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Falconer J, Pucino V, Clayton SA, Marshall JL, Raizada S, Adams H, Philp A, Clark AR, Filer A, Raza K, Young SP, Buckley CD. Spontaneously Resolving Joint Inflammation Is Characterised by Metabolic Agility of Fibroblast-Like Synoviocytes. Front Immunol 2021; 12:725641. [PMID: 34512657 PMCID: PMC8426599 DOI: 10.3389/fimmu.2021.725641] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/09/2021] [Indexed: 01/01/2023] Open
Abstract
Fibroblast-like synoviocytes (FLS) play an important role in maintaining joint homeostasis and orchestrating local inflammatory processes. When activated during injury or inflammation, FLS undergo transiently increased bioenergetic and biosynthetic demand. We aimed to identify metabolic changes which occur early in inflammatory disease pathogenesis which might support sustained cellular activation in persistent inflammation. We took primary human FLS from synovial biopsies of patients with very early rheumatoid arthritis (veRA) or resolving synovitis, and compared them with uninflamed control samples from the synovium of people without arthritis. Metabotypes were compared using NMR spectroscopy-based metabolomics and correlated with serum C-reactive protein levels. We measured glycolysis and oxidative phosphorylation by Seahorse analysis and assessed mitochondrial morphology by immunofluorescence. We demonstrate differences in FLS metabolism measurable after ex vivo culture, suggesting that disease-associated metabolic changes are long-lasting. We term this phenomenon 'metabolic memory'. We identify changes in cell metabolism after acute TNFα stimulation across disease groups. When compared to FLS from patients with early rheumatoid arthritis, FLS from patients with resolving synovitis have significantly elevated mitochondrial respiratory capacity in the resting state, and less fragmented mitochondrial morphology after TNFα treatment. Our findings indicate the potential to restore cell metabotypes by modulating mitochondrial function at sites of inflammation, with implications for treatment of RA and related inflammatory conditions in which fibroblasts play a role.
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Affiliation(s)
- Jane Falconer
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom.,School of Medicine, Institute of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
| | - Valentina Pucino
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sally A Clayton
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jennifer L Marshall
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sabrina Raizada
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Holly Adams
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Andrew Philp
- Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, UNSW Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Andrew R Clark
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Andrew Filer
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Karim Raza
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom.,Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom
| | - Stephen P Young
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Christopher D Buckley
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom.,Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
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Mosor E, Stoffer-Marx M, Steiner G, Raza K, Stack RJ, Simons G, Falahee M, Skingle D, Dobrin M, Schett G, Englbrecht M, Smolen JS, Kjeken I, Hueber AJ, Stamm TA. I Would Never Take Preventive Medication! Perspectives and Information Needs of People Who Underwent Predictive Tests for Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 72:360-368. [PMID: 30710453 PMCID: PMC7064954 DOI: 10.1002/acr.23841] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/29/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Little is known about the experiences, values, and needs of people without arthritis who undergo predictive biomarker testing for the development of rheumatoid arthritis (RA). Our study aimed to explore the perspectives of these individuals and describe their information needs. METHODS A qualitative, multicenter interview study with a thematic analysis was conducted in Austria, Germany and the UK. Individuals were interviewed who underwent predictive biomarker testing for RA and had a positive test result but no diagnosis of any inflammatory joint disease. Participants included patients with arthralgia and asymptomatic individuals. Information and education needs were developed from the qualitative codes and themes using the Arthritis Educational Needs Assessment Tool as a frame of reference. RESULTS Thematic saturation was reached in 34 individuals (76% female, 24 [71%] with arthralgia, and 10 [29%] asymptomatic individuals). Thirty-seven codes were summarized into 4 themes: 1) decision-making around whether to undergo initial predictive testing, 2) willingness to consider further predictive tests, and/or 3) preventive interventions, including medication, and 4) varying reactions after receiving a positive test result. Individuals with arthralgia were more likely to be willing to take preventive action, undergo further testing, and experience psychological distress than asymptomatic individuals. All participants expressed the need for tailored, patient-understandable information. CONCLUSION Individuals at risk of RA are currently the subjects of research aimed at developing better predictive strategies and preventive approaches. Their perceptions and needs should be addressed to inform the future development of interventions combined with education.
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Affiliation(s)
- Erika Mosor
- Medical University of Vienna, Vienna, Austria
| | | | - Günter Steiner
- Medical University of Vienna and Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria
| | - Karim Raza
- University of Birmingham and Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | | | | | | | - Mircia Dobrin
- The Romanian League Against Rheumatism, Timisoara, Romania
| | - Georg Schett
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Ingvild Kjeken
- Oslo Metropolitan University and Diakonhjemmet Hospital, Oslo, Norway
| | - Axel J Hueber
- Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja A Stamm
- Medical University of Vienna and Ludwig Boltzmann Cluster Arthritis and Rehabilitation, Vienna, Austria
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Chaparro-Sanabria JA, Bautista-Molano W, Bello-Gualtero JM, Chila-Moreno L, Castillo DM, Valle-Oñate R, Chalem P, Romero-Sánchez C. Association of adipokines with rheumatic disease activity indexes and periodontal disease in patients with early rheumatoid arthritis and their first-degree relatives. Int J Rheum Dis 2019; 22:1990-2000. [PMID: 31659869 DOI: 10.1111/1756-185x.13724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 09/06/2019] [Accepted: 09/14/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the adipokine levels in early rheumatoid arthritis (eRA) and first-degree relatives (FDR) of patients with RA and establish their association with rheumatic disease activity and periodontal variables. METHOD A cross-sectional study with eRA patients, FDR and a healthy population. Adipokine levels, clinical, joint radiological indexes and periodontal variables were evaluated. A descriptive, bivariate analysis was performed based on the adipokine levels by χ2 , Fisher's test and Mann-Whitney U test. A logistic regression was made for associations. RESULTS High leptin levels were associated with the diagnosis of eRA (odds ratio [OR] = 2.79; 95% CI 1.54-5.07). Early rheumatoid arthritis with high adiponectin levels was less likely to have Multidimensional Health Assessment Questionnaire score >3, body mass index (BMI) >25 and Routine Assessment of Patient Index Data 3 score >12 (OR = 0.16; 95% CI 0.03-0.72). Early rheumatoid arthritis was more likely to present high leptin and interleukin (IL)6 levels with low adiponectin simultaneously (OR = 5.03; 95% CI 1.05-24.0). High leptin levels were associated with the FDR adjusted for IgG2 Porphyromonas gingivalis, swollen joints, P gingivalis and low IL6 (OR = 2.57; 95% CI 1.14-5.95). CONCLUSION High adipokine levels in eRA may modulate the disease activity. Having more than 1 adipokine at high serum levels is associated with increased disability, disease activity and BMI, indicating that RA is controlled by adiponectin levels in the early stages of the disease. High leptin levels, presence of P gingivalis and swollen joints may be the factors associated with the development of RA in FDR.
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Affiliation(s)
- Jeimy A Chaparro-Sanabria
- Rheumatology and Immunology Department, Hospital Militar Central, Bogotá, Colombia.,Clinical Immunology Group-School of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Wilson Bautista-Molano
- Clinical Immunology Group-School of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia.,Cellular and Molecular Immunology Group/INMUBO, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Juan M Bello-Gualtero
- Rheumatology and Immunology Department, Hospital Militar Central, Bogotá, Colombia.,Clinical Immunology Group-School of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Lorena Chila-Moreno
- Clinical Immunology Group-School of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia.,Cellular and Molecular Immunology Group/INMUBO, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Diana M Castillo
- Unit of Oral Basic Investigation, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
| | - Rafael Valle-Oñate
- Rheumatology and Immunology Department, Hospital Militar Central, Bogotá, Colombia
| | - Phillipe Chalem
- Institute of Rheumatology Fernando Chalem Foundation, Bogotá, Colombia
| | - Consuelo Romero-Sánchez
- Rheumatology and Immunology Department, Hospital Militar Central, Bogotá, Colombia.,Clinical Immunology Group-School of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia.,Cellular and Molecular Immunology Group/INMUBO, School of Dentistry, Universidad El Bosque, Bogotá, Colombia
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Seoane IV, Martínez C, García-Vicuña R, Ortiz AM, Juarranz Y, Talayero VC, González-Álvaro I, Gomariz RP, Lamana A. Vasoactive intestinal peptide gene polymorphisms, associated with its serum levels, predict treatment requirements in early rheumatoid arthritis. Sci Rep 2018; 8:2035. [PMID: 29391448 PMCID: PMC5794878 DOI: 10.1038/s41598-018-20400-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/12/2018] [Indexed: 12/14/2022] Open
Abstract
We previously reported that early arthritis (EA) patients with low vasoactive intestinal peptide (VIP) serum levels demonstrate a worse clinical disease course. In this study, we analysed whether variants in the VIP gene correlated with its serum levels and clinical EA parameters. The VIP gene was sequenced in patients with extremely high/low VIP levels, measured by enzyme immunoassay. Sixteen single nucleotide polymorphisms (SNPs) were differentially distributed between both groups, which were subsequently genotyped in two patients’ sets. We observed that patients with rs688136 CC genotype showed higher VIP levels in both discovery (n = 91; p = 0.033) and validation populations (n = 131; p = 0.007). This effect was attenuated by the presence of minor alleles rs35643203 and rs12201140, which showed a clear trend towards low VIP level association (p = 0.118 and p = 0.049, respectively). Functional studies with miR-205-5p, which has a target site in the 3′ UTR close to rs688136, revealed a miRNA-mediated regulatory mechanism explaining the higher VIP gene expression in homozygous patients. Moreover, patients with an rs688136 CC genotype and no minor alleles of the other polymorphisms required less treatment (p = 0.009). We concluded that the identification of polymorphisms associated with VIP serum levels would complement the clinical assessment of the disease severity in rheumatoid arthritis patients.
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Affiliation(s)
- Iria V Seoane
- Departamento de Biología Celular, Facultad de Biología, Universidad Complutense de Madrid, Madrid, 28040, Spain
| | - Carmen Martínez
- Departamento de Biología Celular, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, 28040, Spain
| | - Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa, 28006, Madrid, Spain
| | - Ana M Ortiz
- Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa, 28006, Madrid, Spain
| | - Yasmina Juarranz
- Departamento de Biología Celular, Facultad de Biología, Universidad Complutense de Madrid, Madrid, 28040, Spain
| | - Vanessa C Talayero
- Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa, 28006, Madrid, Spain
| | - Isidoro González-Álvaro
- Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa, 28006, Madrid, Spain
| | - Rosa P Gomariz
- Departamento de Biología Celular, Facultad de Biología, Universidad Complutense de Madrid, Madrid, 28040, Spain.
| | - Amalia Lamana
- Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa, 28006, Madrid, Spain
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Wu HY, Filer A, Styles I, Dehghani H. Development of a multi-wavelength diffuse optical tomography system for early diagnosis of rheumatoid arthritis: simulation, phantoms and healthy human studies. BIOMEDICAL OPTICS EXPRESS 2016; 7:4769-4786. [PMID: 27896015 PMCID: PMC5119615 DOI: 10.1364/boe.7.004769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/30/2016] [Accepted: 07/22/2016] [Indexed: 05/21/2023]
Abstract
A multi-wavelength diffuse optical tomography (DOT) system has been developed to directly extract physiological information, such as total haemoglobin concentration, from tissue in human hand joints. Novel methods for 3D surface imaging and spectrally constrained image reconstruction are introduced and their potential application to imaging of rheumatoid arthritis is discussed. Results are presented from simulation studies as well as experiments using phantoms and data from imaging of three healthy volunteers. The image features are recovered partially for phantom data using transmission measurements only. Images that reveal joint regions and surrounding features within the hand are shown to co-register with co-acquired ultrasound images which are shown to be related to total haemoglobin concentration.
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Affiliation(s)
- Hao Yang Wu
- The Centre for Physical Sciences of Imaging in Biomedical Sciences (PSIBS), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Andrew Filer
- The Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Iain Styles
- The Centre for Physical Sciences of Imaging in Biomedical Sciences (PSIBS), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- School of Computer Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Hamid Dehghani
- The Centre for Physical Sciences of Imaging in Biomedical Sciences (PSIBS), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- School of Computer Science, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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6
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Stack RJ, Stoffer M, Englbrecht M, Mosor E, Falahee M, Simons G, Smolen J, Schett G, Buckley CD, Kumar K, Hansson M, Hueber A, Stamm T, Raza K. Perceptions of risk and predictive testing held by the first-degree relatives of patients with rheumatoid arthritis in England, Austria and Germany: a qualitative study. BMJ Open 2016; 6:e010555. [PMID: 27357193 PMCID: PMC4932277 DOI: 10.1136/bmjopen-2015-010555] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/18/2016] [Accepted: 04/20/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The family members of patients with rheumatoid arthritis (RA) are at increased risk of developing RA and are potential candidates for predictive testing. This study explored the perceptions of first-degree relatives of people with RA about being at risk of RA and engaging in predictive testing. METHODS 34 first-degree relatives (siblings and offspring) of patients with RA from the UK, Germany and Austria participated in semistructured interviews about their perceptions of RA risk and the prospect of predictive testing. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS First-degree relatives were aware of their susceptibility to RA, but were unsure of the extent of their risk. When considering their future risk, some relatives were concerned about the potential impact that RA would have on their lives. Relatives were concerned that knowing their actual risk would increase their anxiety and would affect decisions about their future. Also, relatives were concerned about the levels of uncertainty associated with predictive testing. Those in favour of knowing their future risk felt that they would need additional support to understand the risk information and cope with the emotional impact of this information. CONCLUSIONS Identifying individuals at risk of RA may allow targeted interventions to reduce the risk and consequence of future disease; however, relatives have concerns about predictive testing and risk information. The development of strategies to quantify and communicate risk needs to take these views into account and incorporate approaches to mitigate concerns and minimise the psychological impact of risk information.
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Affiliation(s)
- Rebecca J Stack
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Division of Psychology, Nottingham Trent University, Nottingham, UK
| | - Michaela Stoffer
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- University of Applied Sciences for Health Professionals, Upper Austria, Austria
| | - Mathias Englbrecht
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Erika Mosor
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Marie Falahee
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gwenda Simons
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Josef Smolen
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Chris D Buckley
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Division of Psychology, Nottingham Trent University, Nottingham, UK
| | - Kanta Kumar
- Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK
| | - Mats Hansson
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Axel Hueber
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja Stamm
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Karim Raza
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
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Abstract
PURPOSE OF REVIEW Rheumatoid arthritis (RA) is a heterogeneous chronic immune-mediated inflammatory disease, associated with significant morbidity and reduced life expectancy. Here, we review recent discoveries; particularly those which have attempted to integrate genome-wide association studies (GWAS) with biological pathways and cell types known to play a role in disease pathology in order to expand our current understanding of the pathogenesis of RA. As the role of stromal cells in the pathogenesis of RA has been reviewed in detail in Current Opinions in Rheumatology, this area will not be covered in this review. RECENT FINDINGS Although our understandings of the pathogenic processes that drive disease in RA remain incomplete, remarkable advances over the past year can be highlighted. GWAS have raised awareness of important new risk loci with genes that either are the targets of approved therapies for RA, or involve pathways for drugs that could be repurposed from other disease indications such as cancer. Furthermore, promising strides have been made in predicting the likelihood of developing RA in those at risk using human leukocyte antigen (HLA), smoking, and autoantibody status prediction models. These findings give a fresh insight into RA pathogenesis and help identify new, or repurpose known therapeutic targets from other disease areas. SUMMARY The findings discussed in this review underscore the progress made to date and the need for future studies, investigating disease mechanisms in RA, with particular interest in at-risk RA gene loci, their function in immune and stromal cells within the synovium, and how they interact with environmental factors to initiate and perpetuate disease.
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González-Álvaro I, Ortiz AM, Seoane IV, García-Vicuña R, Martínez C, Gomariz RP. Biomarkers predicting a need for intensive treatment in patients with early arthritis. Curr Pharm Des 2015; 21:170-81. [PMID: 25163741 PMCID: PMC4298237 DOI: 10.2174/1381612820666140825123104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 08/13/2014] [Indexed: 12/29/2022]
Abstract
The heterogeneous nature of rheumatoid arthritis (RA) complicates early recognition and treatment. In recent years, a growing body of evidence has demonstrated that intervention during the window of opportunity can improve the response to treatment and slow—or even stop—irreversible structural changes. Advances in therapy, such as biologic agents, and changing approaches to the disease, such as the treat to target and tight control strategies, have led to better outcomes resulting from personalized treatment to patients with different prognostic markers. The various biomarkers identified either facilitate early diagnosis or make it possible to adjust management to disease activity or poor outcomes. However, no single biomarker can bridge the gap between disease onset and prescription of the first DMARD, and traditional biomarkers do not identify all patients requiring early aggressive treatment. Furthermore, the outcomes of early arthritis cohorts are largely biased by the treatment prescribed to patients; therefore, new challenges arise in the search for prognostic biomarkers. Herein, we discuss the value of traditional and new biomarkers and suggest the need for intensive treatment as a new surrogate marker of poor prognosis that can guide therapeutic decisions in the early stages of RA.
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Affiliation(s)
| | | | | | | | | | - R P Gomariz
- Rheumatology Service, Hospital Universitario de La Princesa, IIS Princesa, Madrid, Spain.
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9
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Machado FS, Furtado RNV, Takahashi RD, de Buosi ALP, Natour J. Sonographic cutoff values for detection of abnormalities in small, medium and large joints: a comparative study between patients with rheumatoid arthritis and healthy volunteers. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:989-998. [PMID: 25701521 DOI: 10.1016/j.ultrasmedbio.2014.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/27/2014] [Accepted: 12/08/2014] [Indexed: 06/04/2023]
Abstract
To determine ultrasound measurements indicative of abnormalities in small, medium and large joints, we conducted a cross-sectional study comparing 60 patients with rheumatoid arthritis (RA) and 78 healthy volunteers. A MyLab 60 ultrasound machine (Esaote) and a linear multifrequency probe were used. Quantitative measurements of synovial recesses and semiquantitative measurements of synovial hyperplasia, power Doppler and bone erosion (scores = 0-3) were performed. The cutoff values for synovial recesses indicating RA (receiver operating characteristic curve, area under the curve >0.800) were found to be (radiocarpal) 3.78 mm and (ulnocarpal) 3.07 mm. Those measurements with the greatest chance of indicating RA (logistic regression analysis expressed as odds ratios [ORs]) were (p < 0.001) measurements of synovial hyperplasia (ulnocarpal, OR = 100, and radiocarpal, OR = 70); synovial power Doppler (radiocarpal, OR = 66); synovial bone erosion (radiocarpal, OR = 324); fifth metatarsophalangeal joint (OR = 100); and second metacarpophalangeal joint (OR = 92). We concluded that for both quantitative and semiquantitative ultrasound measurements, radiocarpal abnormalities increase the chance of detecting RA.
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Affiliation(s)
- Flávia Soares Machado
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Rita Nely Vilar Furtado
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Rogerio Diniz Takahashi
- Radiology Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Ana Leticia Pirosi de Buosi
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil
| | - Jamil Natour
- Rheumatology Division, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil.
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10
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Arana-Guajardo A, Pérez-Barbosa L, Vega-Morales D, Riega-Torres J, Esquivel-Valerio J, Garza-Elizondo M. Application of a prediction model for the progression of rheumatoid arthritis in patients with undifferentiated arthritis. ACTA ACUST UNITED AC 2014; 10:360-3. [PMID: 24932905 DOI: 10.1016/j.reuma.2014.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/17/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Different prediction rules have been applied to patients with undifferentiated arthritis (UA) to identify those that progress to rheumatoid arthritis (RA). The Leiden Prediction Rule (LPR) has proven useful in different UA cohorts. OBJECTIVE To apply the LPR to a cohort of patients with UA of northeastern Mexico. METHODS We included 47 patients with UA, LPR was applied at baseline. They were evaluated and then classified after one year of follow-up into two groups: those who progressed to RA (according to ACR 1987) and those who did not. RESULTS 43% of the AI patients developed RA. In the RA group, 56% of patients obtained a score ≤ 6 and only 15% ≥ 8. 70% who did not progress to RA had a score between 6 and ≤ 8. There was no difference in median score of LPR between groups, p=0.940. CONCLUSION Most patients who progressed to RA scored less than 6 points in the LPR. Unlike what was observed in other cohorts, the model in our population did not allow us to predict the progression of the disease.
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Affiliation(s)
- Ana Arana-Guajardo
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | - Lorena Pérez-Barbosa
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México.
| | - David Vega-Morales
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | - Janett Riega-Torres
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | - Jorge Esquivel-Valerio
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
| | - Mario Garza-Elizondo
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario «Dr. José Eleuterio González», Monterrey, Nuevo León, México
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Pathogenesis of rheumatoid arthritis: from systemic autoimmunity to localised joint disease. Drug Discov Today 2014; 19:1152-4. [PMID: 24859017 DOI: 10.1016/j.drudis.2014.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/14/2014] [Indexed: 12/13/2022]
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12
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Nageeb GS, Elewa EA, Azmy TM, Tantawy H. Risk factors of persistent synovitis development in early undifferentiated arthritis patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2014. [DOI: 10.4103/1110-161x.132461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Martínez C, Ortiz AM, Juarranz Y, Lamana A, Seoane IV, Leceta J, García-Vicuña R, Gomariz RP, González-Álvaro I. Serum levels of vasoactive intestinal peptide as a prognostic marker in early arthritis. PLoS One 2014; 9:e85248. [PMID: 24409325 PMCID: PMC3883710 DOI: 10.1371/journal.pone.0085248] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/25/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Suitable biomarkers are essential for the design of therapeutic strategies in personalized medicine. Vasoactive intestinal peptide (VIP) has demonstrated immunomodulatory properties in autoimmune murine and ex vivo human models. Our aim was to study serum levels of VIP during the follow-up of an early arthritis (EA) cohort and to analyze its value as a biomarker predicting severity and therapeutic requirements. Methods Data from 91 patients on an EA register were analyzed (76% rheumatoid arthritis (RA), 24% undifferentiated arthritis, 73% women, and median age 54 years; median disease duration at entry, 5.4 months). We collected per protocol sociodemographic, clinical, and therapeutic data. VIP levels were determined by enzyme immunoassay in sera harvested from the 91 patients (353 visits; 3.9 visit/patient) and from 100 healthy controls. VIP values below the 25th percentile of those assessed in healthy population were considered low. To determine the effect of independent variables on VIP levels, we performed a longitudinal multivariate analysis nested by patient and visit. A multivariate ordered logistic regression was modeled to determine the effect of low VIP serum levels on disease activity at the end of follow-up. Results VIP concentrations varied considerably across EA patients. Those fulfilling the criteria for RA had the lowest values in the whole sample, although no significant differences were observed compared with healthy donors. Disease activity, which was assessed using DAS28, inversely correlated with VIP levels. After a two-year follow-up, those patients with low baseline levels of VIP displayed higher disease activity and received more intensive treatment. Conclusion Patients who are unable to up-regulate VIP seem to have a worse clinical course despite receiving more intense treatment. Therefore, measurement of VIP levels may be suitable as a prognostic biomarker.
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Affiliation(s)
- Carmen Martínez
- Departamento de Biología Celular, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- * E-mail:
| | - Ana M. Ortiz
- Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa, Madrid, Spain
| | - Yasmina Juarranz
- Departamento de Biología Celular, Facultad de Biología, Universidad Complutense de Madrid, Madrid, Spain
| | - Amalia Lamana
- Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa, Madrid, Spain
| | - Iria V. Seoane
- Departamento de Biología Celular, Facultad de Biología, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Leceta
- Departamento de Biología Celular, Facultad de Biología, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa, Madrid, Spain
| | - Rosa P. Gomariz
- Departamento de Biología Celular, Facultad de Biología, Universidad Complutense de Madrid, Madrid, Spain
| | - Isidoro González-Álvaro
- Servicio de Reumatología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa, Madrid, Spain
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Young SP, Kapoor SR, Viant MR, Byrne JJ, Filer A, Buckley CD, Kitas GD, Raza K. The impact of inflammation on metabolomic profiles in patients with arthritis. ACTA ACUST UNITED AC 2013; 65:2015-23. [PMID: 23740368 PMCID: PMC3840700 DOI: 10.1002/art.38021] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 05/09/2013] [Indexed: 12/29/2022]
Abstract
Objective. Inflammatory arthritis is associated with systemic manifestations including alterations in metabolism. We used nuclear magnetic resonance (NMR) spectroscopy–based metabolomics to assess metabolic fingerprints in serum from patients with established rheumatoid arthritis (RA) and those with early arthritis. Methods. Serum samples were collected from newly presenting patients with established RA who were naive for disease-modifying antirheumatic drugs, matched healthy controls, and 2 groups of patients with synovitis of ≤3 months' duration whose outcomes were determined at clinical followup. Serum metabolomic profiles were assessed using 1-dimensional 1H-NMR spectroscopy. Discriminating metabolites were identified, and the relationships between metabolomic profiles and clinical variables including outcomes were examined. Results. The serum metabolic fingerprint in established RA was clearly distinct from that of healthy controls. In early arthritis, we were able to stratify the patients according to the level of current inflammation, with C-reactive protein correlating with metabolic differences in 2 separate groups (P < 0.001). Lactate and lipids were important discriminators of inflammatory burden in both early arthritis patient groups. The sensitivities and specificities of models to predict the development of either RA or persistent arthritis in patients with early arthritis were low. Conclusion. The metabolic fingerprint reflects inflammatory disease activity in patients with synovitis, demonstrating that underlying inflammatory processes drive significant changes in metabolism that can be measured in the peripheral blood. The identification of metabolic alterations may provide insights into disease mechanisms operating in patients with inflammatory arthritis.
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Arend CF. Ultrasonography in rheumatoid arthritis: what rheumatologists should know. REVISTA BRASILEIRA DE REUMATOLOGIA 2013; 53:88-100. [PMID: 23588519 DOI: 10.1016/s2255-5021(13)70009-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 11/26/2012] [Indexed: 11/24/2022] Open
Abstract
Ultrasonography has recently gained prestige as an adjuvant method for the diagnosis and therapeutic follow-up of rheumatoid arthritis, although radiography remains the imaging modality traditionally and widely used for those purposes. The great advantage of the ultrasonographic study, which has motivated enthusiastic research in the area, resides in its capacity to detect synovitis and bone erosion at a pre-radiographic phase, which has been increasingly valued in preventing late and definitive structural damage. Because that is a relatively new subject, several scientific articles have been published in recent years about the potential applications of ultrasonography in individuals with rheumatoid arthritis, some of which directed to researchers and others to clinical rheumatologists. This study aimed at assessing the currently available bibliography on the subject and at describing only the concepts that are of practical applicability in the daily routine of clinical rheumatologists.
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Frederico Arend C. Ultrassonografia em portadores de artrite reumatoide: o que o reumatologista clínico deve saber. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000100009] [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] Open
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17
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González-Álvaro I, Ortiz AM, Alvaro-Gracia JM, Castañeda S, Díaz-Sánchez B, Carvajal I, García-Vadillo JA, Humbría A, López-Bote JP, Patiño E, Tomero EG, Vicente EF, Sabando P, García-Vicuña R. Interleukin 15 levels in serum may predict a severe disease course in patients with early arthritis. PLoS One 2011; 6:e29492. [PMID: 22242124 PMCID: PMC3248461 DOI: 10.1371/journal.pone.0029492] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/29/2011] [Indexed: 11/28/2022] Open
Abstract
Background Interleukin-15 (IL-15) is thought to be involved in the physiopathological mechanisms of RA and it can be detected in the serum and the synovial fluid of inflamed joints in patients with RA but not in patients with osteoarthritis or other inflammatory joint diseases. Therefore, the objective of this work is to analyse whether serum IL-15 (sIL-15) levels serve as a biomarker of disease severity in patients with early arthritis (EA). Methodology and Results Data from 190 patients in an EA register were analysed (77.2% female; median age 53 years; 6-month median disease duration at entry). Clinical and treatment information was recorded systematically, especially the prescription of disease modifying anti-rheumatic drugs. Two multivariate longitudinal analyses were performed with different dependent variables: 1) DAS28 and 2) a variable reflecting intensive treatment. Both included sIL-15 as predictive variable and other variables associated with disease severity, including rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACPA). Of the 171 patients (638 visits analysed) completing the follow-up, 71% suffered rheumatoid arthritis and 29% were considered as undifferentiated arthritis. Elevated sIL-15 was detected in 29% of this population and this biomarker did not overlap extensively with RF or ACPA. High sIL-15 levels (β Coefficient [95% confidence interval]: 0.12 [0.06–0.18]; p<0.001) or ACPA (0.34 [0.01–0.67]; p = 0.044) were significantly and independently associated with a higher DAS28 during follow-up, after adjusting for confounding variables such as gender, age and treatment. In addition, those patients with elevated sIL-15 had a significantly higher risk of receiving intensive treatment (RR 1.78, 95% confidence interval 1.18–2.7; p = 0.007). Conclusions Patients with EA displaying high baseline sIL-15 suffered a more severe disease and received more intensive treatment. Thus, sIL-15 may be a biomarker for patients that are candidates for early and more intensive treatment.
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Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. J Clin Invest 2011; 121:3375-83. [PMID: 21881215 PMCID: PMC3163962 DOI: 10.1172/jci57158] [Citation(s) in RCA: 537] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The successful treatment of certain autoimmune conditions with the humanized anti-IL-6 receptor (IL-6R) antibody tocilizumab has emphasized the clinical importance of cytokines that signal through the β-receptor subunit glycoprotein 130 (gp130). In this Review, we explore how gp130 signaling controls disease progression and examine why IL-6 has a special role among these cytokines as an inflammatory regulator. Attention will be given to the role of the soluble IL-6R, and we will provide a perspective into the clinical blockade of IL-6 activity in autoimmunity, inflammation, and cancer.
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Affiliation(s)
- Simon A. Jones
- Department of Infection, Immunity and Biochemistry, The School of Medicine, Cardiff University, Cardiff, United Kingdom.
Institute of Biochemistry and Molecular Biology II, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
Institute of Biochemistry, Christian-Albrechts-University, Kiel, Germany
| | - Jürgen Scheller
- Department of Infection, Immunity and Biochemistry, The School of Medicine, Cardiff University, Cardiff, United Kingdom.
Institute of Biochemistry and Molecular Biology II, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
Institute of Biochemistry, Christian-Albrechts-University, Kiel, Germany
| | - Stefan Rose-John
- Department of Infection, Immunity and Biochemistry, The School of Medicine, Cardiff University, Cardiff, United Kingdom.
Institute of Biochemistry and Molecular Biology II, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
Institute of Biochemistry, Christian-Albrechts-University, Kiel, Germany
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Ye C, Cui Y, Wei C, Elston RC, Zhu J, Lu Q. A Non-Parametric Method for Building Predictive Genetic Tests on High-Dimensional Data. Hum Hered 2011; 71:161-70. [DOI: 10.1159/000327299] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 03/10/2011] [Indexed: 12/12/2022] Open
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El-Barbary AM, Kassem EM, El-Sergany MAS, Essa SAM, Eltomey MA. Association of anti-modified citrullinated vimentin with subclinical atherosclerosis in early rheumatoid arthritis compared with anti-cyclic citrullinated peptide. J Rheumatol 2011; 38:828-34. [PMID: 21362765 DOI: 10.3899/jrheum.101143] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate anti-modified citrullinated vimentin (anti-MCV) in early rheumatoid arthritis (RA), including correlation with disease activity and cardiovascular risk factors, compared with anti-cyclic citrullinated peptides (anti-CCP3). METHODS Anti-MCV and anti-CCP3 concentrations were measured in 100 patients with early RA and 100 healthy controls at baseline to determine sensitivity and specificity. Patients received methotrexate (MTX) 0.2 mg/kg/week plus prednisone 10 mg/day. Anti-MCV, anti-CCP3, rheumatoid factor (RF), Disease Activity Score for 28 joints (DAS-28), lipid profile, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein assay (hsCRP), homeostasis model assessment for insulin resistance (HOMA-IR) index, tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), and carotid intima-media thickness (cIMT) were measured before and after 12 months of treatment. RESULTS The sensitivity and specificity for anti-MCV antibody were 75% and 90%, respectively, and for anti-CCP3 antibody 71% and 96%. Serum anti-MCV and serum anti-CCP3 levels at baseline were positively correlated with hsCRP, IL-6, HOMA-IR index, serum RF levels (p < 0.001), and cIMT (p < 0.05). Serum anti-MCV was positively correlated with serum anti-CCP3 levels. There were significant positive correlations between the percentage of changes of anti-MCV levels versus changes in DAS-28, ESR, hsCRP, atherogenic ratios (TC/HDL-C and LDL-C/HDL-C), apolipoprotein A-I, IL-6, TNF-α, HOMA-IR index, and cIMT. These correlations were not found between changes in anti-CCP3 levels compared to clinical, laboratory, and radiological variables. CONCLUSION Anti-MCV was as sensitive as anti-CCP3 in diagnosing early RA. Anti-MCV testing appears to be useful for monitoring associated subclinical atherosclerosis in early RA.
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Affiliation(s)
- Amal M El-Barbary
- Department of Rheumatology and Rehabilitation, Tanta University Faculty of Medicine, Elgesh Street, Tanta, Gharbeia, Egypt.
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Muroi K, Sakuma Y, Izumi T, Sato K, Tanaka A, Ozawa K. A long course of leukocytopenia and splenomegaly with extramedullary hematopoiesis in the absence of clinically manifested rheumatoid arthritis. J Clin Exp Hematop 2010; 50:163-6. [PMID: 21123975 DOI: 10.3960/jslrt.50.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 70-year-old female with a long history of progressive leukocytopenia and giant splenomegaly is described. She had no clinically manifested rheumatoid arthritis, although she complained of slight arthralgia in the digital joints, wrists and ankles at irregular intervals. Repeated bone marrow aspirations showed no cellular atypism, chromosomal abnormalities, or phenotypical abnormalities. Just before splenectomy, both anti-neutrophil antibody positivity and anti-cyclic citrullinated peptide antibody positivity were shown. Histology of the splenectomized spleen showed follicular hyperplasia with plasmacyte infiltration and extramedullary hematopoeisis. After splenectomy, leukocyte counts returned to normal with normal leukocyte differentials and anti-neutrophil antibodies disappeared. She was almost free of arthralgia one year after splenectomy, although the anti-cyclic citrullinated peptide antibody titers remained high.
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Affiliation(s)
- Kazuo Muroi
- Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
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The Changing Management of Inflammatory Arthritis. J Clin Rheumatol 2010; 16:403-7. [DOI: 10.1097/rhu.0b013e31820014e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Filer A, de Pablo P, Allen G, Nightingale P, Jordan A, Jobanputra P, Bowman S, Buckley CD, Raza K. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ann Rheum Dis 2010; 70:500-7. [PMID: 21115552 PMCID: PMC3033529 DOI: 10.1136/ard.2010.131573] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Early therapy improves outcomes in rheumatoid arthritis (RA). It is therefore important to improve predictive algorithms for RA in early disease. This study evaluated musculoskeletal ultrasound, a sensitive tool for the detection of synovitis and erosions, as a predictor of outcome in very early synovitis. METHODS 58 patients with clinically apparent synovitis of at least one joint and symptom duration of ≤3 months underwent clinical, laboratory, radiographic and 38 joint ultrasound assessments and were followed prospectively for 18 months, determining outcome by 1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism criteria. Sensitivity and specificity for 1987 RA criteria were determined for ultrasound variables and logistic regression models were then fitted to evaluate predictive ability over and above the Leiden rule. RESULTS 16 patients resolved, 13 developed non-RA persistent disease and 29 developed RA by 1987 criteria. Ultrasound demonstrated subclinical wrist, elbow, knee, ankle and metatarsophalangeal joint involvement in patients developing RA. Large joint and proximal interphalangeal joint ultrasound variables had poor predictive ability, whereas ultrasound erosions lacked specificity. Regression analysis demonstrated that greyscale wrist and metacarpophalangeal joint involvement, and power Doppler involvement of metatarsophalangeal joints provided independently predictive data. Global ultrasound counts were inferior to minimal power Doppler counts, which significantly improved area under the curve values from 0.905 to 0.962 combined with the Leiden rule. CONCLUSION In a longitudinal study, extended ultrasound joint evaluation significantly increased detection of joint involvement in all regions and outcome groups. Greyscale and power Doppler scanning of metacarpophalangeal joints, wrists and metatarsophalangeal joints provides the optimum minimal ultrasound data to improve on clinical predictive models for RA.
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Affiliation(s)
- Andrew Filer
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, Institute for Biomedical Research, The University of Birmingham, Birmingham B15 2TT, UK.
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Raza K. The Michael Mason prize: early rheumatoid arthritis--the window narrows. Rheumatology (Oxford) 2009; 49:406-10. [PMID: 19955223 DOI: 10.1093/rheumatology/kep392] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RA is a chronic disease in which synovitis drives joint destruction. Immunomodulatory therapy in the established phase of disease limits synovitis, and slows the rate of joint destruction, but is not curative. Increasing evidence suggests that the very early phase of RA, within the first few months after the onset of symptoms, represents a pathologically distinct and temporally transient window during which outcomes can be more effectively modulated by therapy. Furthermore, recent data show that we can accurately predict the development of RA in patients with very early synovitis, using clinical and serological measures. This makes very early targeted treatment a realistic possibility. However, it remains the case that the majority of patients with very early synovitis delay for prolonged periods before seeking medical help. Effective public engagement, to reduce this delay, is the key to translate advances in the fields of pathology, prognostication and therapy into benefit for patients with new onset RA.
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Affiliation(s)
- Karim Raza
- School of Immunity and Infection, University of Birmingham, Birmingham B15 2TT, UK.
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