient: Male, 14-year-old Final Diagnosis: Pott’s puffy tumor Symptoms: Face swelling Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Infectious Diseases • Otolaryngology • Pediatrics and Neonatology
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Affiliation(s)
- Ahmad Miri
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Alice I Sato
- Department of Pediatrics Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pediatrics Infectious Disease, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Ryan K Sewell
- Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Ear, Nose and Throat, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Andrew Huang-Pacheco
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital and Medical Center, Omaha, NE, USA
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12
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Favalli EG, Maioli G, Biggioggero M, Caporali R. Clinical management of patients with rheumatoid arthritis during the COVID-19 pandemic. Expert Rev Clin Immunol 2021; 17:561-571. [PMID: 33787418 DOI: 10.1080/1744666x.2021.1908887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) pandemic raises a great challenge in the management of patients with rheumatoid arthritis (RA), which are generally more susceptible to infection events because of the autoimmune condition itself and the treatment with immunomodulatory drugs. The use of disease-modifying anti-rheumatic drugs (DMARDs), including biologics and targeted-synthetic DMARDs, has aroused particular interest because of both their immunosuppressive effects and their hypothetical potential in COVID-19 treatment.Areas covered: For this narrative review, a literature search was conducted between December 2019 and February 2021 on PubMed including epidemiological studies, gathering the main evidence available to date about the impact of COVID-19 on RA patients and the influence of anti-rheumatic drugs on patients' susceptibility to this infection. We also summarize the recommendations from the international guidelines on the management of rheumatic diseases and treatments in this pandemic context, especially focused on RA.Expert opinion: About a year after the outbreak of the pandemic, we are able to answer some of the most relevant questions regarding patients with RA and their management in this pandemic context. Our efforts must now be directed toward consolidating the currently available data with more rigorous studies and facing new issues and challenges including, foremost, vaccination.
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Affiliation(s)
- Ennio Giulio Favalli
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milano, Italy
| | - Gabriella Maioli
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milano, Italy
| | - Martina Biggioggero
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milano, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milano, Italy.,Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università Degli Studi Di Milano, Milano, Italy
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13
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Tang KT, Lin CC, Lin SC, Wang JH, Tsai SW. Kurarinone Attenuates Collagen-Induced Arthritis in Mice by Inhibiting Th1/Th17 Cell Responses and Oxidative Stress. Int J Mol Sci 2021; 22:ijms22084002. [PMID: 33924467 PMCID: PMC8069507 DOI: 10.3390/ijms22084002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/18/2022] Open
Abstract
Kurarinone is a flavanone, extracted from Sophora flavescens Aiton, with multiple biological effects. Here, we determine the therapeutic potential of kurarinone and elucidate the interplay between kurarinone and the autoimmune disease rheumatoid arthritis (RA). Arthritis was recapitulated by induction of bovine collagen II (CII) in DBA/1 mice as a collagen-induced arthritis (CIA) model. After the establishment of the CIA, kurarinone was given orally from day 21 to 42 (100 mg/kg/day) followed by determination of the severity based on a symptom scoring scale and with histopathology. Levels of cytokines, anti-CII antibodies, and the proliferation and lineages of T cells from the draining lymph nodes were measured using ELISA and flow cytometry, respectively. The expressional changes, including STAT1, STAT3, Nrf2, KEAP-1, and heme oxygenase-1 (HO-1) changes in the paw tissues, were evaluated by Western blot assay. Oxidative stress featured with malondiadehyde (MDA) and hydrogen peroxide (H2O2) activities in paw tissues were also evaluated. Results showed that kurarinone treatment reduced arthritis severity of CIA mice, as well as their levels of proinflammatory cytokines, TNF-α, IL-6, IFN-γ, and IL-17A, in the serum and paw tissues. T cell proliferation was also reduced by kurarinone even under the stimulation of CII and anti-CD3 antibody. In addition, kurarinone reduced STAT1 and STAT3 phosphorylation and the proportions of Th1 and Th17 cells in lymph nodes. Moreover, kurarinone suppressed the production of MDA and H2O2. All while promoting enzymatic activities of key antioxidant enzymes, SOD and GSH-Px. In the paw tissues, upregulation of Nrf-2 and HO-1, and downregulation of KEAP-1 were observed. Overall, kurarinone showed an anti-inflammatory effect by inhibiting Th1 and Th17 cell differentiation and an antioxidant effect exerted in part through activating the Nrf-2/KEAP-1 pathway. These beneficial effects in CIA mice contributed to the amelioration of their arthritis, indicating that kurarinone might be an adjunct treatment option for rheumatoid arthritis.
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Affiliation(s)
- Kuo-Tung Tang
- Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan; (K.-T.T.); (C.-C.L.)
- Faculty of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chi-Chien Lin
- Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan; (K.-T.T.); (C.-C.L.)
- Institute of Biomedical Science, The iEGG and Animal Biotechnology Center, National Chung-Hsing University, Taichung 402, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Shih-Chao Lin
- Bachelor Degree Program in Marine Biotechnology, College of Life Sciences, National Taiwan Ocean University, Keelung 202, Taiwan;
| | - Jou-Hsuan Wang
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan;
| | - Sen-Wei Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Correspondence:
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Sharma D, Chaubey P, Suvarna V. Role of natural products in alleviation of rheumatoid arthritis-A review. J Food Biochem 2021; 45:e13673. [PMID: 33624882 DOI: 10.1111/jfbc.13673] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/15/2022]
Abstract
Rheumatoid arthritis (RHA) is one of the most prevalent complex, chronic, inflammatory diseases, manifested by elevated oxidative stress and inflammatory biomarkers. Prolonged administration of NSAIDs, steroids, and DMARDs, used in the treatment of RHA, is associated with deleterious side effects. This necessitates the urge of new and safe approaches for RHA management, based on the complementary and alternative system of medicine. Documented evidences have suggested that supplementation with nutritional, dietary, and herbal components; can play a crucial role as an adjuvant, in the alleviation of the RHA symptoms, through their influence on the pathological inflammatory processes. Dietary phenolic compounds, flavonoids, carotenoids, and alkaloids with their ability to modulate prooxidant and pro-inflammatory pathways, have been effective in delaying the arthritic disease progression. Moreover, in scientific explorations, herbs containing phenolic compounds, alkaloids, carotenoids flavonoids, spices such as ginger, turmeric, Ayurvedic formulations, different diets such as Mediterranean diet, vegan diet, beverages, and oils such as sesame oil, rice bran oil, vitamins, and probiotics are proven to modulate the action of inflammatory molecules, involved in RHA pathology. Subsequently, the purpose of this review article is to summarize various in vitro, in vivo, and clinical studies in RHA, which have documented remarkable insights into the anti-inflammatory, antioxidant, analgesic, and immunomodulatory, bone erosion preventing properties of dietary, nutritional, and herbal components with the focus on their molecular level mechanisms involved in RHA. Even though major findings were derived from in vitro studies, several in vivo and clinical studies have established the use of diet, herbal, and nutritional management in RHA treatment. PRACTICAL APPLICATIONS: Thickening of the synovial membrane, bone erosion, and cartilage destruction is known to trigger rheumatoid arthritis causing inflammation and pain in bone joints. Continuous intake of NSAIDs, steroids, and DMARD therapy are associated with detrimental side effects. These side effects can be overcome by the use of dietary, nutritional, and herbal interventions based on the complementary and alternative therapy. This concept portrays the food components and other natural components having the potential to promote health, improve general well-being, and reduce the risk of RHA.
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Affiliation(s)
- Dhvani Sharma
- SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Mumbai, India
| | - Pramila Chaubey
- College of Pharmacy, Shaqra University, Kingdom of Saudi Arabia, Saudi Arabia
| | - Vasanti Suvarna
- SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Mumbai, India
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15
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Bell J, Sequeira S, Kamalapathy P, Puvanesarajah V, Hassanzadeh H. Rheumatoid Arthritis Increases Risk of Medical Complications Following Posterior Lumbar Fusion. World Neurosurg 2021; 149:e729-e736. [PMID: 33548531 DOI: 10.1016/j.wneu.2021.01.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a systemic disease with prominent musculoskeletal manifestations that is associated with increased morbidity and mortality in patients undergoing cervical spine surgery; however, few studies have specifically examined postoperative outcomes in patients with RA following lumbar surgery. The aim of this study was to evaluate whether patients with RA who underwent posterior lumbar fusion experienced increased postoperative complications and economic burden compared with patients without RA. METHODS Patients <85 years old who underwent elective 1- or 2-level instrumented posterior lumbar fusion for degenerative lumbar pathology between 2006 and 2012 were identified in the Medicare insurance claims database. Same-day revisions and cases for spinal infection, malignancy, and trauma were excluded. The resulting cohort was divided into patients with RA before fusion and patients without RA (controls). All outcomes of interest were compared using multivariate regression. Reoperation-free survival at 1- and 2-year follow-up was analyzed used log-rank test. Significance was defined as P < 0.05. RESULTS RA patients had significantly higher risk of 90-day readmission (odds ratio [OR] = 1.27, P < 0.001), thromboembolic events (OR = 1.39, P = 0.010), sepsis (OR = 2.32, P < 0.001), pneumonia (OR = 1.57, P = 0.001), and wound complications (OR = 1.41, P < 0.001). Reoperation-free survival was significantly lower in RA patients at 2-year follow-up (90.4% vs. 92.4%, P < 0.001). Following adjusted regression, RA independently contributed to a $1491 increase in additional 90-day costs (P < 0.001). CONCLUSIONS Preexisting RA may increase risk for short-term postoperative medical complications following posterior lumbar fusion, specifically infectious events. In addition, patients with RA have higher rates of subsequent reoperation following index surgery. Patients with RA be should counseled regarding these risks.
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Affiliation(s)
- Joshua Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sean Sequeira
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
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16
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Grainger R, Machado PM, Robinson PC. Novel coronavirus disease-2019 (COVID-19) in people with rheumatic disease: Epidemiology and outcomes. Best Pract Res Clin Rheumatol 2020; 35:101657. [PMID: 33468418 PMCID: PMC7756169 DOI: 10.1016/j.berh.2020.101657] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is concern that people with rheumatic disease, often treated with immunosuppressive or immunomodulatory medication, may be at an increased risk of poor outcomes of novel coronavirus disease-2019 (COVID-19). However, hyperinflammation is a major cause of morbidity and mortality in COVID-19 and treatment with glucocorticoids has been shown to improve outcomes in patients with severe COVID-19. Therefore, uncertainty exists about continuing or withholding immune therapies with the risk of infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review covers the current knowledge with respect to the risk of infection and outcomes and risk factors for poor outcomes in patients with rheumatic disease. We also discuss data from other immune-mediated diseases and its relevance to patients with rheumatic disease. In addition, we cover the limitations of the research efforts to date and how the current knowledge translates into practice guidance. Finally, we discuss our vision of the future research agenda.
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Affiliation(s)
- Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand; Hutt Valley District Health Board, Lower Hutt, Wellington, New Zealand.
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, United Kingdom; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Philip C Robinson
- University of Queensland School of Clinical Medicine, HERSTON, QLD, Australia; Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, HERSTON, QLD, Australia
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17
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Berkovic D, Ackerman IN, Briggs AM, Ayton D. Tweets by People With Arthritis During the COVID-19 Pandemic: Content and Sentiment Analysis. J Med Internet Res 2020; 22:e24550. [PMID: 33170802 PMCID: PMC7746504 DOI: 10.2196/24550] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Emerging evidence suggests that people with arthritis are reporting increased physical pain and psychological distress during the COVID-19 pandemic. At the same time, Twitter's daily usage has surged by 23% throughout the pandemic period, presenting a unique opportunity to assess the content and sentiment of tweets. Individuals with arthritis use Twitter to communicate with peers, and to receive up-to-date information from health professionals and services about novel therapies and management techniques. OBJECTIVE The aim of this research was to identify proxy topics of importance for individuals with arthritis during the COVID-19 pandemic, and to explore the emotional context of tweets by people with arthritis during the early phase of the pandemic. METHODS From March 20 to April 20, 2020, publicly available tweets posted in English and with hashtag combinations related to arthritis and COVID-19 were extracted retrospectively from Twitter. Content analysis was used to identify common themes within tweets, and sentiment analysis was used to examine positive and negative emotions in themes to understand the COVID-19 experiences of people with arthritis. RESULTS In total, 149 tweets were analyzed. The majority of tweeters were female and were from the United States. Tweeters reported a range of arthritis conditions, including rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis. Seven themes were identified: health care experiences, personal stories, links to relevant blogs, discussion of arthritis-related symptoms, advice sharing, messages of positivity, and stay-at-home messaging. Sentiment analysis demonstrated marked anxiety around medication shortages, increased physical symptom burden, and strong desire for trustworthy information and emotional connection. CONCLUSIONS Tweets by people with arthritis highlight the multitude of concurrent concerns during the COVID-19 pandemic. Understanding these concerns, which include heightened physical and psychological symptoms in the context of treatment misinformation, may assist clinicians to provide person-centered care during this time of great health uncertainty.
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Affiliation(s)
- Danielle Berkovic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Akram MS, Pery N, Butler L, Shafiq MI, Batool N, Rehman MFU, Grahame-Dunn LG, Yetisen AK. Challenges for biosimilars: focus on rheumatoid arthritis. Crit Rev Biotechnol 2020; 41:121-153. [PMID: 33040628 DOI: 10.1080/07388551.2020.1830746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Healthcare systems worldwide are struggling to find ways to fund the cost of innovative treatments such as gene therapies, regenerative medicine, and monoclonal antibodies (mAbs). As the world's best known mAbs are close to facing patent expirations, the biosimilars market is poised to grow with the hope of bringing prices down for cancer treatment and autoimmune disorders, however, this has yet to be realized. The development costs of biosimilars are significantly higher than their generic equivalents due to therapeutic equivalence trials and higher manufacturing costs. It is imperative that academics and relevant companies understand the costs and stages associated with biologics processing. This article brings these costs to the forefront with a focus on biosimilars being developed for Rheumatoid Arthritis (RA). mAbs have remarkably changed the treatment landscape, establishing their superior efficacy over traditional small chemicals. Five blockbuster TNFα mAbs, considered as first line biologics against RA, are either at the end of their patent life or have already expired and manufacturers are seeking to capture a significant portion of that market. Although in principle, market-share should be available, withstanding that the challenges regarding the compliance and regulations are being resolved, particularly with regards to variation in the glycosylation patterns and challenges associated with manufacturing. Glycan variants can significantly affect the quality attributes requiring characterization throughout production. Successful penetration of biologics can drive down prices and this will be a welcome change for patients and the healthcare providers. Herein we review the biologic TNFα inhibitors, which are on the market, in development, and the challenges being faced by biosimilar manufacturers.
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Affiliation(s)
- Muhammad Safwan Akram
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK.,National Horizons Centre, Teesside University, Darlington, UK
| | - Neelam Pery
- Institute of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan
| | - Lucy Butler
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK.,National Horizons Centre, Teesside University, Darlington, UK
| | | | - Nayab Batool
- Institute of Biochemistry and Biotechnology, University of the Punjab, Lahore, Pakistan
| | | | | | - Ali K Yetisen
- Department of Chemical Engineering, Imperial College London, London, UK
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Role of Infections in the Pathogenesis of Rheumatoid Arthritis: Focus on Mycobacteria. Microorganisms 2020; 8:microorganisms8101459. [PMID: 32977590 PMCID: PMC7598258 DOI: 10.3390/microorganisms8101459] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease characterized by chronic erosive polyarthritis. A complex interaction between a favorable genetic background, and the presence of a specific immune response against a broad-spectrum of environmental factors seems to play a role in determining susceptibility to RA. Among different pathogens, mycobacteria (including Mycobacterium avium subspecies paratuberculosis, MAP), and Epstein–Barr virus (EBV), have extensively been proposed to promote specific cellular and humoral response in susceptible individuals, by activating pathways linked to RA development. In this review, we discuss the available experimental and clinical evidence on the interplay between mycobacterial and EBV infections, and the development of the immune dysregulation in RA.
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Zhong J, Shen G, Yang H, Huang A, Chen X, Dong L, Wu B, Zhang A, Su L, Hou X, Song S, Li H, Zhou W, Zhou T, Huang Q, Chu A, Braunstein Z, Rao X, Ye C, Dong L. COVID-19 in patients with rheumatic disease in Hubei province, China: a multicentre retrospective observational study. THE LANCET. RHEUMATOLOGY 2020; 2:e557-e564. [PMID: 32838309 PMCID: PMC7333992 DOI: 10.1016/s2665-9913(20)30227-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND In the ongoing COVID-19 pandemic, the susceptibility of patients with rheumatic diseases to COVID-19 remains unclear. We aimed to investigate susceptibility to COVID-19 in patients with autoimmune rheumatic diseases during the ongoing COVID-19 pandemic. METHODS We did a multicentre retrospective study of patients with autoimmune rheumatic diseases in Hubei province, the epicentre of the COVID-19 outbreak in China. Patients with rheumatic diseases were contacted through an automated telephone-based survey to investigate their susceptibility to COVID-19. Data about COVID-19 exposure or diagnosis were collected. Families with a documented history of COVID-19 exposure, as defined by having at least one family member diagnosed with COVID-19, were followed up by medical professionals to obtain detailed information, including sex, age, smoking history, past medical history, use of medications, and information related to COVID-19. FINDINGS Between March 20 and March 30, 2020, 6228 patients with autoimmune rheumatic diseases were included in the study. The overall rate of COVID-19 in patients with an autoimmune rheumatic disease in our study population was 0·43% (27 of 6228 patients). We identified 42 families in which COVID-19 was diagnosed between Dec 20, 2019, and March 20, 2020, in either patients with a rheumatic disease or in a family member residing at the same physical address during the outbreak. Within these 42 families, COVID-19 was diagnosed in 27 (63%) of 43 patients with a rheumatic disease and in 28 (34%) of 83 of their family members with no rheumatic disease (adjusted odds ratio [OR] 2·68 [95% CI 1·14-6·27]; p=0·023). Patients with rheumatic disease who were taking hydroxychloroquine had a lower risk of COVID-19 infection than patients taking other disease-modifying anti-rheumatic drugs (OR 0·09 [95% CI 0·01-0·94]; p=0·044). Additionally, the risk of COVID-19 was increased with age (adjusted OR 1·04 [95%CI 1·01-1·06]; p=0·0081). INTERPRETATION Patients with autoimmune rheumatic disease might be more susceptible to COVID-19 infection than the general population. FUNDING National Natural Science Foundation of China and the Tongji Hospital Clinical Research Flagship Program.
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Affiliation(s)
- Jixin Zhong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guifen Shen
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huiqin Yang
- Department of Rheumatology and Immunology, Wuhan No.1 Hospital, Wuhan, Hubei, China
| | - Anbin Huang
- Department of Rheumatology and Immunology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoqi Chen
- Department of Rheumatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Li Dong
- Department of Rheumatology and Immunology, Jingzhou City Central Hospital of Hubei Province, Jingzhou, Hubei, China
| | - Bin Wu
- Department of Rheumatology and Immunology, The First People's Hospital of Jingzhou, Jingzhou, Hubei, China
| | - Anbin Zhang
- Department of Rheumatology and Immunology, Xiangyang Central Hospital, Xiangyang, Hubei, China
| | - Linchong Su
- Department of Rheumatology and Immunology, Minda Hospital of Hubei Minzu University, Enshi, China
| | - Xiaoqiang Hou
- The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei, China
| | - Shulin Song
- Department of Rheumatology and Immunology, The First People's Hospital of Yichang, Yichang, Hubei, China
| | - Huiling Li
- Department of Rheumatology and Immunology, The Traditional Chinese Medical Hospital of Hubei Province, Wuhan, Hubei, China
| | - Wenyu Zhou
- Department of Rheumatology and Immunology, Wuhan Fourth Hospital (Puai Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tao Zhou
- Department of Rheumatology and Immunology, Wuhan Puren Hospital affiliated to Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Qin Huang
- Department of Nephrology and Rheumatology, Enshi Tujia and Miao Autonomous Prefecture Central Hospital, Enshi, Hubei, China
| | - Aichun Chu
- Department of Prevention and Health Care, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | | | - Xiaoquan Rao
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Cong Ye
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lingli Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,Correspondence to: Prof Lingli Dong, Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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Chung TT, Ko HJ, Lau CS, Chung HY. A retrospective study on the risk of tuberculosis in patients with rheumatoid arthritis. Rheumatol Int 2020; 40:983-990. [PMID: 32318800 DOI: 10.1007/s00296-020-04583-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022]
Abstract
Tuberculosis (TB) is an important preventable infection in patients with rheumatoid arthritis (RA). To determine the risk of TB in patients with RA by comparing with those with non-specific back pain (NSBP), and to identify the risk factors in the RA group. Medical data were retrieved from a centralized electronic database. A total of 1099 patients with RA and 2489 patients with NSBP were identified. Clinical data, comorbidities, and use of individual disease-modifying anti-rheumatic drugs (DMARDs) were retrieved. Risks of TB in patients with RA and NSBP were compared by propensity score (PS) adjusted analysis with known or potential risk factors for TB. Risk factors of TB were also determined in patients with RA. There were 14 cases of TB in RA group and 25 cases in NSBP group. Median duration of follow-up were 11.3 (0.1-21.9) years in RA group and 15.4 (0.1-24.4) years in NSBP group. The risk of TB in patients with RA was 2.53 times higher (HR 2.53; 95% CI 1.29, 4.94; p < 0.01) than in patients with NSBP. After excluding patients on DMARDs, the risk became similar (HR 2.72; 95% CI 0.81, 9.14; p = 0.11). Independent risk factors found were etanercept (HR 7.16; 95% CI 1.41, 36.30; p = 0.02), and previous TB infection (HR 25.23; 95% CI 6.99, 91.09; p < 0.001). The risk of extrapulmonary involvement between RA and NSBP groups was similar (HR 1.21; 95% CI 0.22, 6.57; p = 0.83). The risk of TB was increased in patients with RA. Anti-TNF therapy was an identified risk factor.
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Affiliation(s)
- Tin Tsun Chung
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Ho Juen Ko
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- University College London, London, UK
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.
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Kuo CF, Burns PB, Chen JS, Wang L, Chung KC. Risk of preventable hospitalization before and after diagnosis among rheumatoid arthritis patients compared to non-rheumatoid arthritis controls. Joint Bone Spine 2019; 87:149-156. [PMID: 31811929 DOI: 10.1016/j.jbspin.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of the study is to investigate the risk of preventable hospitalization among patients with rheumatoid arthritis (RA). METHODS We identified 11,852 incident RA patients and 59,260 age-, sex-, and index year-matched controls from the Taiwan National Health Insurance Database. Index date was the RA diagnosis date for cases, which was assigned to their matched controls. The odds ratios (OR) of preventable hospitalizations between RA patients and controls were estimated using a mixed effect model adjusted for age, sex, patient characteristics, Elixhauser comorbidity index, medical utilization and regional medical resources. RESULTS The overall annualized incidence of preventable hospitalization in RA patients and controls was 38.7 vs. 20.9 events per 1,000 person-years (adjusted OR, 1.61; 95% confidence interval [CI], 1.51-1.71). The adjusted OR of preventable hospitalization in RA patients compared to matched controls was 1.17 (1.00-1.37) one year prior to RA diagnosis and remained elevated after RA diagnosis. Adjusted ORs (95% CI) for specific preventable hospitalization categories were 1.93 (1.58-2.36) for chronic obstructive pulmonary disease, 1.64 (1.21-2.21) for asthma, 1.95 (1.78-2.13) for bacterial pneumonia, and 1.59 (1.44-1.75) for urinary tract infection. When assessing the trend of individual preventable hospitalizations before and after diagnosis, bacterial pneumonia and urinary tract infection hospitalizations had a significantly higher OR in RA patients one year before diagnosis and five years afterward (adjusted OR ranges 2.75 to 4.48 and 1.83 to 3.07 respectively, all P-values<0.05) CONCLUSION: RA is independently associated with a higher risk of preventable hospitalization specifically for chronic lung diseases and infections.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK; Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Patricia B Burns
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Jung-Sheng Chen
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lu Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, United States.
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Seto R, Mathias LM, Kelly A, Panush RS. Should a patient with rheumatoid arthritis be a kidney donor? Clin Rheumatol 2018; 38:251-256. [PMID: 30411174 DOI: 10.1007/s10067-018-4350-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022]
Abstract
We cared for a woman with sero-positive rheumatoid arthritis (RA), in clinical remission on oral methotrexate (MTX) and hydroxychloroquine, who wished to donate a kidney to a brother with end-stage renal disease (ESRD). We could find scant literature about this unusual clinical circumstance, and therefore review pertinent aspects of renal disease in RA, perioperative medical management, maintenance of disease remission, outcomes for RA patients who have donated kidneys, and relevant ethical issues. Renal complications in RA are not uncommon, with as many as 50% of patients at risk of reduced eGFR. This reflects anti-rheumatic and analgetic medication use (non-steroidal anti-inflammatory drugs, acetaminophen, DMARDs [cyclosporine and, historically, D-penicillamine and gold compounds], and others), glomerulitis, interstitial nephritis, complicating Sjogren's syndrome, vasculitis, or amyloidosis, and/or emergence of an "overlap" syndrome or other rheumatic disorder. The literature suggests that MTX need not be interrupted for surgery. The risk of perioperative infection to our patient would be low and remission should be sustained. We are aware of one study of six patients with RA who donated kidneys; they experienced no complications, ESRD, or deaths after a median follow-up of 8.2 years. Our ethical responsibilities are to balance patient autonomy of decision-making while assuring clinical beneficence and minimizing potential maleficence. Our perspective was that it would not be unreasonable to support this patient donating a kidney if, when fully informed, that remained her wish.
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Affiliation(s)
- Richard Seto
- Departments of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Lauren M Mathias
- Departments of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - Andrew Kelly
- Division of Rheumatology, Departments of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
- Philadelphia Hospital, Phildelphia, PA, USA
| | - Richard S Panush
- Division of Rheumatology, Departments of Medicine, Keck School of Medicine, University of Southern California and Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA.
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24
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Side effects of methotrexate therapy for rheumatoid arthritis: A systematic review. Eur J Med Chem 2018; 158:502-516. [PMID: 30243154 DOI: 10.1016/j.ejmech.2018.09.027] [Citation(s) in RCA: 295] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 12/27/2022]
Abstract
Methotrexate (MTX) is used as an anchor disease-modifying anti-rheumatic drugs (DMARDs) in treating rheumatoid arthritis (RA) because of its potent efficacy and tolerability. MTX benefits a large number of RA patients but partially suffered from side effects. A variety of side effects can be associated with MTX when treating RA patients, from mild to severe or discontinuation of the treatment. In this report, we reviewed the possible side effects that MTX might cause from the most common gastrointestinal toxicity effects to less frequent malignant diseases. In order to achieve regimen with less side effects, the administration of MTX with appropriate dose and a careful pretreatment inspection is necessary. Further investigations are required when combining MTX with other drugs so as to enhance the efficacy and reduce side effects at the same time. The management of MTX treatment is also discussed to provide strategies for occurred side effects. Thus, this review will provide scholars with a comprehensive understanding the side effects of MTX administration by RA patients.
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Staurengo-Ferrari L, Trevelin SC, Fattori V, Nascimento DC, de Lima KA, Pelayo JS, Figueiredo F, Casagrande R, Fukada SY, Teixeira MM, Cunha TM, Liew FY, Oliveira RD, Louzada-Junior P, Cunha FQ, Alves-Filho JC, Verri WA. Interleukin-33 Receptor (ST2) Deficiency Improves the Outcome of Staphylococcus aureus-Induced Septic Arthritis. Front Immunol 2018; 9:962. [PMID: 29867945 PMCID: PMC5968393 DOI: 10.3389/fimmu.2018.00962] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/18/2018] [Indexed: 01/29/2023] Open
Abstract
The ST2 receptor is a member of the Toll/IL-1R superfamily and interleukin-33 (IL-33) is its agonist. Recently, it has been demonstrated that IL-33/ST2 axis plays key roles in inflammation and immune mediated diseases. Here, we investigated the effect of ST2 deficiency in Staphylococcus aureus-induced septic arthritis physiopathology. Synovial fluid samples from septic arthritis and osteoarthritis individuals were assessed regarding IL-33 and soluble (s) ST2 levels. The IL-33 levels in samples from synovial fluid were significantly increased, whereas no sST2 levels were detected in patients with septic arthritis when compared with osteoarthritis individuals. The intra-articular injection of 1 × 107 colony-forming unity/10 μl of S. aureus American Type Culture Collection 6538 in wild-type (WT) mice induced IL-33 and sST2 production with a profile resembling the observation in the synovial fluid of septic arthritis patients. Data using WT, and ST2 deficient (−/−) and interferon-γ (IFN-γ)−/− mice showed that ST2 deficiency shifts the immune balance toward a type 1 immune response that contributes to eliminating the infection due to enhanced microbicide effect via NO production by neutrophils and macrophages. In fact, the treatment of ST2−/− bone marrow-derived macrophage cells with anti-IFN-γ abrogates the beneficial phenotype in the absence of ST2, which confirms that ST2 deficiency leads to IFN-γ expression and boosts the bacterial killing activity of macrophages against S. aureus. In agreement, WT cells achieved similar immune response to ST2 deficiency by IFN-γ treatment. The present results unveil a previously unrecognized beneficial effect of ST2 deficiency in S. aureus-induced septic arthritis.
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Affiliation(s)
- Larissa Staurengo-Ferrari
- Departamento de Patologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Brazil
| | - Silvia C Trevelin
- Cardiovascular Division, British Heart Foundation Centre, King's College London, London, United Kingdom.,Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Victor Fattori
- Departamento de Patologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Brazil
| | - Daniele C Nascimento
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Kalil A de Lima
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Jacinta S Pelayo
- Departamento de Microbiologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Brazil
| | - Florêncio Figueiredo
- Laboratory of Pathology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | - Rubia Casagrande
- Department of Pharmaceutical Sciences, Healthy Sciences Centre, Londrina State University, Londrina, Brazil
| | - Sandra Y Fukada
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Mauro M Teixeira
- Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Instituto de Ciencias Biologicas (ICB), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thiago M Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Foo Y Liew
- Division of Immunology, Infection and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Rene D Oliveira
- Division of Clinical Immunology, School of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Paulo Louzada-Junior
- Division of Clinical Immunology, School of Medicine of Ribeirao Preto, University of São Paulo, Ribeirao Preto, Brazil
| | - Fernando Q Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - José C Alves-Filho
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Waldiceu A Verri
- Departamento de Patologia, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Londrina, Brazil
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26
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Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections. Int J Mol Sci 2017; 18:ijms18020293. [PMID: 28146077 PMCID: PMC5343829 DOI: 10.3390/ijms18020293] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 12/11/2022] Open
Abstract
Systemic rheumatic diseases have significant morbidity and mortality, due in large part to concurrent infections. The lung has been reported among the most frequent sites of infection in patients with rheumatic disease, who are susceptible to developing pneumonia sustained both by common pathogens and by opportunistic microorganisms. Patients with rheumatic disease show a peculiar vulnerability to infectious complications. This is due in part to intrinsic disease-related immune dysregulation and in part to the immunosuppressive treatments. Several therapeutic agents have been associated to a wide spectrum of infections, complicating the management of rheumatic diseases. This review discusses the most frequent pulmonary infections encountered in rheumatic diseases, focusing on opportunistic agents, consequent diagnostic challenges and appropriate therapeutic strategies.
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27
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Stevens EM, Frendø M, von Buchwald C. Late diagnosis of odontogenic sinusitis with near-fatal outcome - a case report. Clin Case Rep 2016; 4:261-4. [PMID: 27014448 PMCID: PMC4771853 DOI: 10.1002/ccr3.485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 11/30/2015] [Accepted: 12/16/2015] [Indexed: 11/17/2022] Open
Abstract
Subdural empyema is a rare but potentially life‐threatening complication to sinusitis. Awareness of infection and early diagnosis is of the essence when dealing with a putatively immunosuppressed patient. Furthermore, patients at increased risk of infections due to immunosuppression need to be fully informed of risks associated with their treatment.
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Affiliation(s)
- Elizabeth M Stevens
- Department of Otolaryngology, Head and Neck Surgery and Audiology Rigshospitalet Copenhagen University Hospital Blegdamsvej 9 DK 2100 Copenhagen Denmark
| | - Martin Frendø
- Department of Otolaryngology, Head and Neck Surgery and Audiology Rigshospitalet Copenhagen University Hospital Blegdamsvej 9 DK 2100 Copenhagen Denmark
| | - Christian von Buchwald
- Department of Otolaryngology, Head and Neck Surgery and Audiology Rigshospitalet Copenhagen University Hospital Blegdamsvej 9 DK 2100 Copenhagen Denmark
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28
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Lau CS, Chia F, Harrison A, Hsieh TY, Jain R, Jung SM, Kishimoto M, Kumar A, Leong KP, Li Z, Lichauco JJ, Louthrenoo W, Luo SF, Nash P, Ng CT, Park SH, Suryana BPP, Suwannalai P, Wijaya LK, Yamamoto K, Yang Y, Yeap SS. APLAR rheumatoid arthritis treatment recommendations. Int J Rheum Dis 2015; 18:685-713. [DOI: 10.1111/1756-185x.12754] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Chak Sing Lau
- Division of Rheumatology and Clinical Immunology; Queen Mary Hospital; University of Hong Kong; Hong Kong
| | - Faith Chia
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore City Singapore
| | - Andrew Harrison
- Department of Medicine; University of Otago Wellington; Wellington South New Zealand
| | - Tsu-Yi Hsieh
- Section of Allergy, Immunology and Rheumatology, and Section of Clinical Skills Training; Taichung Veterans General Hospital; Taichung Taiwan
| | | | - Seung Min Jung
- Division of Rheumatology; Department of Internal Medicine; The Catholic University of Korea; St. Mary's Hospital; Seoul South Korea
| | | | - Ashok Kumar
- Department of Rheumatology; Fortis Flt. Lt Rajan Dhall Hospital; New Delhi India
| | - Khai Pang Leong
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore City Singapore
| | - Zhanguo Li
- Department of Rheumatology; Peking University People's Hospital; Beijing China
| | | | - Worawit Louthrenoo
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology; Chang Gung Memorial Hospital and Chang Gung University; Tao-Yuan Taiwan
| | - Peter Nash
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Chin Teck Ng
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Sung-Hwan Park
- Division of Rheumatology; Department of Internal Medicine; The Catholic University of Korea; St. Mary's Hospital; Seoul South Korea
| | - Bagus Putu Putra Suryana
- Rheumatology Division; Department of Internal Medicine; Brawijaya University; Saiful Anwar General Hospital; Malang Indonesia
| | - Parawee Suwannalai
- Allergy, Immunology and Rheumatology Division; Internal Medicine Department; Faculty of Medicine; Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Linda Kurniaty Wijaya
- Division of Rheumatology; Department of Internal Medicine; University of Indonesia; Jakarta Indonesia
| | - Kazuhiko Yamamoto
- Department of Allergy and Rheumatology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yue Yang
- Department of Rheumatology; Peking University People's Hospital; Beijing China
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29
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Downey C. Serious infection during etanercept, infliximab and adalimumab therapy for rheumatoid arthritis: A literature review. Int J Rheum Dis 2015. [DOI: 10.1111/1756-185x.12659] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Colum Downey
- Graduate Entry Medical School; University of Limerick; Limerick Ireland
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30
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Therapeutic effects of hybrid liposomes with downregulation of inflammatory cytokine for model mice of rheumatoid arthritis in vivo. Bioorg Med Chem Lett 2015; 25:2686-9. [PMID: 25978959 DOI: 10.1016/j.bmcl.2015.04.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/14/2015] [Accepted: 04/22/2015] [Indexed: 01/17/2023]
Abstract
Therapeutic effects of HL for a collagen-induced arthritis (CIA) mouse models of HL-23 composed of 95mol% l-α-dimyristoylphosphatidylcholine (DMPC) and 5mol% polyoxyethylenedodecylether (C12(EO)23) in vivo were examined. Remarkably high therapeutic effects of HL-23 for CIA mouse models were obtained on the basis of clinical assessment of arthritis. The reduction of hyperplastic synovial membrane (pannus tissue) and destruction of the cartilage and bone by HL-23 was revealed on the basis of hematoxylin and eosin (HE) and safranin O staining. Furthermore, the downregulation of inflammatory cytokines such as interleukin (IL)-1β, tumor necrosis factor (TNF)-α, and IL-6 for CIA mouse models treated with HL-23 were investigated. Remarkably high therapeutic effects without joint swelling were obtained in CIA mouse models treated with HL-23.
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31
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Jamilloux Y, Valeyre D, Lortholary O, Bernard C, Kerever S, Lelievre L, Neel A, Broussolle C, Seve P. The spectrum of opportunistic diseases complicating sarcoidosis. Autoimmun Rev 2015; 14:64-74. [PMID: 25305373 DOI: 10.1016/j.autrev.2014.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/23/2014] [Indexed: 12/21/2022]
Abstract
Sarcoidosis is an inflammatory disease marked by a paradoxical immune status. The anergic state, which results from various immune defects, contrasts with the inflammatory formation of granulomas. Sarcoidosis patients may be at risk for opportunistic infections (OIs) and a substantial number of cases have been reported, even in untreated sarcoidosis. It is not clear how OIs in patients with sarcoidosis are different from other groups at risk. In this review, we discuss the most common OIs: mycobacterial infection (including tuberculosis), cryptococcosis, progressive multifocal leukoencephalopathy, and aspergillosis. Unlike peripheral lymphocytopenia, corticosteroids are a major risk factor for OIs but the occurrence of Ols in untreated patients suggests more complex predisposing mechanisms. Opportunistic infections presenting with extrapulmonary features are often misdiagnosed as new localizations of sarcoidosis. Aspergillomas mostly develop on fibrocystic lungs. Overall, physicians should be aware of the possible occurrence of OIs during sarcoidosis, even in untreated patients.
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Jang DW, Jeong I, Kim SJ, Kim SW, Park SY, Kwon YH, Jeong YO, Lee JY, Kim BS, Kim WS, Joh JS. Pulmonary cryptococcosis that mimicked rheumatoid nodule in rheumatoid arthritis lesion. Tuberc Respir Dis (Seoul) 2014; 77:266-70. [PMID: 25580144 PMCID: PMC4286785 DOI: 10.4046/trd.2014.77.6.266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/04/2014] [Accepted: 08/28/2014] [Indexed: 11/24/2022] Open
Abstract
Recently, the incidence of pulmonary cryptococcosis is gradually increasing in rheumatoid arthritis (RA) patients. Pulmonary rheumatoid nodules (PRN) are rare manifestations of RA. Eighteen months ago, a 65-year old woman was admitted to hospital due to multiple nodules (2.5×2.1×2 cm) with cavitations in the right lower lobe. She was diagnosed with RA three year ago. She had been taking methotrexate, leflunomide, and triamcinolone. A video-assisted thoracoscopic surgery biopsy was performed and PRN was diagnosed. However, a newly growing huge opacity with cavitation was detected in the same site. Pulmonary cryptococcal infection was diagnosed through a transthoracic computed tomograpy guided needle biopsy. Cryptococcus antigen was detected in serum but not in cerebrospinal fluid. The patient was treated with oral fluconazole which resulted clinical improvement and regression of the nodule on a series of radiography. Herein, we report the case of pulmonary cryptococcosis occurring in the same location as that of the PRN.
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Affiliation(s)
- Dong Won Jang
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Ina Jeong
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Seon Jae Kim
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Seok Won Kim
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Soo Yeon Park
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yong Hwan Kwon
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yeon Oh Jeong
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Ji Yeon Lee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Bo Sung Kim
- Department of Pathology, National Medical Center, Seoul, Korea
| | - Woo-Shik Kim
- Department of Thoracic and Cardiovascular Surgery, National Medical Center, Seoul, Korea
| | - Joon-Sung Joh
- Department of Internal Medicine, National Medical Center, Seoul, Korea
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Therapeutic effect of dimethyl dimethoxy biphenyl dicarboxylate on collagen-induced arthritis in rats. Chin J Integr Med 2014; 21:846-54. [PMID: 24584757 DOI: 10.1007/s11655-014-1746-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To study the effect of oral administration of dimethyl dimethoxy biphenyl dicarboxylate (DDB) on adjusting angiogeneic/inflammatory mediators and ameliorating the pathology of bones in rats with collagen-induced arthritis (CIA). METHODS Wistar rat model of CIA was set up using bovine collagen type II. Fifty rats were divided into five groups randomly: normal, CIA model, DDB treatment, methotrexate (MTX) treatment, and combined DDB+MTX treatment. Ankle joints of rats were imaged with digital X-ray machine to show the destruction of joints. Fore and hind paw and knee joints were removed above the ankle joint then processed for haematoxylin and eosin staining. Plasma levels of vascular endothelial growth factor (VEGF), platelet derived growth factor, interleukin-8 (IL-8), IL-4, tumor necrosis factor α (TNF-α), and cyclooxygenase-2 (COX-2) were quantified by enzyme-linked immunosorbent assay. Nitric oxide levels were detected by Griess reagent. RESULTS Compared with the CIA model group, a remarkable reduction in various angiogenic (VEGF and IL-8) and inflammatory mediators (TNF-α, IL-4 and COX-2) after treatment with DDB either alone or combined with MTX P<0.05 or P<0.01). Histopathological and X-ray findings were confirmatory to the observed DDB anti-arthritic effect. The DDB-treated group showed amelioration in signs of arthritis which appeared essentially similar to normal. CONCLUSION Our data shed light on the therapeutic efficacy of DDB in experimental rheumatoid arthritis (RA) compared with a choice drug (MTX) and it may be offered as a second-line drug in the treatment of RA.
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Miranda JV, Pinto Peñaranda LF, Muñoz Grajales C, Márquez Hernández JD, Rodríguez Padilla LM, Velásquez Franco CJ. Infecciones en pacientes con artritis reumatoide: medicamentos moduladores de la respuesta biológica versus fármacos modificadores de la enfermedad. Seguimiento a un año. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/s0121-8123(14)70144-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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OX40L blockade is therapeutic in arthritis, despite promoting osteoclastogenesis. Proc Natl Acad Sci U S A 2014; 111:2289-94. [PMID: 24469824 DOI: 10.1073/pnas.1321071111] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
An immune response is essential for protection against infection, but, in many individuals, aberrant responses against self tissues cause autoimmune diseases such as rheumatoid arthritis (RA). How to diminish the autoimmune response while not augmenting infectious risk is a challenge. Modern targeted therapies such as anti-TNF or anti-CD20 antibodies ameliorate disease, but at the cost of some increase in infectious risk. Approaches that might specifically reduce autoimmunity and tissue damage without infectious risk would be important. Here we describe that TNF superfamily member OX40 ligand (OX40L; CD252), which is expressed predominantly on antigen-presenting cells, and its receptor OX40 (on activated T cells), are restricted to the inflamed joint in arthritis in mice with collagen-induced arthritis and humans with RA. Blockade of this pathway in arthritic mice reduced inflammation and restored tissue integrity predominantly by inhibiting inflammatory cytokine production by OX40L-expressing macrophages. Furthermore, we identify a previously unknown role for OX40L in steady-state bone homeostasis. This work shows that more targeted approaches may augment the "therapeutic window" and increase the benefit/risk in RA, and possibly other autoimmune diseases, and are thus worth testing in humans.
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Fischer S, Agmon-Levin N, Shapira Y, Porat Katz BS, Graell E, Cervera R, Stojanovich L, Gómez Puerta JA, Sanmartí R, Shoenfeld Y. Toxoplasma gondii: bystander or cofactor in rheumatoid arthritis. Immunol Res 2014; 56:287-92. [PMID: 23553228 DOI: 10.1007/s12026-013-8402-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Parasitic infections may induce variable immunomodulatory effects and control of autoimmune disease. Toxoplasma gondii (T. gondii) is a ubiquitous intracellular protozoan that was recently associated with autoimmunity. This study was undertaken to investigate the seroprevalence and clinical correlation of anti-T. gondii antibodies in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We evaluated sera from European patients with RA (n = 125) and SLE (n = 164) for the prevalence of anti-T. gondii IgG antibodies (ATXAb), as well as other common infections such as Cytomegalovirus, Epstein-Barr, and Rubella virus. The rates of seropositivity were determined utilizing the LIAISON chemiluminescent immunoassays (DiaSorin, Italy). Our results showed a higher seroprevalence of ATXAb in RA patients, as compared with SLE patients [63 vs. 36 %, respectively (p = 0.01)]. The rates of seropositivity of IgG against other infectious agents were comparable between RA and SLE patients. ATXAb-seropositivity was associated with older age of RA patients, although it did not correlate with RA disease activity and other manifestations of the disease. In conclusion, our data suggest a possible link between exposure to T. gondii infection and RA.
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Affiliation(s)
- Svetlana Fischer
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 52621, Tel HaShomer, Israel
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Papadopoulou D, Sipsas NV. Comparison of national clinical practice guidelines and recommendations on vaccination of adult patients with autoimmune rheumatic diseases. Rheumatol Int 2013; 34:151-63. [PMID: 24322451 DOI: 10.1007/s00296-013-2907-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/15/2013] [Indexed: 12/15/2022]
Abstract
The aim of the study is to identify and compare national recommendations on vaccination of adult patients with autoimmune rheumatic diseases (ARDs) in Europe, North America, and Australia. We conducted a search for recommended immunizations in adult patients with ARDs in the Medline database and the Web sites of National Rheumatologic Societies, Ministries of Health, National Advisory Committees on Immunization, and other relevant National Scientific Societies. We compared national guidelines and identified points of agreement and differences. Guidelines on vaccination of adult patients with ARDs were identified in 21 countries. Points of agreement include administering influenza and pneumococcal vaccines in addition to inactivated age-appropriate or travel-related vaccines, and avoiding the use of live vaccines in immunocompromised patients with ARDs. The most important differences concern the steroid dose that induces immunosuppression, the time interval between live vaccines and the initiation of immunosuppressive treatment, herpes zoster vaccination, and the preferred pneumococcal vaccine in patients with ARDs. We observed significant differences among national recommendations on immunizations in patients with ARDs, reflecting the lack of evidence-based data.
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Affiliation(s)
- Despoina Papadopoulou
- Pain and Palliative Care Clinic, Aretaieion Hospital and Medical School, National and Kapodistrian University of Athens, Vasilisis Sofias 76, 11528, Athens, Greece,
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Sharma P, Pathak K. Are biological targets the final goal for rheumatoid arthritis therapy? Expert Opin Biol Ther 2012; 12:1611-22. [PMID: 22954024 DOI: 10.1517/14712598.2012.721769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic inflammatory joint disorder that is characterized by inflammation of synovial membrane and the release of inflammatory cytokines that ultimately results in joint destruction and disability. The therapeutic treatment plan for treating RA patient initiates with disease-modifying antirheumatic agents (DMARDs) and ends with the use of biological agents. Sometimes a combination of DMARDs and the biological agents are aggressively initiated. But this is not sufficient to retard the underlying progression of the disease and hence the disease-associated pain persists. The solution lies in the treatment of causative factors. Modern therapy aims at targeting newer target sites that can not only overcome the problem of pain and disability but also minimize the occurrence of adverse effects faced by the traditional therapeutic approach. AREAS COVERED This review covers the pathological background of the disease in brief, the traditional and newer biologicals, therapeutic targets and novel therapies for rheumatoid arthritis. EXPERT OPINION Better management of the disease can be achieved by focusing on the causes and the factors of the disease. Newer therapies and targeting sites discussed in this review focus on treating the disability at the cellular level without affecting body's immune response and minimizing the chances of infection and inflammation.
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Affiliation(s)
- Puja Sharma
- Department of Pharmaceutics, Rajiv Academy for Pharmacy, Uttar Pradesh, India
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Chen L, Bao B, Wang N, Xie J, Wu W. Oral Administration of Shark Type II Collagen Suppresses Complete Freund's Adjuvant-Induced Rheumatoid Arthritis in Rats. Pharmaceuticals (Basel) 2012; 5:339-52. [PMID: 24281405 PMCID: PMC3763645 DOI: 10.3390/ph5040339] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/12/2012] [Accepted: 03/21/2012] [Indexed: 11/28/2022] Open
Abstract
Objective: Shark type II collagen (SCII) is extracted as a glycoprotein from the cartilage of blue shark (Prionace glauca). We aim to confirm the effects of oral tolerance of SCII on inflammatory and immune responses to the ankle joint of rheumatoid-arthritis rats induced by Complete Freund’s Adjuvant (CFA). Materials and Methods: The onset of rheumatoid arthritis (RA) was observed 14 ± x days after injection of CFA. Rats in the control group were treated with acetic acid by oral administration (0.05 mmol kg−1d−1, days 14–28), while rats in experimental groups were treated by oral administration with SCII (1 or 3 mg kg−1d−1, days 14–28), Tripterygium wilfordii polyglycosidium (TWP) (10 mg kg−1d−1, days 14–28), and bovine type II collagen from US (US-CII) (1 mg kg−1d−1, days 14–28), respectively. The severity of arthritis was evaluated by the articular swelling. The immunological indexes observed included delayed type hypersensitivity (DTH) reaction, the level of interleukins 10 (IL-10) in rat blood serum and morphological characterization. Mixed lymphocyte culture (MLC) was performed to investigate the relationship between T cell apoptosis and specific immune tolerance induced by SCII. Results: Treatment with SCII for 2 weeks significantly attenuated the acute inflammation. The rats orally administrated with SCII at the level of 3 mg kg−1d−1 (SCII 3) and US-CII had decreased DTH reaction compared with rats in control group. Rats treated with SCII 3 had the highest level of IL-10 with 102 pg/mL. SCII with concentration of 10 μg/L could help to significantly enhance level of Fas/Apo-1 in T cell in vitro. The result of histological staining indicated that the recovery of the articular membranes of ankle joint in SCII 3 group was greatly enhanced. Conclusions: Our results suggest that appropriate dose of SCII can not only ameliorate symptoms but also modify the disease process of Complete-Freunds-Adjuvant-induced arthritis. Oral administration of SCII might be a potential candidate as a novel drug for further investigation.
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Affiliation(s)
- Lijuan Chen
- Shanghai Ocean University, No. 999, Hu Cheng Loop-road, Lingang New City, Shanghai 201306, China; (L.C.)
| | - Bin Bao
- Shanghai Ocean University, No. 999, Hu Cheng Loop-road, Lingang New City, Shanghai 201306, China; (L.C.)
| | - Nanping Wang
- Shanghai Fisheries Research Institute, No. 265 Jiamusi Road, Yangpu District, Shanghai 200433, China;
| | - Jing Xie
- Shanghai Ocean University, No. 999, Hu Cheng Loop-road, Lingang New City, Shanghai 201306, China; (L.C.)
| | - Wenhui Wu
- Shanghai Ocean University, No. 999, Hu Cheng Loop-road, Lingang New City, Shanghai 201306, China; (L.C.)
- Author to whom correspondence should be addressed; ; Tel.: +86-21-6190-00388; Fax: +86-21-6190-0354
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Choi EY, Kim JO, Kim YS, Yoon HJ, Jun JB, Sung YK. A Case of Pneumocystis Jirovecii Pneumonia in a Patient with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2012. [DOI: 10.4078/jrd.2012.19.6.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Eun-Young Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jin-Ok Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young-Sam Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Ho-Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Bum Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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Gjertsson I, Jonsson IM, Peschel A, Tarkowski A, Lindholm C. Formylated Peptides Are Important Virulence Factors in Staphylococcus aureus Arthritis in Mice. J Infect Dis 2011; 205:305-11. [DOI: 10.1093/infdis/jir713] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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García Olid B, Guirao Arrabal E, Alcalá Díaz JF, Fernández de la Puebla RÁ. [Visceral leishmaniasis in two patients treated with methotrexate for rheumatoid arthritis]. Enferm Infecc Microbiol Clin 2011; 30:52. [PMID: 22079224 DOI: 10.1016/j.eimc.2011.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 08/30/2011] [Accepted: 08/31/2011] [Indexed: 11/28/2022]
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Wambugu SN, Mathiu PM, Gakuya DW, Kanui TI, Kabasa JD, Kiama SG. Medicinal plants used in the management of chronic joint pains in Machakos and Makueni counties, Kenya. JOURNAL OF ETHNOPHARMACOLOGY 2011; 137:945-955. [PMID: 21782014 DOI: 10.1016/j.jep.2011.06.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/21/2011] [Accepted: 06/24/2011] [Indexed: 05/31/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Traditional medicines play an important role in the management of chronically painful and debilitating joint conditions, particularly in the rural Africa. However, their potential use as sources of medicines has not been fully exploited. The present study was carried to find the medicinal plants traditionally used to manage chronic joint pains in Machakos and Makueni counties in Kenya. MATERIALS AND METHODS To obtain this ethnobotanical information, 30 consenting traditional herbal medical practitioners were interviewed exclusively on medicinal plant use in the management of chronic joint pains, in a pre-planned workshop. RESULTS AND DISCUSSION In this survey, a total of 37 plants belonging to 32 genera and 23 families were cited as being important for treatment of chronic joint pains. The most commonly cited plant species were Pavetta crassipes K. Schum, Strychnos henningsii Gilg., Carissa spinarum L., Fagaropsis hildebrandtii (Engl.) Milve-Redh. and Zanthoxylum chalybeum Engl. Acacia mellifera (Vahl) Benth., Amaranthus albus L., Balanites glabra Mildbr. & Schltr., Grewia fallax K. Schum., Lactuca capensis, Launaea cornuta (Oliv. & Hiern) O. Jeffrey, Lippia kituiensis Vatke, Pappea capensis Eckl. & Zeyh. and Pennisetum glaucum (L.) R. Br. are documented for the first time as being important in the management of chronic joint pains. CONCLUSIONS The findings of this study show that a variety of medicinal plants are used in the management of chronic joint pains and the main mode of administration is oral.
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Affiliation(s)
- Stanley N Wambugu
- Department of Veterinary Anatomy and Physiology, University of Nairobi, Nairobi, Kenya.
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Rosenblum H, Amital H. Anti-TNF therapy: safety aspects of taking the risk. Autoimmun Rev 2011; 10:563-8. [PMID: 21570495 DOI: 10.1016/j.autrev.2011.04.010] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 04/14/2011] [Indexed: 12/17/2022]
Abstract
Rheumatoid arthritis (RA) therapy has been revolutionized in recent years following the introduction of three main anti-tumor necrosis factor-alpha inhibitors (anti-TNF) agents, infliximab, adalimumab and etanercept. Evidence in the literature indicates that patients treated with anti-TNF agents are at increased risk for bacterial infections, but it is not clear if this is a result of the treatment or of disease severity. The treatment has been recognized as a clear risk factor for reactivation of latent TB infections. So far, observational studies have not indicated any increased overall risk of cancer in RA patients treated with anti-TNF. The overall risk of lymphoma in these patients does not appear to differ greatly from that recorded among untreated patients, but rather is associated with the degree of disease activity rather than the type of therapy. There is a consensus in the literature that the likelihood of drug survival with infliximab is inferior to both adalimumab and etanercept, mostly due to increased risk of infection or allergic reactions. Due to the lack of head to head studies, there is no agreement as to which agent has the highest rates of treatment response and disease remission.
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Affiliation(s)
- Hemda Rosenblum
- Department of Medicine D, Meir Medical Center, Kfar Saba, Israel
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46
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Ichihara H, Hino M, Makizono T, Umebayashi M, Matsumoto Y, Ueoka R. Inhibitory effects of hybrid liposomes on the growth of synoviocyte causing rheumatoid arthritis. Bioorg Med Chem Lett 2011; 21:207-10. [PMID: 21123065 DOI: 10.1016/j.bmcl.2010.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 10/26/2010] [Accepted: 11/04/2010] [Indexed: 11/19/2022]
Abstract
Inhibitory effects of HL-n composed of 95 mol% L-α-dimyristoylphosphatidylcholin (DMPC) and 5 mol% polyoxyethylenedodecylether (C(12)(EO)(n), n = 21, 23, or 25) on the growth of human rheumatoid arthritis (RA) fibroblast-like synoviocytes (HFLS-RA) in vitro were examined. Remarkably high inhibitory effects of HL-n on the growth of HFLS-RA cells were obtained. The induction of apoptosis by HL-n was revealed on the basis of TUNEL method. Furthermore, the therapeutic effects of HL-23 using mouse models of arthritis were investigated. Therapeutic effects without joint swelling were obtained in mouse models of RA treated with HL.
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Affiliation(s)
- Hideaki Ichihara
- Division of Applied Life Science, Graduate School of Engineering, Sojo University, 4-22-1 Ikeda, Kumamoto 860-0082, Japan
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Zidi I, Bouaziz A, Mnif W, Bartegi A, Al-Hizab FA, Amor NB. Golimumab therapy of rheumatoid arthritis: an overview. Scand J Immunol 2010; 72:75-85. [PMID: 20618765 DOI: 10.1111/j.1365-3083.2010.02423.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Golimumab is a new approved humanized antibody for the treatment of rheumatoid arthritis (RA). This antibody belonging to biologic agents is raised against the pro-inflammatory cytokine tumour necrosis factor-alpha playing an essential role in the initiation of RA. To date, Golimumab administration for patients with RA, as indicated by USA Food and Drug Administration, is subcutaneous combined with methotrexate (MTX). Here, we have reviewed current literature with a focus on characteristics of Golimumab and also have exposed the clinical trials either using MTX or not using MTX. We have also highlighted the incoming clinical trials on Golimumab and have proposed some indications for the future studies based on a setting of clinical data and post-marketing observational studies. These studies will advance rheumatologists' decisions in the beginning of RA therapeutic interventions to insure the best outcomes for patients with RA and to improve their quality of life.
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Affiliation(s)
- I Zidi
- Laboratory of Biochemistry, Research Unit 02/UR/09-01, Higher Institute of Biotechnology, Monastir, Tunisia.
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Carl HD, Gelse K, Swoboda B. Der rheumatische Fuß als Focus bakterieller Infektionen. Z Rheumatol 2010; 69:550-6. [DOI: 10.1007/s00393-010-0665-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhang P, Li J, Han Y, Wei Yu X, Qin L. Traditional Chinese medicine in the treatment of rheumatoid arthritis: a general review. Rheumatol Int 2010; 30:713-8. [DOI: 10.1007/s00296-010-1370-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 01/27/2010] [Indexed: 11/29/2022]
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50
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Yang M, Xiao C, Wu Q, Niu M, Yao Q, Li K, Chen Y, Shi C, Chen D, Feng G, Xia C. Anti-inflammatory effect of Sanshuibaihu decoction may be associated with nuclear factor-kappa B and p38 MAPK alpha in collagen-induced arthritis in rat. JOURNAL OF ETHNOPHARMACOLOGY 2010; 127:264-273. [PMID: 19914365 DOI: 10.1016/j.jep.2009.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 10/19/2009] [Accepted: 11/08/2009] [Indexed: 05/28/2023]
Abstract
Sanshuibaihu decoction (SSBH) is an anti-arthritic Chinese herbal formula which has been used in the treatment of rheumatoid arthritis (RA) for many years. We herein aimed to confirm its anti-arthritic effect and explore the potential mechanism of action on collagen-induced arthritis (CIA) in rats. CIA was induced by immunizing 50 female Wistar rats with bovine type II collagen. 13 days following the immunization rats with CIA were treated with SSBH (50mg/kg), leflunomide (LEF) (10mg/kg) and physiological saline for 30 days, and rats without CIA were left untreated. After the treatment, paw edema was obviously improved in SSBH-treated rats, with the significant difference of arthritis score (F=6.032, P=0.006) observed between the three treated groups. In pathological observation, SSBH-treated rats showed a significant improvement of inflammatory infiltration, synovial hyperplasia, cartilage and bone destruction and joint fusion. After the treatment of SSBH, radiological score of knee (t=11.504, P=0.000) and ankle joints (t=9.250, P=0.000) was decreased significantly. In situ hybridization on joint tissue section indicated only slight synovial hyperblastosis and expression of NF-kappaB in SSBH-treated rats. Image analysis indicated a significant difference of means of integrated optical density (MIOD) (F=3.956, P=0.040) and means of stained area (MSA) (F=3.867, P=0.032) of NF-kappaB between the three treated groups. MIOD and MSA of SSBH-treated group were significantly lower vs control. Enzyme linked immunosorbent assay (ELISA) showed a significant difference (F=10.167, P=0.000) of the amount of p-p38 MAPKalpha in the three treated groups. The detected amount of p-p38 MAPKalpha in SSBH-treated group was significantly lower vs control. These results show SSBH has an inhibiting effect on CIA, which may be associated with NF-kappaB and p38 MAPKalpha.
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Affiliation(s)
- Min Yang
- Department of Internal Medicine, School of Traditional Chinese Medicine, Southern Medical University, 510515 Guangzhou, Guangdong Province, PR China
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