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Chen ZY, Ou-Yang MH, Li SW, Ou R, Chen ZH, Wei S. Concomitant atypical knee gout and seronegative rheumatoid arthritis: A case report. World J Clin Cases 2024; 12:5245-5252. [DOI: 10.12998/wjcc.v12.i22.5245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Gout and seronegative rheumatoid arthritis (SNRA) are two distinct inflammatory joint diseases whose co-occurrence is relatively infrequently reported. Limited information is available regarding the clinical management and prognosis of these combined diseases.
CASE SUMMARY A 57-year-old woman with a 20-year history of joint swelling, tenderness, and morning stiffness who was negative for rheumatoid factor and had a normal uric acid level was diagnosed with SNRA. The initial regimen of methotrexate, leflunomide, and celecoxib alleviated her symptoms, except for those associated with the knee. After symptom recurrence after medication cessation, her regimen was updated to include iguratimod, methotrexate, methylprednisolone, and folic acid, but her knee issues persisted. Minimally invasive needle-knife scope therapy revealed proliferating pannus and needle-shaped crystals in the knee, indicating coexistent SNRA and atypical knee gout. After postarthroscopic surgery to remove the synovium and urate crystals, and following a tailored regimen of methotrexate, leflunomide, celecoxib, benzbromarone, and allopurinol, her knee symptoms were significantly alleviated with no recurrence observed over a period of more than one year, indicating successful management of both conditions.
CONCLUSION This study reports the case of a patient concurrently afflicted with atypical gout of the knee and SNRA and underscores the significance of minimally invasive joint techniques as effective diagnostic and therapeutic tools in the field of rheumatology and immunology.
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Affiliation(s)
- Zhou-Yi Chen
- Department of Chinese Medicine, General Hospital of Southern Theater Command, Guangzhou 510010, Guangdong Province, China
| | - Min-Hua Ou-Yang
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Shao-Wei Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Rui Ou
- Department of Gout, Guangdong Hydropower Hospital, Guangzhou 511340, Guangdong Province, China
| | - Zhi-Huang Chen
- Department of Chinese Medicine, General Hospital of Southern Theater Command, Guangzhou 510010, Guangdong Province, China
| | - Song Wei
- Department of Chinese Medicine, General Hospital of Southern Theater Command, Guangzhou 510010, Guangdong Province, China
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Chrastina M, Dráfi F, Pružinská K, Poništ S, Kamga KS, Khademnematolahi S, Bilka F, Novák P, Pašková Ľ, Bauerová K. Crocus sativus L. Extract (Saffron) Effectively Reduces Arthritic and Inflammatory Parameters in Monotherapy and in Combination with Methotrexate in Adjuvant Arthritis. Nutrients 2023; 15:4108. [PMID: 37836391 PMCID: PMC10574733 DOI: 10.3390/nu15194108] [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: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Rheumatoid arthritis (RA), an autoimmune disease, is characterized by inflammation that affects not only the liver but also other organs and the musculoskeletal system. The standard therapy for RA is methotrexate (MTX), which has safety limitations. The extract from Crocus sativus L. (saffron-SF) is also known for its anti-inflammatory effects. Therefore, we decided to investigate the potential benefit of SF in monotherapy via two doses (SF1-25 mg/kg of b.w.; SF2-50 mg/kg of b.w.) and in combination with MTX (0.3 mg/kg of b.w., twice a week) using adjuvant arthritis in rats. To evaluate these therapeutic settings, we used biometric, immunological, and biochemical parameters, as well as the relative gene expression of the mRNA in the liver. Our results showed a statistically significant increase in the experimental animals' body weight and the arthritic score (AS) on day 14 for monotherapy with SF1 and SF2. The change of hind paw volume (CHPV) was significant only for SF2 monotherapy on the 14th day of the experiment. A combination of SF1 and SF2 with MTX significantly modulated all the biometric parameters during the experimental period. Additionally, AS and CHPV improved considerably compared to MTX monotherapy on day 21. Furthermore, all monotherapies and combination therapies were significant for the biochemical parameter γ-glutamyl transferase (GGT) in the joint. GGT activity in the spleen was less pronounced; only MTX in combination with SF1 significantly modified this parameter. The higher dose of SF monotherapy (SF2) was similarly significant with respect to immunological parameters, such as plasmatic IL-17A, IL-1β, and MMP-9 on day 21. The combination of both doses of SF with MTX significantly improved these immunological parameters, except for C-reactive protein (CRP), which was influenced only by the higher dose of SF2 in combination with MTX in plasma at the end of the experiment. A different effect was found for the relative expression of CD36 mRNA, where only SF1 significantly decreased gene expression in the liver. However, the relative gene mRNA expression of IL-1β in the liver was significantly reduced by the SF monotherapies and the combination of both SF doses with MTX. Our findings showed SF's partial antiarthritic and anti-inflammatory potential in monotherapy, but the effect was stronger in combination with MTX.
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Affiliation(s)
- Martin Chrastina
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine SAS, 841 04 Bratislava, Slovakia; (M.C.); (K.P.); (S.P.); (K.S.K.); (S.K.)
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Malá Hora 10701/4A, 036 01 Martin, Slovakia
| | - František Dráfi
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine SAS, 841 04 Bratislava, Slovakia; (M.C.); (K.P.); (S.P.); (K.S.K.); (S.K.)
| | - Katarína Pružinská
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine SAS, 841 04 Bratislava, Slovakia; (M.C.); (K.P.); (S.P.); (K.S.K.); (S.K.)
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Malá Hora 10701/4A, 036 01 Martin, Slovakia
| | - Silvester Poništ
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine SAS, 841 04 Bratislava, Slovakia; (M.C.); (K.P.); (S.P.); (K.S.K.); (S.K.)
| | - Kevine Silihe Kamga
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine SAS, 841 04 Bratislava, Slovakia; (M.C.); (K.P.); (S.P.); (K.S.K.); (S.K.)
- Faculty of Science, University of Yaoundé 1, Yaoundé P.O. Box 812, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé P.O. Box 1364, Cameroon
| | - Sasan Khademnematolahi
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine SAS, 841 04 Bratislava, Slovakia; (M.C.); (K.P.); (S.P.); (K.S.K.); (S.K.)
- Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovičova 6, 842 15 Bratislava, Slovakia
| | - František Bilka
- Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, 832 32 Bratislava, Slovakia; (F.B.); (P.N.); (Ľ.P.)
| | - Peter Novák
- Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, 832 32 Bratislava, Slovakia; (F.B.); (P.N.); (Ľ.P.)
| | - Ľudmila Pašková
- Faculty of Pharmacy, Comenius University in Bratislava, Odbojárov 10, 832 32 Bratislava, Slovakia; (F.B.); (P.N.); (Ľ.P.)
| | - Katarína Bauerová
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine SAS, 841 04 Bratislava, Slovakia; (M.C.); (K.P.); (S.P.); (K.S.K.); (S.K.)
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P2X7R Mediates the Synergistic Effect of ATP and MSU Crystals to Induce Acute Gouty Arthritis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:3317307. [PMID: 36686377 PMCID: PMC9851801 DOI: 10.1155/2023/3317307] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/26/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
Activation of the nod-like receptor protein 3 (NLRP3) inflammasome by monosodium urate (MSU) crystals has been identified as the molecular basis for the acute inflammatory response in gouty arthritis. However, MSU crystals alone are not sufficient to induce acute gouty arthritis (AGA). Adenosine triphosphate (ATP) is an endogenous signaling molecule involved in the NLRP3 inflammasome activation. We aimed to explore the role of ATP in MSU crystal-induced AGA development. In peripheral blood mononuclear cell-derived macrophages obtained from gout patients, we observed a synergistic effect of ATP on MSU crystal-induced IL-1β release. Furthermore, in a rat model of spontaneous gout, we demonstrated that a synergistic effect of ATP and MSU crystals, but not MSU crystals alone, is essential for triggering AGA. Mechanistically, this synergistic effect is achieved through the purinergic receptor P2X7 (P2X7R). Blockade of P2X7R prevented AGA induction in rats after local injection of MSU crystals, and carrying the mutant hP2X7R gene contributed to the inhibition of NLRP3 inflammasome activation induced by costimulation of MSU crystals and ATP in vitro. Taken together, these results support the synergistic effect of ATP on MSU crystal-induced NLRP3 inflammasome activation facilitating inflammatory episodes in AGA. In this process, P2X7R plays a key regulatory role, suggesting targeting P2X7R to be an attractive therapeutic strategy for the treatment of AGA.
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Li X, Liu Y, Luo C, Tao J. Z1456467176 alleviates gouty arthritis by allosterically modulating P2X7R to inhibit NLRP3 inflammasome activation. Front Pharmacol 2022; 13:979939. [PMID: 36052144 PMCID: PMC9424684 DOI: 10.3389/fphar.2022.979939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
NLRP3 inflammasome activation is a central process in initiating gout flares. The unique conformational rearrangement of the P2X7 receptor (P2X7R) upon ATP binding is critical for the activation of the NLRP3 inflammasome. However, studies on allosteric modulation of P2X7R in gout treatment are limited. Here, we aimed to investigate the therapeutic implications of targeting P2X7R in gout by designing a P2X7R allosteric inhibitor and validating the inhibitory function on NLRP3 inflammasome activation. Through virtual screening, we identified Z1456467176 (N-{3-[(2-aminoethyl) sulfamoyl] phenyl}-2-methyl-3-[3-(trifluoromethyl) phenyl] propanamide hydrochloride) bound to the drug-binding pocket as a potential antagonist of P2X7R. In functional assays, ATP- or BzATP-induced P2X7R function was assessed in vitro in HEK-293T cells overexpressing hP2X7R (dye uptake assay) and macrophages (IL-1β release assay). Z1456467176 exhibited a stable and significant P2X7R inhibitory effect. Importantly, in MSU crystal-induced gout, the presence and involvement of ATP were confirmed. Z1456467176 blocked ATP-induced activation of the NLRP3-caspase-1-IL-1β pathway and exerted promising effects in reducing gouty joint inflammation in rats. In addition, molecular docking and molecular dynamics simulation studies showed that the P27XR protein conformation was remodeled by Z1456467176 binding. Collectively, our results provide a potent P2X7R allosteric inhibitor that facilitates the remission of MSU crystal-induced gout inflammation by inhibiting NLRP3 inflammasome activation, suggesting that allosteric inhibition of P2X7R represents a new direction in gout treatment.
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Sivera F, Andres M, Dalbeth N. A glance into the future of gout. Ther Adv Musculoskelet Dis 2022; 14:1759720X221114098. [PMID: 35923650 PMCID: PMC9340313 DOI: 10.1177/1759720x221114098] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open
Abstract
Gout is characterized by monosodium urate (MSU) crystal deposits in and within joints. These deposits result from persistent hyperuricaemia and most typically lead to recurrent acute inflammatory episodes (gout flares). Even though some aspects of gout are well characterized, uncertainties remain; this upcoming decade should provide further insights into many of these uncertainties. Synovial fluid analysis allows for the identification of MSU crystals and unequivocal diagnosis. Non-invasive methods for diagnosis are being explored, such as Raman spectroscopy and imaging modalities. Both ultrasound and dual-energy computed tomography (DECT) allow the detection of MSU crystals; this not only provides a mean of diagnosis, but also has furthered gout knowledge defining the presence of a preclinical deposition in asymptomatic hyperuricaemia. Scientific consensus establishes the beginning of gout as the beginning of symptoms (usually the first flare), but the concept is currently under review. For effective long-term gout management, the main goal is to promote crystal dissolution treatment by reducing serum urate below 6 mg/dL (or 5 mg/dL if faster crystal dissolution is required). Current urate-lowering therapies' (ULTs) options are limited, with allopurinol and febuxostat being widely available, and probenecid, benzbromarone, and pegloticase available in some regions. New xanthine oxidase inhibitors and, especially, uricosurics inhibiting urate transporter URAT1 are under development; it is probable that the new decade will see a welcomed increase in the gout therapeutic armamentarium. Cardiovascular and renal comorbidities are common in gout patients. Studies determining whether optimal treatment of gout will positively impact these comorbidities are currently lacking, but will hopefully be forthcoming. Overall, the single change that will most impact gout management is greater uptake of international rheumatology society recommendations. Innovative strategies, such as nurse-led interventions based on these recommendations have recently demonstrated treatment success for people with gout.
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Affiliation(s)
- Francisca Sivera
- Rheumatology Unit, Hospital General
Universitario Elda, Ctra Sax s/n, Elda 03600, Alicante, Spain
- Department Medicine, Universidad Miguel
Hernandez, Elche, Spain
| | - Mariano Andres
- Department Medicine, Universidad Miguel
Hernandez, Elche, Spain
- Rheumatology Unit, Hospital General
Universitario Alicante, Alicante, Spain
- Alicante Institute of Sanitary and Biomedical
Research (ISABIAL), Alicante, Spain
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Krekeler M, Baraliakos X, Tsiami S, Braun J. High prevalence of chondrocalcinosis and frequent comorbidity with calcium pyrophosphate deposition disease in patients with seronegative rheumatoid arthritis. RMD Open 2022; 8:rmdopen-2022-002383. [PMID: 35701012 PMCID: PMC9198698 DOI: 10.1136/rmdopen-2022-002383] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background The crystal-induced calcium pyrophosphate deposition disease (CPPD) clinically appearing as pseudogout differs from the mere radiographic finding of chondrocalcinosis (CC) but may cause symptoms resembling rheumatoid arthritis (RA). Objective To study the prevalence of CPPD and CC in rheumatic diseases focusing on differences between seropositive and seronegative RA. Patients and methods In a retrospective study design, we analysed records and radiographs of consecutive new patients presenting to our centre between January 2017 and May 2020. 503 patients were identified based on expert diagnoses: 181 with CPPD, 262 with RA, 142 seropositive (54.2%) and 120 seronegative RA, gout (n=30) and polymyalgia rheumatica (n=30), mean symptom duration <1 year in almost all patients. Results The majority of patients had only one rheumatological diagnosis (86.9%). Most patients with CPPD (92.6%) had radiographic CC, primarily in the wrists. The prevalence of CC was higher in seronegative (32.3%) than in seropositive RA (16.6%), respectively (p<0.001). Patients with CPPD were older (p<0.001) and had acute attacks more frequently than patients with RA (p<0.001), who had symmetric arthritis more often (p=0.007). The distribution pattern of osteoarthritic changes in radiographs of hands and wrists differs between patients with RA and CPPD. CC was present in more than one joint in 73.3% of patients with CPPD, 9.6% with seropositive and 18.7% with seronegative RA. Discussion CPPD and CC were more frequent in seronegative versus seropositive RA. Symmetry of arthritis and acuteness of attacks differentiated best between CPPD and RA but localisation of joint involvement did not. Co-occurrence of both diseases was frequently observed.
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Affiliation(s)
- Martin Krekeler
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Germany
| | | | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet, Herne, Germany.,Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Herne, Germany
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Khaild SM, Fagir AM, Taha ZI, Elshareef AA, Mohammed MH, Saeed KM, Elagib EM, Ibrahim EM, William J. Prevalence of Hypertension in Sudanese Patients With Gouty Arthritis. Cureus 2022; 14:e24248. [PMID: 35602803 PMCID: PMC9116687 DOI: 10.7759/cureus.24248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background In this study, we aimed to study the frequency of hypertension in Sudanese patients with gouty arthritis attending the largest three tertiary hospitals in Khartoum and correlate it with serum uric acid levels. Methodology An observational, descriptive, cross-sectional, hospital-based study was conducted in rheumatology clinics in Khartoum state, Sudan, from August 2020 to January 2021 involving 100 participants. Data were collected, prepared, and analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Results In this study, 100 participants were enrolled. The majority were males (79%), with 45% of the participants in the age group of 61-75 years. Overall, 89% of participants had symptoms of gouty arthritis, with the knee being the most common joint affected in 27% of participants. Most participants had a uric acid level above the target (6 mg/dL). The most frequently used uric acid lowering agent was found to be allopurinol in 85% of the patients. Furthermore, among those with gouty arthritis, 51% had hypertension with nearly half being insufficiently controlled. The frequency of undiagnosed hypertension among the participants was found to be 19%, which was statistically significant among gouty arthritis patients (p-value < 0.0001). Upon further analysis of our hypertensive participants, 79.5% of males (n = 35) had high blood pressure levels, which was statistically significant as well (p-value = 0.005), with the highest prevalence being among the age group of 61-75 years. Of those who were hypertensive, 51% had a history of concomitant comorbidity. Overall, 90% of the hypertensive participants (n = 40) had joint symptoms. Moreover, serum uric acid level was above the target in 93% of the participants. Conclusions Hypertension was found to be the most frequently recognized comorbidity in gouty arthritic patients, with more than a third remaining undiagnosed. Moreover, the male gender was a significant risk factor for hypertension among the gouty arthritis participants. Nevertheless, most patients with high blood pressure levels had concurrent elevated uric acid levels.
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Affiliation(s)
| | - Amro M Fagir
- Internal Medicine, Al Ain Hospital, Abu Dhabi, ARE
| | - Ziryab I Taha
- Rheumatology, Sudan Medical Specialization Board, Khartoum North, SDN
- Internal Medicine, University of Bahri, Khartoum, SDN
| | | | | | | | | | | | - Jimmy William
- Internal Medicine, Sligo University Hospital, Sligo, IRL
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Nada D, Gaber R, Mahmoud AS, Elkhouly R, Alashkar D. Hyperuricemia Among Egyptian Rheumatoid Arthritis Patients. Is It an Association or an Inflammatory Marker? A Cross-Sectional Observational Study. Open Access Rheumatol 2021; 13:305-314. [PMID: 34675698 PMCID: PMC8502065 DOI: 10.2147/oarrr.s331488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/21/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To detect the prevalence of hyperuricemia in Egyptian rheumatoid arthritis (RA) patients as well as to assess its association with the severity of joint inflammation and disease-modifying antirheumatic drugs (DMARDs) in those patients. METHODS A total of 150 RA patients were recruited; all patients were subjected to (1) clinical and functional assessment by disease activity score in 28 joints (DAS28) and modified health assessment questionnaire (MHAQ). (2) Laboratory investigations: serum uric acid (SUA) level, complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), tumor necrosis factor α (TNF-α), interleukin 1 (IL1), and interleukin 6 (IL6) levels. (3) Radiological evaluation: (A) plain X-ray of both hands and feet; (B) musculoskeletal ultrasound (MSUS) of both wrists, hands, shoulder, ankle, and knee joints. RESULTS SUA was significantly correlated with disease activity by DAS28. Acute-phase reactants and inflammatory markers (IL1β, IL6, and TNF-α) were also significantly elevated in RA patients with low and high hyperuricemia compared to those with normal SUA. A total of 90% of RA patients with low hyperuricemia had synovial proliferation with power Doppler (1+ and 2+), and 30 patients had mild effusion (1+), while nearly all patients with high hyperuricemia had hypoechoic synovial proliferation (2+ and 3+), and 20 patients had moderate effusion. However, 70% RA patients with normal serum uric acid showed mild synovitis and effusion (1+). No significant association was found between the administered DMARDs and levels of SUA as well as inflammatory markers; however, high-dose steroid treatment was associated with high SUA level. CONCLUSION Elevation of serum uric acid levels in Egyptian RA patients was prevalent and might be an inflammatory marker for severity of joint inflammation. Moreover, higher doses of steroids could be considered a cause of hyperuricemia.
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Affiliation(s)
- Doaa Nada
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, Egypt
| | - Rasha Gaber
- Medical Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, Egypt
| | - Al Shymaa Mahmoud
- Radiology Departments, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, Egypt
| | - Radwa Elkhouly
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, Egypt
| | - Doaa Alashkar
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Tanta University, Tanta, Al Gharbeia Governorate, Egypt
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Zhao X, Kim YR, Min Y, Zhao Y, Do K, Son YO. Natural Plant Extracts and Compounds for Rheumatoid Arthritis Therapy. ACTA ACUST UNITED AC 2021; 57:medicina57030266. [PMID: 33803959 PMCID: PMC8001474 DOI: 10.3390/medicina57030266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023]
Abstract
Natural plant extracts and compounds (NPECs), which originate from herbs or plants, have been used in the clinical treatment of rheumatoid arthritis (RA) for many years. Over the years, many scientists have carried out a series of studies on the treatment of RA by NPEC. They found a high quantity of active NPECs with broad application prospects. In view of various complex functions of these NPECs, exploring their potential as medicines for RA treatment will be beneficial for RA patients. Thus, to help advance the development of high-quality NPECs for RA, we herein aimed to review the research progress of NPECs in the treatment of RA in recent years. Our findings showed that, from the pharmacological perspective, natural plant extracts or mixed herbal compounds effectively regulate the immune system to alleviate RA by inhibiting pro-inflammatory cytokines. Further, individualized medication can be applied according to each patient's physical condition. However, the pathogenesis of RA and its immune mechanism has not been fully understood and requires further studies.
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Affiliation(s)
- Xiangyu Zhao
- Interdisciplinary Graduate Program in Advanced Convergence Technology and Science, Jeju National University, Jeju 63243, Korea; (X.Z.); (Y.M.)
| | - Young-Rok Kim
- Department of Animal Biotechnology, Faculty of Biotechnology, Jeju National University, Jeju 63243, Korea;
| | - Yunhui Min
- Interdisciplinary Graduate Program in Advanced Convergence Technology and Science, Jeju National University, Jeju 63243, Korea; (X.Z.); (Y.M.)
| | - Yaping Zhao
- School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, Shanghai Jiao Tong University, Shanghai 200240, China;
| | - Kyoungtag Do
- Department of Animal Biotechnology, Faculty of Biotechnology, Jeju National University, Jeju 63243, Korea;
- Correspondence: (K.D.); (Y.-O.S.); Tel.: +82-64-754-3334 (K.D.); +82-64-754-3331 (Y.-O.S.)
| | - Young-Ok Son
- Interdisciplinary Graduate Program in Advanced Convergence Technology and Science, Jeju National University, Jeju 63243, Korea; (X.Z.); (Y.M.)
- Department of Animal Biotechnology, Faculty of Biotechnology, Jeju National University, Jeju 63243, Korea;
- Bio-Health Materials Core-Facility Center, Jeju National University, Jeju 63243, Korea
- Practical Translational Research Center, Jeju National University, Jeju 63243, Korea
- Correspondence: (K.D.); (Y.-O.S.); Tel.: +82-64-754-3334 (K.D.); +82-64-754-3331 (Y.-O.S.)
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Buch MH, Eyre S, McGonagle D. Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis. Nat Rev Rheumatol 2020; 17:17-33. [PMID: 33293696 DOI: 10.1038/s41584-020-00541-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 12/13/2022]
Abstract
Despite nearly three decades of advances in the management of rheumatoid arthritis (RA), a substantial minority of patients are exposed to multiple DMARDs without necessarily benefitting from them; a group of patients variously designated as having 'difficult to treat', 'treatment-resistant' or 'refractory' RA. This Review of refractory RA focuses on two types of patients: those for whom multiple targeted therapies lack efficacy and who have persistent inflammatory pathology, which we designate as persistent inflammatory refractory RA (PIRRA); and those with supposed refractory RA who have continued disease activity that is predominantly independent of objective evidence of inflammation, which we designate as non-inflammatory refractory RA (NIRRA). These two types of disease are not mutually exclusive, but identifying those individuals with predominant PIRRA or NIRRA is important, as it informs distinct treatment and management approaches. This Review outlines the clinical differences between PIRRA and NIRRA, the genetic and epigenetic mechanisms and immune pathways that might contribute to the immunopathogenesis of recalcitrant synovitis in PIRRA, and a possible basis for non-inflammatory symptomatology in NIRRA. Future approaches towards the definition of refractory RA and the application of single-cell and integrated omics technologies to the identification of refractory RA endotypes are also discussed.
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Affiliation(s)
- Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK. .,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK. .,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
| | - Stephen Eyre
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Chiou A, England BR, Sayles H, Thiele GM, Duryee MJ, Baker JF, Singh N, Cannon GW, Kerr GS, Reimold A, Gaffo A, Mikuls TR. Coexistent Hyperuricemia and Gout in Rheumatoid Arthritis: Associations With Comorbidities, Disease Activity, and Mortality. Arthritis Care Res (Hoboken) 2020; 72:950-958. [PMID: 31074584 DOI: 10.1002/acr.23926] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/07/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although hyperuricemia and gout can complicate the course of rheumatoid arthritis (RA), the impact of these factors on outcomes in RA is unclear. We undertook this study to examine associations of coexistent hyperuricemia and gout with RA disease measures, RA treatments, and survival. METHODS Participants from a longitudinal RA study were categorized by the presence of gout and serum urate (UA) status. Groups were compared by baseline patient characteristics, RA disease activity, treatments, and comorbidities. Associations of baseline serum UA levels with all-cause and cardiovascular disease (CVD)-related mortality were examined in multivariable survival analyses. RESULTS Of 1,999 participants with RA, 341 (17%) had serum UA concentrations of >6.8 mg/dl, and 121 (6.1%) were diagnosed with gout. There were no significant associations of serum UA concentration or gout with RA disease activity or treatment at enrollment, with the exception that those with gout were more likely to be receiving sulfasalazine and less likely to be receiving nonsteroidal antiinflammatory drugs. After adjustments for age and sex, moderate hyperuricemia (serum UA >6.8 to ≤8 mg/dl) was associated with an increased risk of CVD-related mortality (hazard ratio 1.56 [95% confidence interval 1.11-2.21]). This association was attenuated and not significant following additional adjustment for comorbidities that more commonly accompany hyperuricemia. Results corresponding with serum UA concentrations of >8.0 mg/dl were similar, although not reaching statistical significance in any model. There were no associations of baseline serum UA concentration with all-cause mortality. CONCLUSION Our study reports the frequency of hyperuricemia and gout in patients with RA. These results demonstrate strong associations of hyperuricemia with CVD mortality in this population, a risk that appears to be driven by excess comorbidity.
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Affiliation(s)
| | - Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | | | - Geoffrey M Thiele
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | - Michael J Duryee
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | - Joshua F Baker
- Corporal Michael J. Crescenz VAMC and University of Pennsylvania, Philadelphia
| | | | - Grant W Cannon
- Salt Lake City VAMC and University of Utah, Salt Lake City
| | - Gail S Kerr
- Washington, DC VAMC, Georgetown University, and Howard University, Washington, DC
| | | | - Angelo Gaffo
- Birmingham VAMC and University of Alabama at Birmingham
| | - Ted R Mikuls
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska
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Abstract
BACKGROUND Non-invasive imaging modalities are used for the morphological and functional evaluation and diagnosis of gout; however, none of these methods are sufficiently sensitive or specific for the diagnosis of gout. By the use of dual-energy computed tomography (DECT) the direct visualization of sodium urate deposition is now possible. Moreover, it is possible to show the different pathological situations, disease activity and monitoring of tophaceous gout. The positive DECT scan became one of the 2015 ACR/EULAR classification criteria for gout 2 years ago. MATERIAL AND METHODS The literature search from 2009-2017 in PubMed, with the search criteria "Dual Energy CT and Gout" revealed 77 publications on the DECT method. RESULTS The DECT technique has a high sensitivity (90-100%) and a high specificity (83-89%) for diagnosing gout. The development of a semiquantitative scoring method also enables measurement of the severity of urate deposits at specific sites. CONCUSION The gold standard for the diagnosis of gout is still the detection of monosodium urate monohydrate crystals by polarizing microscopy after a joint punction; however with the DECT it is possible to non-invasively visualize, measure and score urate deposition and is therefore suitable for estimating the severity and prognosis. Although not clinical validated, DECT may sometimes help to detect gout. More studies should be conducted.
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Abstract
RATIONALE Rheumatoid arthritis (RA) and gout are common rheumatic diseases. However, their coexistance has been rarely reported. Here in, we describe a case of a middle aged Chinese woman having RA complicated with atypical gout on both the knee joints. PATIENT CONCERNS A 44-year-old Chinese woman complained of swelling and tenderness of multiple joints since 10 months. She had a positive rheumatoid factor and high titers of anti-CCP antibody. She was diagnosed with RA, and commenced on methotrexate, leflunomide, and methylprednisolone. Her symptoms of pain and swelling over interphalangeal and wrists joints subsided except the knee joints. She was started with treat to target treatment (TTT) for RA and rest of her medications was adjusted accordingly. Surprisingly, her symptoms did not improve ever after the addition of a biologic agent, tumor necrosis factor (TNF)-α receptor antagonist. DIAGNOSIS Presence of urate crystals in the synovium was viewed under polarization microscope which was extracted from one of the knee joint. Hence, we established the diagnosis of RA complicated with gout. INTERVENTIONS We commenced her on TNF-α receptor antagonist, colchicines, and febuxostat. OUTCOMES Her symptoms of pain and swelling improved significantly on both the knees and no longer recurred. LESSONS Coexistence of RA and gout has been rarely reported as it is not frequently seen in clinical practice. Hence, when patients with RA with oligoarthritis repeatedly do not respond to TTT, a standard antirheumatism treatment, the possibility of RA complicating with gout should be rule out.
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Abstract
The definition of asymptomatic hyperuricemia remains unclear, as no consensus exists about the serum urate cutoff or the relevance of ultrasound findings. Comorbidities associated with hyperuricemia have increased in frequency over the past two decades. Hyperuricemia (and/or gout) may be a cause or a consequence of a comorbidity. Whereas epidemiological studies suggest that hyperuricemia may be linked to cardiovascular, metabolic, and renal comorbidities, Mendelian randomization studies have not provided proof that these links are causal. Discrepancies between findings from observational studies and clinical trials preclude the development of recommendations about the potential benefits of urate-lowering therapy (ULT) in individual patients with asymptomatic hyperuricemia. The risk/benefit ratio of ULT is unclear. The risk of developing gout, estimated at 50%, must be weighed against the risk of cutaneous and cardiovascular side effects of xanthine oxidase inhibitors. The need for optimal comorbidity management, in contrast, is universally accepted. Medications for comorbidities that elevate urate levels should be discontinued and replaced with medications that have the opposite effect. Therapeutic lifestyle changes, weight loss as appropriate, and sufficient physical activity are useful for improving general health. Whether ULT has beneficial effects on comorbidities will be known only when well-powered interventional trials with relevant primary endpoints are available.
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Affiliation(s)
- Gérard Chalès
- Faculté de Médecine de Rennes, 2, avenue du professeur Léon-Bernard, 35000 Rennes, France.
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15
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Mechanistic immunological based classification of rheumatoid arthritis. Autoimmun Rev 2018; 17:1115-1123. [PMID: 30213700 DOI: 10.1016/j.autrev.2018.06.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/14/2018] [Indexed: 12/12/2022]
Abstract
The classical autoimmunity paradigm in rheumatoid arthritis (RA) is strongly supported by immunogenetics suggesting follicular helper T-cell responses driving high titre specific autoantibodies that pre-dates disease onset. Using the immunological disease continuum model of inflammation against self with "pure" adaptive and innate immune disease at opposite boundaries, we propose a novel immune mechanistic classification describing the heterogeneity within RA. Mutations or SNPs in autoinflammatory genes including MEFV and NOD2 are linked to seronegative RA phenotypes including some so called palindromic RA cases. However, just as innate and adaptive immunity are closely functionally integrated, some ACPA+ RA cases have superimposed "autoinflammatory" features including abrupt onset attacks, severe attacks, self-limiting attacks, relevant autoinflammatory mutations or SNPs and therapeutic responses to autoinflammatory pathway therapies including colchicine and IL-1 pathway blockade. An emergent feature from this classification that non-destructive RA phenotypes, both innate and adaptive, have disease epicentres situated in the extracapsular tissues. This mixed innate and adaptive immunopathogenesis may be the key to understanding severe disease flares, resistant disease subsets that are unresponsive to standard therapy and for therapies that target the autoinflammatory component of disease that are not currently considered by expert therapeutic recommendations.
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16
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Wang P, Smith SE, Garg R, Lu F, Wohlfahrt A, Campos A, Vanni K, Yu Z, Solomon DH, Kim SC. Identification of monosodium urate crystal deposits in patients with asymptomatic hyperuricemia using dual-energy CT. RMD Open 2018; 4:e000593. [PMID: 29556417 PMCID: PMC5856918 DOI: 10.1136/rmdopen-2017-000593] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/31/2018] [Accepted: 02/15/2018] [Indexed: 12/27/2022] Open
Abstract
Objectives Dual-energy CT (DECT) scan is a sensitive and specific tool used to visualise and quantify monosodium urate (MSU) crystal deposits in the joints. Few studies have examined MSU crystal deposits in patients with asymptomatic hyperuricemia (ie, hyperuricemia in the absence of gout) using DECT. Methods We conducted a prospective, non-interventional cross-sectional study to detect MSU crystal deposits on DECT scans among patients with asymptomatic hyperuricemia. We also examined patient factors associated with subclinical MSU crystal deposits. Out of 130 subjects aged ≥40 years with metabolic syndrome screened for serum uric acid (sUA) levels ≥6.5 mg/dL, 46 underwent a foot/ankle DECT scan. Results The mean age of the study participants was 62 (±8) years, 41% were men and the mean sUA level was 7.8 (±1.0) mg/dL. Seven (15%) of 46 patients had MSU crystal deposits on DECT with a mean total volume of 0.13 (±0.14) cm3. In the univariable logistic regression analysis, older age had a significant association with presence of MSU crystal deposits (OR 1.20, 95% CI 1.03 to 1.39), but sUA did not (OR 1.36, 95% CI 0.63 to 2.95). In the univariable analysis, sUA levels showed a trend towards a modest linear association (β=0.11, P=0.09) with total volume of MSU crystal deposits. Conclusions Fifteen per cent of patients with asymptomatic hyperuricemia had subclinical MSU crystal deposits on foot/ankle DECT scans. Older age, but not sUA, was significantly associated with presence of subclinical MSU crystal deposits among patients with asymptomatic hyperuricemia. Clinical significance of these subclinical MSU crystal deposits needs to be determined.
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Affiliation(s)
- Penny Wang
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rajesh Garg
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fengxin Lu
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alyssa Wohlfahrt
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anarosa Campos
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Vanni
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhi Yu
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel H Solomon
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Seoyoung C Kim
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Alabsi H, Alreshoodi S, Low E, Sultan N, Murray N, Mallinson P, Munk PL, Ouellette HA. Advancements in Dual-Energy CT Applications for Musculoskeletal Imaging. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0249-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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18
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Abstract
Acute gout arthritis flares contribute dominantly to gout-specific impaired health-related quality of life, representing a progressively increasing public health problem. Flares can be complex and expensive to treat, partly due to the frequent comorbidities. Unmet needs in gout management are more pressing given the markedly increasing gout flare hospital admission rates. In addition, chronic gouty arthritis can cause joint damage and functional impairment. This review addresses new knowledge on the basis for the marked, inherent variability of responses to deposited urate crystals, including the unpredictable and self-limited aspects of many gout flares. Specific topics reviewed include how innate immunity and two-signal inflammasome activation intersect with diet, metabolism, nutritional biosensing, the microbiome, and the phagocyte cytoskeleton and cell fate. The paper discusses the roles of endogenous constitutive regulators of inflammation, including certain nutritional biosensors, and emerging genetic and epigenetic factors. Recent advances in the basis of variability in responses to urate crystals in gout provide information about inflammatory arthritis, and have identified potential new targets and strategies for anti-inflammatory prevention and treatment of gouty arthritis.
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Affiliation(s)
- Robert Terkeltaub
- VA San Diego Healthcare System, 111K, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA. .,Department of Medicine, University of California San Diego, San Diego, CA, USA.
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Zhu J, Li A, Jia E, Zhou Y, Xu J, Chen S, Huang Y, Xiao X, Li J. Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study. Arthritis Res Ther 2017; 19:83. [PMID: 28464949 PMCID: PMC5414368 DOI: 10.1186/s13075-017-1286-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/24/2017] [Indexed: 12/27/2022] Open
Abstract
Background Previous studies have revealed that ankylosing spondylitis (AS), as the progenitor of axial spondyloarthritis (AxSpA), has been characterized by the insidiously progressive nature of sacroiliitis and spondylitis. Dual-energy computed tomography (DECT) has recently been used to analyse the deposition of monosodium urate (MSU) crystals with higher sensitivity and specificity. However, it remains unclear whether the existence of the MSU crystal deposition detected by DECT at the sacroiliac joint in patients with AxSpA also is associated with the existing structural damage. Here, we performed this study to show the DECT MSU crystal deposits in AxSpA patients without coexisting gout and to ascertain the relationship between the MSU crystal deposition and the structural joint damage of sacroiliac joints. Methods One hundred and eighty-six AxSpA patients without coexisting gout were recruited. The plain radiographs of the sacroiliac joint were obtained, along with the DECT scans at the pelvis and the clinical variables. All statistics based on the left or right sacroiliac joint damage grading (0–4) were calculated independently. Bivariate analysis and ordinal logistic regression was performed between the clinical features and radiographic grades at the sacroiliac joint. Results At the pelvis, large quantities of MSU crystal deposition were found in patients with AxSpA. The average MSU crystal volume at the left sacroiliac joint, the right sacroiliac joint, and the pelvis were 0.902 ± 1.345, 1.074 ± 1.878, and 5.272 ± 9.044 cm3, values which were correlated with serum uric acid concentrations (r = 0.727, 0.740, 0.896; p < 0.001). In bivariate analysis, wide clinical variables were associated with the changes in sacroiliac joint damage. Further, the AxSpA duration, BASFI score, and the volume of MSU crystal at both sides of sacroiliac joint were associated with the progress of radiographic grade at the sacroiliac joints in the ordinal logistic models (left AOR = 1.180, 3.800, 1.920; right AOR = 1.190, 3.034, 1.418; p < 0.01). Conclusions Large quantities of MSU crystal deposition detected by DECT were found at the pelvis in AxSpA patients without coexisting gout. In addition to AxSpA duration and BASFI score, the MSU crystal deposition at the sacroiliac joint is associated with the progress of radiographic grade at sacroiliac joints in those patients.
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Affiliation(s)
- Junqing Zhu
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Aiwu Li
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Ertao Jia
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Yi Zhou
- Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong, 511400, China
| | - Juan Xu
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Shixian Chen
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Yinger Huang
- Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China
| | - Xiang Xiao
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Juan Li
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China. .,Department of Internal Medicine of Traditional Chinese Medicine, College of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510510, China.
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20
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Petsch C, Araujo E, Hueber A, Schett G, Manger B, Rech J. Gout mimicking rheumatoid arthritis. Semin Arthritis Rheum 2017; 46:e15. [DOI: 10.1016/j.semarthrit.2016.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/15/2016] [Indexed: 01/08/2023]
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21
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Jayakumar D, Sehra ST, Anand S, Stallings GW, Danve A. Role of Dual Energy Computed Tomography Imaging in the Diagnosis of Gout. Cureus 2017; 9:e985. [PMID: 28229032 PMCID: PMC5318147 DOI: 10.7759/cureus.985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gout is a well-known inflammatory arthritis and affects four percent of the United States population. It results from the deposition of uric acid crystals in joints, tendons, bursae, and other surrounding tissues. Prevalence of gout has increased in the recent decade. Gout is usually seen in conjunction with other chronic comorbid conditions like cardiac disease, metabolic syndrome, and renal disease. The diagnosis of this inflammatory arthritis is confirmed by visualization of monosodium urate (MSU) crystals in the synovial fluid. Though synovial fluid aspiration is the standard of care, it is often deferred because of inaccessibility of small joints, patient assessment during intercritical period, or procedural inexperience in a primary care office. Dual energy computed tomography (DECT) is a relatively new imaging modality which shows great promise in the diagnosis of gout. It is a good noninvasive alternative to synovial fluid aspiration. DECT is increasingly useful in diagnosing cases of gout where synovial fluid fails to demonstrate monosodium urate crystals. In this article, we will review the mechanism, types, advantages, and disadvantages of DECT.
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Affiliation(s)
| | | | - Suneesh Anand
- Covenant Medical Center, Central Michigan University
| | | | - Abhijeet Danve
- Yale New Haven Hospital, Yale University School of Medicine
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Imaging of gout: New tools and biomarkers? Best Pract Res Clin Rheumatol 2016; 30:638-652. [PMID: 27931959 DOI: 10.1016/j.berh.2016.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 12/27/2022]
Abstract
While joint aspiration and crystal identification by polarizing microscopy remain the gold standard for diagnosing tophaceous gout, agreement among medical and ancillary health personnel examining synovial fluid using polarizing microscopy for the detection of monosodium urate (MSU) crystals appears to be poor. Imaging modalities, including conventional radiography (CR), ultrasonography (US), magnetic resonance imaging (MRI), and dual-energy computed tomography (DECT), have been found to provide information on the deposition of MSU crystals in tissues, and the consequences of such deposition. CR can demonstrate typical "punched out lesions" with marginal overhangs, but the sensitivity for erosion detection is better for DECT and US. US is inexpensive and can identify tophus deposition in and around joints, erosions, and tissue inflammation if power Doppler US is used. MRI can show tophi, bone marrow edema, and inflammation, but MRI findings of tophi may be nonspecific. DECT can identify and color-code tophaceous material, and provide an overview of the tophus burden of a joint area. Because of the lower number of available studies, the strength of evidence for the newer imaging can be improved through further research.
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