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Hasanpour H, Falak R, Mokhtarian K, Sadeghi F, Masoumi E, Asadollahi P, Badirzadeh A, Azami SJ, Gholami MD, Pashangzadeh S, Gharagozlou MJ, Naserifar R, Mowlavi G. The effects of Fasciola hepatica recombinant proteins (peroxiredoxin and cathepsin L1) on Crohn's disease experimental model. Parasite Immunol 2024; 46:e13019. [PMID: 38275199 DOI: 10.1111/pim.13019] [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: 04/09/2022] [Revised: 11/19/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024]
Abstract
The immunomodulatory potential of the excretory-secretory (E/S) proteins of the helminths has been shown in previous investigations. This study evaluated the effects of the recombinants and excretory-secretory proteins of the Fasciola hepatica on induced colitis in Balb/c mice. The F. hepatica Recombinant proteins, Cathepsin L1 and Peroxiredoxin, and E/S proteins were intraperitoneally injected into the three mice groups as the case groups, while the control groups received PBS. Colitis was induced in mice by intraluminal administration of the 2, 4, 6-Trinitrobenzenesulfonic acid solution (TNBS). After 8 h, the case groups received the second dosage of the treatments, and it was repeated 24 h later. The immunological, pathological, and macroscopic changes were evaluated 3 days after colitis induction. The macroscopic evaluation revealed significantly lower inflammatory scores in the mice treated with recombinant Peroxiredoxin (rPRX) and recombinant Cathepsin L1 (rCL1). Despite the macroscopic observation, the pathological finding was insignificant between the groups. IFN-γ secretion was significantly lower in splenocytes of the groups that received rPRX, rCL1, and E/S than the controls. IL-10 showed significantly higher levels in groups treated with rPRX and rCL1 than controls, whereas the level of IL-4 was not statistically significant. Excretory-secretory proteins of the F. hepatica showed immunomodulatory potency and the main effects observed in this study were through the reduction of inflammatory cytokine and inflammation manifestation as well as induction of anti-inflammatory cytokines.
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Affiliation(s)
- Hamid Hasanpour
- Department of Parasitology and Mycology, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Reza Falak
- Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Mokhtarian
- Department of Parasitology and Mycology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fatemeh Sadeghi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Elham Masoumi
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA
- Ludwig Center for Metastasis Research, University of Chicago, Chicago, Illinois, USA
| | - Parisa Asadollahi
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Alireza Badirzadeh
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sanaz Jafarpour Azami
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Salar Pashangzadeh
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Razi Naserifar
- Department of Parasitology and Mycology, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Gholamreza Mowlavi
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Bergstra SA, Sepriano A, Chopra A, Winchow LL, Vega-Morales D, Salomon-Escoto K, Matthijssen XME, Landewé RB. Country-level socioeconomic status relates geographical latitude to the onset of RA: a worldwide cross-sectional analysis in the METEOR registry. Ann Rheum Dis 2023; 82:1018-1024. [PMID: 37230737 DOI: 10.1136/ard-2023-224080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Age at rheumatoid arthritis (RA) onset varies by geographical latitude. We have investigated to what extent differences in patient-specific factors and country-level socioeconomic indicators explain this variability. METHODS Patients with RA from the worldwide METEOR registry were included. Bayesian multilevel structural equation models were used to study the relationship between the absolute value of (hospital) geographical latitude and age at diagnosis (as a proxy for age at RA onset). We examined to what extent this effect is mediated by individual patient characteristics and by country-specific socioeconomic indicators and disentangled whether the observed effects occurred at the patient, hospital, or country levels. RESULTS We included 37 981 patients from 93 hospitals in 17 geographically widespread countries. Mean age at diagnosis per country ranged from 39 (Iran) to 55 (Netherlands) years. Per degree increase in country latitude (between 9.9° and 55.8°), mean age at diagnosis increased by 0.23 years (95% credibility interval: 0.095 to 0.38) (reflecting >10 years difference in age at RA onset). For hospitals within a country, this latitude effect was negligible. Inclusion of patient-specific factors (eg, gender, anticitrullinated protein antibodies status) in the model augmented the main effect from 0.23 to 0.36 years. Inclusion of country-level socioeconomic indicators (eg, gross domestic product per capita) in the model almost effaced the main effect (from 0.23 to 0.051 (-0.37 to 0.38)). CONCLUSIONS Patients living closer to the equator get RA at a younger age. This latitude gradient was not explained by individual patient characteristics, but rather by countries' socioeconomic status, providing a direct link between countries' level of welfare and the clinical onset of RA.
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Affiliation(s)
- Sytske Anne Bergstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandre Sepriano
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Universidade Nova de Lisboa, NOVA Medical School, Lisbon, Portugal
| | | | - Lai-Ling Winchow
- University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - David Vega-Morales
- Hospital General de Zona No. 17, Instituto Mexicano del Seguro, Monterrey, Mexico
| | - Karen Salomon-Escoto
- University of Massachusetts Chan School of Medicine, UMass Memorial Health Rheumatology Center, Worcester, Massachusetts, USA
| | | | - Robert Bm Landewé
- Amsterdam Rheumatology Center, Amsterdam Medical Center, Amsterdam, The Netherlands
- Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
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3
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Zhao JH, Ma S, Li CY, Zhang HC, Zhao LJ, Zhang ZY. Clinically approved small-molecule drugs for the treatment of rheumatoid arthritis. Eur J Med Chem 2023; 256:115434. [PMID: 37148849 DOI: 10.1016/j.ejmech.2023.115434] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
Rheumatoid arthritis (RA) is a persistent autoimmune ailment that is typified by the development of pannus, proliferation of synovial lining cells, microvascular neogenesis, infiltration of interstitial inflammatory cells, and destruction of cartilage and bone tissue. The disease not only imposes physical pain and economic burden on patients, but also results in a significant decline in their quality of life, rendering it a leading cause of disability. General treatment and drugs are commonly employed to alleviate the condition and symptoms of RA. Cyclooxygenase (COX), janus kinase (JAK), glucocorticoid receptor (GR) et al. have been identified as the main therapeutic targets for RA. This article provides a comprehensive review of the clinical applications and synthetic routes of 26 representative drugs for the treatment of RA, with the aim of facilitating the discovery of more effective new drugs for the treatment of this debilitating disease.
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Affiliation(s)
- Jian-Hui Zhao
- Department of Orthopedics, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Shuai Ma
- Department of Orthopedics, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Chao-Yuan Li
- Department of Orthopedics, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Hong-Chao Zhang
- Department of Orthopedics, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Li-Jie Zhao
- The Rogel Cancer Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, United States; School of Pharmaceutical Sciences & Key Laboratory of Advanced Drug Preparation Technologies, Ministry of Education, Zhengzhou University, Zhengzhou, 450001, China.
| | - Zi-Yan Zhang
- Department of Orthopedics, The second Hospital, Jilin University, Changchun, 130021, China.
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4
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Venetsanopoulou AI, Kalpourtzi N, Alamanos Y, Gavana M, Vantarakis A, Hadjichristodoulou C, Mouchtouri VA, Chlouverakis G, Trypsianis G, Drosos AA, Touloumi G, Voulgari PV. Prevalence of rheumatoid arthritis in Greece: results from the national health examination survey EMENO. Rheumatol Int 2023; 43:1349-1355. [PMID: 37000296 DOI: 10.1007/s00296-023-05316-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023]
Abstract
Rheumatoid arthritis (RA) is considered the most common form of autoimmune arthritis. The disease's prevalence is around 0.5-1% worldwide, but it seems to vary among different populations. The aim of this study was to estimate the prevalence of self-reported diagnosed RA in the general adult population in Greece. The data were derived from the Greek Health Examination Survey EMENO, a population-based survey performed between 2013 and 2016. Of the 6006 participants (response rate 72%), 5884 were eligible for this study. Prevalence estimates were calculated according to the study design. Prevalence of self-reported RA was estimated to be overall 0.5% (95% CI 0.4-0.7) being approximately three times higher in women than in men (0.7% vs 0.2%, p value = 0.004). A decrease in the prevalence of RA was observed in urban areas of the country. In contrast, higher disease rates were reported in individuals with lower socioeconomic status. Multivariable regression analysis showed that gender, age, and income were related to the occurrence of the disease. Osteoporosis and thyroid disease were the two comorbidities observed at statistically significant higher rates in individuals with self-reported RA. The prevalence of self-reported RA in Greece is similar to that reported in other European countries. Gender, age, and income are the main factors related to the disease's prevalence in Greece.
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Affiliation(s)
- Aliki I Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Natasa Kalpourtzi
- Departmentof Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Yannis Alamanos
- Institute of Epidemiology, Preventive Medicine and Public Health, Corfu, Greece
| | - Magda Gavana
- Department of Primary Health Care, General Practice and Health Services Research, Medical School of Aristotle University, Thessaloniki, Greece
| | | | | | - Varvara A Mouchtouri
- Departmentof Hygiene and Epidemiology, Medical Faculty, University of Thessaly, Larissa, Greece
| | | | - Grigoris Trypsianis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Thrace, Greece
| | - Alexandros A Drosos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece
| | - Giota Touloumi
- Departmentof Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi V Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
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Arleevskaya M, Takha E, Petrov S, Kazarian G, Renaudineau Y, Brooks W, Larionova R, Korovina M, Valeeva A, Shuralev E, Mukminov M, Kravtsova O, Novikov A. Interplay of Environmental, Individual and Genetic Factors in Rheumatoid Arthritis Provocation. Int J Mol Sci 2022; 23:ijms23158140. [PMID: 35897715 PMCID: PMC9329780 DOI: 10.3390/ijms23158140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023] Open
Abstract
In this review, we explore systemization of knowledge about the triggering effects of non-genetic factors in pathogenic mechanisms that contribute to the development of rheumatoid arthritis (RA). Possible mechanisms involving environmental and individual factors in RA pathogenesis were analyzed, namely, infections, mental stress, sleep deprivation ecology, age, perinatal and gender factors, eating habits, obesity and smoking. The non-genetic factors modulate basic processes in the body with the impact of these factors being non-specific, but these common challenges may be decisive for advancement of the disease in the predisposed body at risk for RA. The provocation of this particular disease is associated with the presence of congenital loci minoris resistentia. The more frequent non-genetic factors form tangles of interdependent relationships and, thereby, several interdependent external factors hit one vulnerable basic process at once, either provoking or reinforcing each other. Understanding the specific mechanisms by which environmental and individual factors impact an individual under RA risk in the preclinical stages can contribute to early disease diagnosis and, if the factor is modifiable, might be useful for the prevention or delay of its development.
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Affiliation(s)
- Marina Arleevskaya
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia;
- Correspondence: ; Tel.: +7-89172-886-679; Fax: +7-843-238-5413
| | - Elena Takha
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
| | - Sergey Petrov
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Environmental Sciences, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Gevorg Kazarian
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
| | - Yves Renaudineau
- Department of Immunology, CHU Toulouse, INSERM U1291, CNRS U5051, University Toulouse IIII, 31000 Toulouse, France;
| | - Wesley Brooks
- Department of Chemistry, University of South Florida, Tampa, FL 33620, USA;
| | - Regina Larionova
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
| | - Marina Korovina
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia;
| | - Anna Valeeva
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
| | - Eduard Shuralev
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Environmental Sciences, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Malik Mukminov
- Central Research Laboratory, Kazan State Medical Academy, 420012 Kazan, Russia; (E.T.); (S.P.); (G.K.); (R.L.); (M.K.); (A.V.); (E.S.); (M.M.)
- Institute of Environmental Sciences, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Olga Kravtsova
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia;
| | - Andrey Novikov
- Mathematical Center, Sobolev Instiute of Mathematics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia;
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6
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Arunsi UO, Chioma OE, Etusim PE, Owumi SE. Indigenous Nigeria medicinal herbal remedies: A potential source for therapeutic against rheumatoid arthritis. Exp Biol Med (Maywood) 2022; 247:1148-1178. [PMID: 35708153 PMCID: PMC9335509 DOI: 10.1177/15353702221102901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Rheumatoid arthritis (RA) is a debilitating disease associated with locomotion impairment, and conventional therapeutic drugs are not optimal for managing RA. There is an avalanche of medications used for the management of RA. Still, studies have shown that they are associated with severe side effects, including hepatotoxicity, retinopathy, and cardiotoxicity disorders of the central nervous system (CNS), skin, blood, and infections. Complementary and alternative medicine (CAM) is currently gaining attention as a novel panacea for managing debilitating diseases, such as RA. Nigerian folk herbal remedies are replete with a plethora of curative medicine, albeit unvalidated scientifically but with seemingly miraculous provenance. Studies of the identification of bioactive compounds present in these botanicals using advanced spectral analytical techniques have enhanced our understanding of the role of Nigerian herbal remedies in the treatment and management of RA. Interestingly, experimental studies abound that the bioactive compounds present in the extracts of plant botanicals protected animals from the development of RA in different experimental models and reduced the toxicity associated with conventional therapeutics. Validated mechanisms of RA amelioration in human and animal models include suppression of the expression of NF-κB, IL-1β, TNF-α, IL-6, IL-8, IL-17, IL-23, chemokines, TGF-β, RANKL, RANK, iNOS, arginase, COX-2, VEGFA, VEGFR, NFATC1, and TRAP in the synoviocytes. Decreased ROS, NO, MDA, carbonyl groups, and PGE2 in the synovial fluid increased the expression of PPARα/γ; antioxidant and anti-inflammatory molecules also improve RA etiology. In this mini-review, we discuss the global burden of RA, the novel role of plant-based botanicals as potential therapeutics against signaling pathways in RA. Also addressed is the possible repurposing/reprofiling of plant botanicals to increase their therapeutic index among RA patients that patronize traditional healers in Nigeria with a global projection.
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Affiliation(s)
- Uche O Arunsi
- Cancer Immunology and Biotechnology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK,Department of Biochemistry, Faculty of Biological and Physical Sciences, Abia State University, Uturu, 440001, Nigeria
| | - Ogbuka E Chioma
- Department of Social and Environmental Forestry, Faculty of Renewable Natural Resources, University of Ibadan, Ibadan 200005, Nigeria
| | - Paschal E Etusim
- Department of Animal and Environmental Biology, Faculty of Biological and Physical Sciences, Abia State University, Uturu 200, Nigeria
| | - Solomon E Owumi
- Cancer Research and Molecular Biology Laboratories, Department of Biochemistry, Faculty of Basic Medical Sciences, University of Ibadan, Ibadan 200005, Nigeria,Solomon Owumi.
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7
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Venetsanopoulou AI, Alamanos Y, Skalkou A, Voulgari PV, Drosos AA. The changing incidence of rheumatoid arthritis over time in north-west Greece: data from a referral centre. Scand J Rheumatol 2022:1-8. [PMID: 35545952 DOI: 10.1080/03009742.2022.2058178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown aetiology that affects approximately 1% of the population. The disease presents a temporal variability in different geographic areas. We investigated RA incidence over a 40-year-period in a defined area of north-west Greece, with a total population of about 400 000 inhabitants. METHOD This incidence study was based on retrospective review of clinical records among adults with RA newly diagnosed from 1980 to 2019 at the referral university hospital of Ioannina. An incident case was defined as any patient diagnosed with RA based on the 1987 American College of Rheumatology criteria, over 16-years-old, and resident in the study area for at least 1 year before diagnosis. RESULTS Out of 1411 cases diagnosed, women constituted a 2.65-fold higher number than men, with a lower mean age at diagnosis. The overall age-adjusted annual incidence rate (95% confidence interval) was 9.5 (8.5-10.5) for the total observation period, 11.7 (10.7-13.0) in 1980-1989, 10.4 (9.4-10.8) in 1990-1999, 9.8 (8.9-10.8) in 2000-2009, and 6.1 (5.3-6.9) in 2010-2019, presenting a statistically significant decline over time, along with a constant decrease in rheumatoid factor (RF)-positive incidence for both sexes. CONCLUSION Our findings suggest a decrease in the incidence of RA over 40 years in a geographically defined Greek population. Also, the progressive decrease in the incidence of RF-positive disease may relate to less severe expression of RA in Greek patients. These trends could be explained by different clinical, serological, and genetic factors reported in Greece compared to northern European countries.
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Affiliation(s)
- A I Venetsanopoulou
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Y Alamanos
- Institute of Epidemiology, Preventive Medicine and Public Health, Corfu, Greece
| | - A Skalkou
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - P V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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8
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Zhang C, Huang W, Huang C, Zhou C, Tang Y, Wei W, Li Y, Tang Y, Luo Y, Zhou Q, Chen W. VHPKQHR Peptide Modified Ultrasmall Paramagnetic Iron Oxide Nanoparticles Targeting Rheumatoid Arthritis for T1-Weighted Magnetic Resonance Imaging. Front Bioeng Biotechnol 2022; 10:821256. [PMID: 35295653 PMCID: PMC8918785 DOI: 10.3389/fbioe.2022.821256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022] Open
Abstract
Magnetic resonance imaging (MRI) could be the ideal diagnostic modality for early rheumatoid arthritis (RA). Vascular cell adhesion molecule-1 (VCAM-1) is highly expressed in synovial locations in patients with RA, which could be a potential target protein for RA diagnosis. The peptide VHPKQHR (VHP) has a high affinity to VCAM-1. To make the contrast agent to target RA at an early stage, we used VHP and ultrasmall paramagnetic iron oxide (USPIO) to synthesize UVHP (U stands for USPIO) through a chemical reaction with 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride and N-hydroxysuccinimide. The size of UVHP was 6.7 nm; the potential was −27.7 mV, and the r2/r1 value was 1.73. Cytotoxicity assay exhibited that the cell survival rate was higher than 80% at even high concentrations of UVHP (Fe concentration 200 µg/mL), which showed the UVHP has low toxicity. Compared with no TNF-α stimulation, VCAM-1 expression was increased nearly 3-fold when mouse aortic endothelial cells (MAECs) were stimulated with 50 ng/mL TNF-α; cellular Fe uptake was increased very significantly with increasing UVHP concentration under TNF-α treatment; cellular Fe content was 17 times higher under UVHP with Fe concentration 200 µg/mL treating MAECs. These results indicate that UVHP can target overexpression of VCAM-1 at the cellular level. RA mice models were constructed with adjuvant-induced arthritis. In vivo MRI and biodistribution results show that the signal intensity of knee joints was increased significantly and Fe accumulation in RA model mice compared with normal wild-type mice after injecting UVHP 24 h. These results suggest that we have synthesized a simple, low-cost, and less toxic contrast agent UVHP, which targeted VCAM-1 for early-stage RA diagnosis and generates high contrast in T1-weighted MRI.
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Affiliation(s)
- Chunyu Zhang
- MOE Key Laboratory of Laser Life Science, Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
- Guangzhou Key Laboratory of Spectral Analysis and Functional Probes, College of Biophotonics, South China Normal University, Guangzhou, China
| | - Wentao Huang
- MOE Key Laboratory of Laser Life Science, Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
- Guangzhou Key Laboratory of Spectral Analysis and Functional Probes, College of Biophotonics, South China Normal University, Guangzhou, China
| | - Chen Huang
- Department of Minimally Invasive Interventional Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Chengqian Zhou
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger, Baltimore, MD, United States
| | - Yukuan Tang
- Department of Minimally Invasive Interventional Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Wei Wei
- Institution of GuangDong Cord Blood Bank, Guangzhou, China
| | - Yongsheng Li
- Institution of GuangDong Cord Blood Bank, Guangzhou, China
| | - Yukuan Tang
- Department of Minimally Invasive Interventional Radiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- *Correspondence: Yukuan Tang, ; Yu Luo, ; Quan Zhou, ; Wenli Chen,
| | - Yu Luo
- Shanghai Engineering Technology Research Center for Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Noncoding RNA, Institute for Frontier Medical Technology, College of Chemistry and Chemical Engineering, Shanghai University of Engineering Science, Shanghai, China
- *Correspondence: Yukuan Tang, ; Yu Luo, ; Quan Zhou, ; Wenli Chen,
| | - Quan Zhou
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Yukuan Tang, ; Yu Luo, ; Quan Zhou, ; Wenli Chen,
| | - Wenli Chen
- MOE Key Laboratory of Laser Life Science, Institute of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, South China Normal University, Guangzhou, China
- Guangzhou Key Laboratory of Spectral Analysis and Functional Probes, College of Biophotonics, South China Normal University, Guangzhou, China
- *Correspondence: Yukuan Tang, ; Yu Luo, ; Quan Zhou, ; Wenli Chen,
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9
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Abstract
Historically, rheumatic diseases have not received much attention in Africa, particularly in sub-Saharan Africa, possibly owing to a focus on the overwhelming incidence of infectious diseases and the decreased life span of the general population in this region. Global attention and support, together with better health policies and planning, have improved outcomes for many infectious diseases; thus, increasing attention is being turned to chronic non-communicable diseases. Rheumatic diseases were previously considered to be rare among Africans but there is now a growing interest in these conditions, particularly as the number of rheumatologists on the continent increases. This interest has resulted in a growing number of publications from Africa on the more commonly encountered rheumatic diseases, as well as case reports of rare diseases. Despite the limited amount of available data, some aspects of the epidemiology, genetics and clinical and laboratory features of rheumatic diseases in African populations are known, as is some detail on the use of therapeutics. Similarities and differences in these conditions can be seen across the multi-ethnic and genetically diverse African continent, and it is hoped that increased awareness of rheumatic diseases in Africa will lead to earlier diagnosis and better outcomes for patients. The prevalence of rheumatic diseases is increasing in African countries, leading to an increased need for specialist rheumatologists and disease-modifying drugs. In this Review, the authors outline what is currently known about the state of rheumatic diseases in Africa. In the past, there has been an emphasis on communicable diseases in Africa, but attention has now shifted towards non-communicable diseases such as rheumatic diseases. Common rheumatic diseases are seen in Africa and are both comparable and different from presentations seen outside of Africa. Diverse genetic and environmental factors affect the presentation of common rheumatic diseases among different African nations. A shortage of appropriately trained staff, laboratory testing capacity and effective medications exists across the whole continent. Advocacy and research are needed to increase awareness of the risk factors, presentations and management of rheumatic diseases in Africa. Specialized treatment guidelines are needed for resource-poor countries in Africa.
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Faghani M, Mohammadghasemi F, Rafat Z, Sasani E. Serum melatonin level in patients with rheumatoid arthritis: A systematic review and meta-analysis. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_331_20] [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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Venkatesh MP, Kumar TP, Pai DR. Targeted drug delivery of Methotrexate in situ gels for the treatment of Rheumatoid Arthritis. Saudi Pharm J 2020; 28:1548-1557. [PMID: 33424248 PMCID: PMC7783075 DOI: 10.1016/j.jsps.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/15/2020] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis (RA) is considered a debilitating disease that increases the risk of significant morbidity and premature mortality. To circumvent drug-related toxicity and ineffectiveness of anti-inflammatory drugs, there is a significant need for an advanced delivery system that increases bioavailability. The feasibility of in situ gel of methotrexate sodium (MTS) as an effective management for Rheumatoid arthritis was investigated. It was formulated with pluronic F-127 (PLF-127) as primary polymer, hydroxypropyl methylcellulose K4M (HK4M), and polycarbophil (PCL) as a copolymer and characterized by various parameters. The efficacy evaluation by Freund's complete adjuvant (FCA) model, biocompatibility assessment by histopathological studies conducted. The optimized in situ gel (M4) was thermoresponsive, released 93.26 ± 2.39% MTS at 96 hours. In addition, distribution of MTS was even in the optimized sterile and syringeable in situ gel. In vivo studies on wistar rats demonstrated a substantial reduction in paw oedema during the 28-day study period and were biocompatible with the tissues at the injection site. The study was successful in formulating, optimizing MTS in situ gel for effective management of RA.
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Affiliation(s)
- Madhugiri Prakash Venkatesh
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru 570015, Karnataka, India
| | - Tegginmat Pramod Kumar
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru 570015, Karnataka, India
| | - Deeksha Ramananda Pai
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru 570015, Karnataka, India
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Intracytoplasmic Expression of IL-6 and IL-17A in Circulating CD4+ T Cells Are Strongly Associated with and Predict Disease Activity in Rheumatoid Arthritis: A Case-Control Study in Ghana. Int J Rheumatol 2020; 2020:2808413. [PMID: 33101416 PMCID: PMC7568150 DOI: 10.1155/2020/2808413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background T cell cytokines play important roles in the development and progression of rheumatoid arthritis (RA). Loss of Th1/Th2 and Th17/Treg balance has been reported in several inflammatory autoimmune diseases. However, their role in RA within hitherto rare Ghanaian context has not been explored. Here, we evaluated the intracytoplasmic CD4+ T cell cytokine patterns in rheumatoid arthritis patients in Ghana and determined their relationship with disease activity. Methods This case-control study included 48 newly diagnosed RA patients and 30 apparent healthy controls from two major hospitals in Ghana. Validated structured questionnaires were administered to obtain demographic data; blood samples were collected and processed for flow cytometric analysis. Results IFN-γ, TNF-α, IL-4, IL-6, IL-10, IL-17A, IL-6/IL-4, and IL-17/IL-10 expressions were significantly higher in RA cases compared to the healthy controls. The expression of IL-6 (0.00 (0.00-0.98) vs. 0.82 (0.34-1.10) vs. 1.56 (1.39-1.68), p < 0.0001), IL-17A (0.00 (0.00-0.02) vs. 0.19 (0.09-0.30) vs. 0.99 (0.64-1.25), p < 0.0001), and IL-17A/IL-10 (0.00 (0.00-0.39) vs. 0.15 (0.09-0.26) vs. 0.88 (0.41-1.47), p < 0.0001) increased significantly from the healthy controls through RA patients with low DAS scores to RA patients with moderate DAS scores. IL-6 (β = 0.681, r2 = 0.527, p < 0.0001), IL-17A (β = 0.770, r2 = 0.593, p < 0.0001), and IL-17A/IL-10 (β = 0.677, r2 = 0.452, p < 0.0001) expressions were significantly directly associated with DAS28 scores. IL-6 (cutoff = 1.32, sensitivity = 100.0%, specificity = 100.0%, accuracy = 100.0%, and AUC = 1.000) and IL-17A (cutoff = 0.58, sensitivity = 100.0%, specificity = 100.0%, accuracy = 100.0%, and AUC = 1.000) presented with the best discriminatory power in predicting moderate DAS scores from low DAS scores. Conclusion Th1- and Th17-related cytokines predominate in the pathophysiology of RA, with IL-6 and IL-17 being principally and differentially expressed based on the severity of the disease. IL-6 and IL-17A could serve as useful prognostic and disease-monitoring markers in RA in the African context.
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Sussman M, Tao C, Patel P, Tundia N, Clewell J, Menzin J. Cost-utility analyses of targeted immunomodulators in rheumatoid arthritis: systematic review. J Med Econ 2020; 23:610-623. [PMID: 31971039 DOI: 10.1080/13696998.2020.1720219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: Cost-utility (CU) modeling is a common technique used to determine whether new treatments represent good value for money. As with any modeling exercise, findings are a direct result of methodology choices, which may vary widely. Several targeted immuno-modulators have been launched in recent years to treat moderate-to-severe rheumatoid arthritis (RA) which have been evaluated using CU methods. Our objectives were to identify common and innovative modeling choices in moderate-to-severe RA and to highlight their implications for future models in RA.Materials and methods: A systematic literature search was conducted to identify CU models in moderate-to-severe RA published from January 2013 to June 2019. Studies must have included an active comparator and used quality-adjusted life-years (QALYs) as the common measure of effectiveness. Modeling methods were characterized by stakeholder perspective, simulation type, mapping between parameters, and data sources.Results: Thirty-one published modeling studies were reviewed spanning 13 countries and 9 drugs, with common methodological choices and innovations observed among them. Over the evaluated time period, we observed common methods and assumptions that are becoming more prominent in the RA CU modeling landscape, including patient-level simulations, two-stage models combining trial results and real-world evidence, real-world treatment durations, long-term health consequences, and Health Assessment Questionnaire (HAQ)-related hospitalization costs. Models that consider the societal perspective are increasingly being developed as well.Limitations: This review did not consider studies that did not report QALYs as a utility measure, models published only as conference abstracts, or cost-consequence models that did not report an incremental CU ratio.Conclusions: CU modeling for RA increasingly reflects real-world conditions and patient experiences which are anticipated to provide better information in the assessment of health technologies. Future CU models in RA should consider applying the observed advances in modeling choices to optimize their CU predictions and simulation of real-world outcomes.
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Affiliation(s)
- Matthew Sussman
- Modeling and Evidence, Boston Health Economics, LLC, Boston, MA, USA
| | - Charles Tao
- Modeling and Evidence, Boston Health Economics, LLC, Boston, MA, USA
| | - Pankaj Patel
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Namita Tundia
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Jerry Clewell
- Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA
| | - Joseph Menzin
- Modeling and Evidence, Boston Health Economics, LLC, Boston, MA, USA
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Waterborg CEJ, Broeren MGA, Blaney Davidson EN, Koenders MI, van Lent PLEM, van den Berg WB, van der Kraan PM, van de Loo FAJ. The level of synovial AXL expression determines the outcome of inflammatory arthritis, possibly depending on the upstream role of TGF-β1. Rheumatology (Oxford) 2020; 58:536-546. [PMID: 30508140 DOI: 10.1093/rheumatology/key337] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 10/15/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the role of AXL, a member of the anti-inflammatory TYRO3, AXL MER (TAM) receptor family, in arthritis. METHODS KRN serum transfer arthritis was induced in Axl-/- and wild-type mice. Knee and ankle joints were scored macro- and microscopically. Synovial gene and protein expression of Axl was determined in naïve and TGF-β1-overexpressing joints. AXL expression was determined in M1-like or M2-like macrophages and RA synovium. Human macrophages, fibroblasts and synovial micromasses were stimulated with TGF-β1 or the AXL inhibitor R428. RESULTS Ankle joints of Axl-/- mice showed exacerbated arthritis pathology, whereas no effect of Axl gene deletion was observed on gonarthritis pathology. To explain this spatial difference, we examined the synovium of naïve mice. In contrast to the knee, the ankle synovial cells prominently expressed AXL. Moreover, the M2-like macrophage phenotype was the dominant cell type in the naïve ankle joint. Human M2-like macrophages expressed higher levels of AXL and blocking AXL increased their inflammatory response. In the murine ankle synovium, gene expression of Tgfb1 was increased and Tgb1 correlated with Axl. Moreover, TGFB1 and AXL expression also correlated in human RA synovium. In human macrophages and synovial micromasses, TGF-β1 enhanced AXL expression. Moreover, TGF-β1 overexpression in naïve murine knee joints induced synovial AXL expression. CONCLUSION Differences in synovial AXL expression are in accordance with the observation that AXL dampens arthritis in ankle, but not in knee joints. We provide evidence that the local differences in AXL expression could be due to TGF-β1, and suggest similar pathways operate in RA synovium.
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Affiliation(s)
- Claire E J Waterborg
- Experimental Rheumatology, Department of Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathijs G A Broeren
- Experimental Rheumatology, Department of Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Esmeralda N Blaney Davidson
- Experimental Rheumatology, Department of Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marije I Koenders
- Experimental Rheumatology, Department of Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter L E M van Lent
- Experimental Rheumatology, Department of Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim B van den Berg
- Experimental Rheumatology, Department of Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter M van der Kraan
- Experimental Rheumatology, Department of Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Fons A J van de Loo
- Experimental Rheumatology, Department of Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Kamruzzaman AKM, Chowdhury MR, Islam MN, Sultan I, Ahmed S, Shahin A, Alam MM, Azad MA, Hassan MM, Amin MZ, Sinha S, Ahmad HI, Shazzad MN, Ahmad SN, Haq SA, Rasker JJ. The knowledge level of rheumatoid arthritis patients about their disease in a developing country. A study in 168 Bangladeshi RA patients. Clin Rheumatol 2019; 39:1315-1323. [PMID: 31828544 DOI: 10.1007/s10067-019-04859-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/29/2019] [Accepted: 11/14/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess disease-related knowledge of rheumatoid arthritis (RA) patients PATIENTS AND METHODS: Consecutive RA patients were invited from the rheumatology departments of BSMM University, Dhaka, Bangladesh. The Bangla version of the Patient Knowledge Questionnaire (B-PKQ) was used. Correlations between the B-PKQ scores and clinical-demographic data were measured using Pearson's correlation coefficient. Impact of independent variables on the level of knowledge about RA was analyzed through multiple regression analysis. Possible explanatory variables included the following: age, disease duration, formal education level, and Bangla Health Assessment Questionnaire (B-HAQ) score. Analysis of variance (ANOVA) was used to test the difference between demographical, clinical, and socioeconomic variables. For statistical analysis, SPSS statistics version 20 was used. RESULTS A total of 168 RA patients could be included. The mean B-PKQ score was 9.84 (range 1-20) from a possible maximum of 30. The mean time for answering the questionnaire was 24.3 min (range 15-34). Low scores were observed in all domains but the lowest were in medications and joint protection/energy conservation. Knowledge level was higher (15.5) in 6 patients who had RA education before enrollment. B-PKQ showed positive correlation with education level (r = 0.338) and negative correlation with HAQ (r = -0.169). The B-PKQ showed no correlation with age, disease duration, having first degree family member with RA, education from other sources (neighbor, RA patient, nurses), or information from mass media. CONCLUSIONS Disease-related knowledge of Bangladeshi RA patients was poor in all domains. Using these findings, improved education and knowledge will result in better disease control.Key Points• Little is known about the knowledge of RA patients regarding their disease and its treatment in Bangladesh and in developing countries in general.• We found that the knowledge of Bangladeshi RA patients regarding their disease was poor in all domains; it correlated positive with education level and negative with function (HAQ), but showed no correlation with age or disease duration.• The findings of this study can be used for improving current patient education programs by health professionals and through mass media.• Better disease control of RA may be achieved by improving patient knowledge in a developing country like Bangladesh, but also in other parts of the world.
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Affiliation(s)
- A K M Kamruzzaman
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Minhaj Rahim Chowdhury
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Nazrul Islam
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Imtiaz Sultan
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Shamim Ahmed
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Abu Shahin
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Mohammad Mahbubul Alam
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Ak Azad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - M Masudul Hassan
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Zahid Amin
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Sudeshna Sinha
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Habib Imtiaz Ahmad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Nahiduzzamane Shazzad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Sonia Nasreen Ahmad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Syed Atiqul Haq
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Johannes Jacobus Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
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Farrag SM, Abdelnaby MM, Mohamed AE. Adaptation and validation of an Arabic version of a 10-item patient-reported outcome measure of physical function in rheumatoid arthritis. Int J Rheum Dis 2019; 23:309-315. [PMID: 31825149 DOI: 10.1111/1756-185x.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/09/2019] [Accepted: 11/17/2019] [Indexed: 11/29/2022]
Abstract
AIM To adapt and validate an Arabic version of the short form of physical function measure (PF-10a), a generic questionnaire for physical function, in Egyptian patients with rheumatoid arthritis (RA). METHODS After standardized linguistic validation of the Arabic version of PF-10a, with forward and backward translation, the questionnaire was completed by 70 Egyptian RA patients who were diagnosed according to American College of Rheumatology/European League Against Rheumatism 2010 classification criteria, on two occasions 3-5 days apart. The internal consistency and test-retest reliability were evaluated using Cronbach's alpha and intra-class correlation. The content validity of the Arabic PF-10a was tested against Health Assessment Questionnaire Disability Index (HAQ-DI), Clinical Disease Activity Index (CDAI) and Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28-ESR). In addition, serology results, hand radiographs, and treatments received were all recorded. RESULTS Most of our patients were female (88.6%) with a mean age of 49.2 ± 10.5 years. They had a mean disease duration of 7.3 ± 7 years and an active disease with a mean CDAI of 33.1 ± 12.6. The mean value of PF-10a was 34.6 ± 6.2. The Cronbach's alpha for Arabic PF-10a was 0.904. Intra-CLASS CORRELATION was 0.897. Arabic PF-10a correlated strongly with HAQ-DI (-0.746), moderately with CDAI, patient global assessment, and pain (-0.457, -0.417, and -0.371 respectively). CONCLUSION The validation study showed that the Arabic PF-10a had acceptable psychometric characteristics, in terms of internal consistency and construct validity. The Arabic PF-10a is a reliable and valid instrument to be used by Arabic RA patients.
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Affiliation(s)
- Shaza Mohamed Farrag
- Deptartment of Physical Medicine, Rheumatology and Rehabilitation, Damietta Specialized Hospital, Damietta, Egypt
| | - Mai Mohamed Abdelnaby
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Aly Elsayed Mohamed
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Muszbek N, Proudfoot C, Fournier M, Chen CI, Kuznik A, Kiss Z, Gal P, Michaud K. Cost-Effectiveness of Sarilumab Added to Methotrexate in the Treatment of Adult Patients with Moderately to Severely Active Rheumatoid Arthritis Who Have Inadequate Response or Intolerance to Tumor Necrosis Factor Inhibitors. J Manag Care Spec Pharm 2019; 25:1268-1280. [PMID: 31663465 PMCID: PMC10397978 DOI: 10.18553/jmcp.2019.25.11.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite a substantial number of treatment options in rheumatoid arthritis (RA) following tumor necrosis factor inhibitor (TNFi) inadequate response or intolerance (TNF-IR), a lack of clarity on the optimal approach remains. Sarilumab, a human monoclonal anti-interleukin-6 receptor alpha antibody, can be used as monotherapy or in combination with methotrexate or other conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) in TNF-IR patients. OBJECTIVE To conduct a cost-utility analysis from a U.S. health care system perspective for sarilumab subcutaneous 200 mg + methotrexate versus abatacept + methotrexate or a bundle of TNFi + methotrexate for treatment of adult patients with moderately to severely active RA and TNF-IR. METHODS Analysis was conducted via individual patient simulation based on patient profiles from the TARGET trial (NCT01709578); a 6-month decision tree was followed by lifetime semi-Markov model with 6-month cycles. Treatment response at 6 months, informed by network meta-analysis, was based on American College of Rheumatology (ACR) 20/50/70 criteria; patients achieving ≥ ACR20 continued with current therapy, and other patients moved to the next line of biologic DMARD therapy or conventional synthetic DMARD palliative treatment. Direct costs included wholesale acquisition drug costs and administration and routine care costs. Routine care costs and quality-adjusted life-years (QALYs) were estimated by predicting the Health Assessment Questionnaire Disability Index score based on treatment response and were imputed from published equations. RESULTS Sarilumab + methotrexate dominated the TNFi bundle + methotrexate, achieving lower costs ($319,324 vs. $356,096) and greater effectiveness (4.27 vs. 4.15 QALYs), and was on the cost-efficiency frontier with abatacept + methotrexate ($360,211 and 4.29 QALYs). Abatacept + methotrexate was not cost-effective versus sarilumab + methotrexate. Scenario analyses indicated the results were robust; sarilumab + methotrexate became dominant against abatacept + methotrexate after reduced model horizon, minimum response based on ACR50 or ACR70, or time to discontinuation per treatment class. Sarilumab + methotrexate was also dominant versus the TNFi bundle; when class-specific time to treatment discontinuation was specified, sarilumab remained cost-effective with an incremental cost-effectiveness ratio of $36,894. CONCLUSIONS Sarilumab + methotrexate can be considered an economically dominant (more effective, less costly) option versus a second TNFi + methotrexate; compared with abatacept + methotrexate, it is a less costly but less effective option for patients with moderately to severely active RA who have previously failed TNFi. DISCLOSURES This study was funded by Sanofi and Regeneron Pharmaceuticals. Kiss and Gal are employees of Evidera, which received consulting fees from Sanofi/Regeneron for conducting this study. Muszbek was employed by Evidera at the time of this study. Kuznik and Chen are current employees of and stockholders in Regeneron Pharmaceuticals. Fournier is an employee of and stockholder in Sanofi. Proudfoot is a former employee of and current stockholder in Sanofi and current employee and stockholder in ViiV Healthcare/GlaxoSmithKline. Michaud has received grant funding from Pfizer and the Rheumatology Research Foundation. The sponsors were involved in the study design, collection, analysis, and interpretation of data as well as data checking of information provided in the manuscript. The authors had unrestricted access to study data, were responsible for all content and editorial decisions, and received no honoraria related to the development of this publication.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antirheumatic Agents/economics
- Antirheumatic Agents/therapeutic use
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/economics
- Cost-Benefit Analysis
- Decision Trees
- Drug Therapy, Combination/economics
- Drug Therapy, Combination/methods
- Female
- Humans
- Male
- Methotrexate/economics
- Methotrexate/therapeutic use
- Middle Aged
- Models, Economic
- Severity of Illness Index
- Treatment Outcome
- Tumor Necrosis Factor Inhibitors/economics
- Tumor Necrosis Factor Inhibitors/therapeutic use
- Young Adult
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Affiliation(s)
| | | | | | | | | | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas
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18
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Economic Evaluation of Sarilumab in the Treatment of Adult Patients with Moderately-to-Severely Active Rheumatoid Arthritis Who Have an Inadequate Response to Conventional Synthetic Disease-Modifying Antirheumatic Drugs. Adv Ther 2019; 36:1337-1357. [PMID: 31004324 PMCID: PMC6824456 DOI: 10.1007/s12325-019-00946-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Indexed: 02/07/2023]
Abstract
Introduction Assess the cost-effectiveness (US healthcare payer perspective) of sarilumab subcutaneous (SC) 200 mg + methotrexate versus conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) or targeted DMARD + methotrexate for moderate-to-severe rheumatoid arthritis (RA) in adults with inadequate response to methotrexate. Methods Microsimulation based on patient profiles from MOBILITY (NCT01061736) was conducted via a 6-month decision tree and lifetime Markov model with 6-monthly cycles. Treatment response at 6 months was informed by a network meta-analysis and based on American College of Rheumatology (ACR) response. Responders: patients with ACR20 response who continued with therapy; non-responders: ACR20 non-responders who transitioned to the subsequent treatment. Utilities and quality-adjusted life-years (QALYs) were estimated via mapping 6-month ACR20/50/70 response to relative change in Health Assessment Questionnaire Disability Index score (short term) and based on published algorithms (long term). Direct costs considered drugs (wholesale acquisition costs), administration and routine care. Results Lifetime QALYs and costs for treatment sequences on the efficiency frontier were 3.43 and $115,019 for active csDMARD, 5.79 and $430,918 for sarilumab, and 5.94 and $524,832 for etanercept (all others dominated). Sarilumab was cost-effective versus tocilizumab and csDMARD (incremental cost-effectiveness ratios of $84,079/QALY and $134,286/QALY). Probabilistic sensitivity analysis suggested comparable costs and slightly improved health benefits for sarilumab versus tocilizumab, irrespective of threshold. Conclusion In patients with moderate-to-severe RA, sarilumab 200 mg SC every 2 weeks + methotrexate can be considered a cost-effective treatment option, with lower costs and greater health benefits than alternative treatment sequences (+ methotrexate) beginning with adalimumab, certolizumab, golimumab and tofacitinib and below commonly accepted cost-effectiveness thresholds against tocilizumab + methotrexate or csDMARD active treatment. Funding Sanofi and Regeneron Pharmaceuticals, Inc. Electronic supplementary material The online version of this article (10.1007/s12325-019-00946-1) contains supplementary material, which is available to authorized users.
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Fournier M, Chen CI, Kuznik A, Proudfoot C, Mallya UG, Michaud K. Sarilumab monotherapy compared with adalimumab monotherapy for the treatment of moderately to severely active rheumatoid arthritis: an analysis of incremental cost per effectively treated patient. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:117-128. [PMID: 30787625 PMCID: PMC6368117 DOI: 10.2147/ceor.s183076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Treatment outcomes and direct medical costs were examined, from a US health payer perspective, of monotherapy with sarilumab 200 mg subcutaneous (SC) every 2 weeks (Q2W) vs adalimumab 40 mg SC Q2W/QW in adult patients with moderately to severely active rheumatoid arthritis who are intolerant of, inadequate responders to, or considered inappropriate candidates for continued methotrexate treatment. Patients and methods Short-term analysis was based on 24-week wholesale acquisition costs of drugs and treatment response observed in the MONARCH Phase III trial (NCT02332590) per American College of Rheumatology (ACR) 20/50 criteria and European League Against Rheumatism (EULAR) Moderate/Good Disease Activity Score 28-joint count erythrocyte sedimentation rate. Long-term analysis, which also considered drug administration and routine care costs, was conducted via a 6-month decision tree and a 1- to 10-year Markov model with microsimulation of patient profiles from the MOBILITY Phase III trial (NCT01061736). Utilities and quality-adjusted life-years (QALYs) were estimated by mapping 6-month ACR levels to a relative change in Health Assessment Questionnaire – Disability Index score and via published algorithms. Results For sarilumab and adalimumab, respectively, 24-week drug costs were $18,954 and $29,232, and costs per responder were $26,435 vs $50,055 on ACR20; $41,475 vs $98,425 on ACR50; and $22,511 vs $41,230 on EULAR Moderate/Good. Base case results at 10 years for total costs and QALYs were $176,977 and 2.75 for sarilumab and $212,136 and 2.61 for adalimumab, respectively. Sarilumab was consistently the more effective and cost-saving treatment across all short-term and long-term incremental analyses. Conclusion Sarilumab monotherapy was the economically dominant treatment on incremental cost per responder and incremental cost per QALY compared with adalimumab monotherapy. These results were maintained within the sensitivity analyses.
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Affiliation(s)
- Marie Fournier
- Health Economics & Value Assessment, Sanofi France, Chilly-Mazarin, France,
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, USA.,The National Databank for Rheumatic Diseases, Wichita, KS, USA
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20
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Safi S, Frommholz D, Reimann S, Götz W, Bourauel C, Neumann A, Hoerauf A, Illges H, Safi A, Jäger A, Hübner MP, Gölz L. Comparative study on serum‐induced arthritis in the temporomandibular and limb joint of mice. Int J Rheum Dis 2019; 22:636-645. [DOI: 10.1111/1756-185x.13486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 11/15/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sema Safi
- Department of Orthodontics University Hospital of Bonn Bonn Germany
| | - David Frommholz
- Department of Natural Sciences, Immunology and Cell Biology University of Applied Sciences Bonn‐Rhein‐Sieg Rheinbach Germany
| | | | - Werner Götz
- Department of Orthodontics University Hospital of Bonn Bonn Germany
| | | | - Anna‐Lena Neumann
- Institute for Medical Microbiology, Immunology, and Parasitology University Hospital of Bonn Bonn Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology, and Parasitology University Hospital of Bonn Bonn Germany
| | - Harald Illges
- Department of Natural Sciences, Immunology and Cell Biology University of Applied Sciences Bonn‐Rhein‐Sieg Rheinbach Germany
| | - Ali‐Farid Safi
- Department for Oral and Craniomaxillofacial Plastic Surgery University of Cologne Cologne Germany
| | - Andreas Jäger
- Department of Orthodontics University Hospital of Bonn Bonn Germany
| | - Marc P. Hübner
- Institute for Medical Microbiology, Immunology, and Parasitology University Hospital of Bonn Bonn Germany
| | - Lina Gölz
- Department of Orthodontics University Hospital of Bonn Bonn Germany
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21
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Ben Achour W, Bouaziz M, Mechri M, Zouari B, Bahlous A, Abdelmoula L, Laadhar L, Sellami M, Sahli H, Cheour E. A cross sectional study of bone and cartilage biomarkers: correlation with structural damage in rheumatoid arthritis. Libyan J Med 2018; 13:1512330. [PMID: 30160204 PMCID: PMC6127838 DOI: 10.1080/19932820.2018.1512330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The aim of our study was to assess the relationship between bone and cartilage remodeling biomarkers and joint damage in Rheumatoid Arthritis (RA), and to detect whether they have the capacity to predict the progression of joint disease assessment by computed tomography (CT) erosion score. We analyzed 65 female patients with established RA in our Rheumatology Department. Serum levels of bone and cartilage markers were measured: osteocalcin (OC), N-propeptide of type I collagen (PINP), collagen type I and II, C-telopeptide (CTX I, CTX-II) and cartilage oligomeric matrix protein (COMP). Radiography of both wrist and MCP joints were available. Two expert-readers independently scored articular damage and progression using the High-resolution low dose CT scan in a blinded fashion. 65 female patients with established RA with a median age of 44 years were included. The median disease-duration was two years and the median (Disease activity score) DAS 28 score at 4.46 [2.65-7.36]. The percentage of patient with low disease activity was 13.8%, while 55.4 and 30.8% for those with moderate and high disease activity respectively. The resorption bone markers were high in active versus non-active RA. Wrist and MCP erosion scores were also associated with RA activity. Our study shows that biomarkers of bone and cartilage collagen breakdown were related to specific joint erosion in RA and could predict subsequent radiographic damage in RA. Further larger scale longitudinal studies maybe needed to confirm our data.
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Affiliation(s)
- Wael Ben Achour
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Mouna Bouaziz
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia.,b Radiology Department , Orthopedics kassab institute , Tunis , Tunisia
| | - Meriem Mechri
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia.,b Radiology Department , Orthopedics kassab institute , Tunis , Tunisia
| | - Béchir Zouari
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Afef Bahlous
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia.,c Biochemistry Department , Pasteur Institute , Tunis , Tunisia
| | - Leila Abdelmoula
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Lilia Laadhar
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Maryam Sellami
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Hela Sahli
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
| | - Elhem Cheour
- a Rheumatology Department La Rabta Hospital, Immunology-Rheumatology Research Laboratory LR05SP01 , University of Tunis-El Manar , Tunis , Tunisia
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22
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Kato E, Sawada T, Tahara K, Hayashi H, Tago M, Mori H, Nishino J, Matsui T, Tohma S. The age at onset of rheumatoid arthritis is increasing in Japan: a nationwide database study. Int J Rheum Dis 2017; 20:839-845. [PMID: 28205423 DOI: 10.1111/1756-185x.12998] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To determine whether the age at onset of rheumatoid arthritis (RA) has increased in Japan using a nationwide database (National Database of Rheumatic Diseases by iR-net in Japan, NinJa). METHOD We analyzed the data of RA patients who had been diagnosed with early RA (disease duration < 2 years) and newly registered in 2003, 2008 or 2013. RESULTS The numbers of patients who developed RA in 2002-2003, 2007-2008, and 2012-2013 were 536, 812 and 1864, respectively. The mean age at RA onset increased significantly from 55.8 years in 2002-2003 and 57.0 years in 2007-2008 to 59.9 years in 2012-2013. The peak age shifted from the 50-59 years age group in 2002-2003 to the 60-69 years age group in 2012-2013. There was no apparent difference in the age at RA onset between male and female RA patients. Notably, in the period 2002-2003, the prevalence of RA was markedly higher in the age group of 50-59 years, which included the first 'baby boomers', than in the age groups of 30-39 and 40-49 years, even with consideration of the variations in the age composition of the general population. CONCLUSIONS We have demonstrated that the age at RA onset in Japan has increased significantly over the last decade. This can be attributed to Japan's aging population. In addition, the high prevalence of RA among the first baby boomers suggests that environmental factors might also have contributed to the increase in age at RA onset in Japan.
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Affiliation(s)
- Eri Kato
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Tetsuji Sawada
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Koichiro Tahara
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Haeru Hayashi
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mayu Tago
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hiroaki Mori
- Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Jinju Nishino
- Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Kanagawa, Japan
| | - Toshihiro Matsui
- Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeto Tohma
- Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Kanagawa, Japan
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23
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Afroz S, Giddaluru J, Vishwakarma S, Naz S, Khan AA, Khan N. A Comprehensive Gene Expression Meta-analysis Identifies Novel Immune Signatures in Rheumatoid Arthritis Patients. Front Immunol 2017; 8:74. [PMID: 28210261 PMCID: PMC5288395 DOI: 10.3389/fimmu.2017.00074] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/17/2017] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis (RA), a symmetric polyarticular arthritis, has long been feared as one of the most disabling forms of arthritis. Identification of gene signatures associated with RA onset and progression would lead toward development of novel diagnostics and therapeutic interventions. This study was undertaken to identify unique gene signatures of RA patients through large-scale meta-profiling of a diverse collection of gene expression data sets. We carried out a meta-analysis of 8 publicly available RA patients’ (107 RA patients and 76 healthy controls) gene expression data sets and further validated a few meta-signatures in RA patients through quantitative real-time PCR (RT-qPCR). We identified a robust meta-profile comprising 33 differentially expressed genes, which were consistently and significantly expressed across all the data sets. Our meta-analysis unearthed upregulation of a few novel gene signatures including PLCG2, HLA-DOB, HLA-F, EIF4E2, and CYFIP2, which were validated in peripheral blood mononuclear cell samples of RA patients. Further, functional and pathway enrichment analysis reveals perturbation of several meta-genes involved in signaling pathways pertaining to inflammation, antigen presentation, hypoxia, and apoptosis during RA. Additionally, PLCG2 (phospholipase Cγ2) popped out as a novel meta-gene involved in most of the pathways relevant to RA including inflammasome activation, platelet aggregation, and activation, thereby suggesting PLCG2 as a potential therapeutic target for controlling excessive inflammation during RA. In conclusion, these findings highlight the utility of meta-analysis approach in identifying novel gene signatures that might provide mechanistic insights into disease onset, progression and possibly lead toward the development of better diagnostic and therapeutic interventions against RA.
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Affiliation(s)
- Sumbul Afroz
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad , Hyderabad , India
| | - Jeevan Giddaluru
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad , Hyderabad , India
| | - Sandeep Vishwakarma
- Centre for Liver Research and Diagnostics, Central Laboratory for Stem Cell Research and Translational Medicine, Deccan College of Medical Sciences, Kanchanbagh , Hyderabad , India
| | - Saima Naz
- Centre for Liver Research and Diagnostics, Central Laboratory for Stem Cell Research and Translational Medicine, Deccan College of Medical Sciences, Kanchanbagh , Hyderabad , India
| | - Aleem Ahmed Khan
- Centre for Liver Research and Diagnostics, Central Laboratory for Stem Cell Research and Translational Medicine, Deccan College of Medical Sciences, Kanchanbagh , Hyderabad , India
| | - Nooruddin Khan
- Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad , Hyderabad , India
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24
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Latitude gradient influences the age of onset of rheumatoid arthritis: a worldwide survey. Clin Rheumatol 2016; 36:485-497. [PMID: 27995382 DOI: 10.1007/s10067-016-3481-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/07/2016] [Indexed: 02/04/2023]
Abstract
The age of onset of rheumatoid arthritis (RA) is an important outcome predictor. Northern countries report an age of RA onset of around 50 years, but apparently, variability exists across different geographical regions. The objective of the present study is to assess whether the age of onset of RA varies across latitudes worldwide. In a proof-of-concept cross-sectional worldwide survey, rheumatologists from preselected cities interviewed 20 consecutive RA patients regarding the date of RA onset (RAO, when the patient first noted a swollen joint). Other studied variables included location of each city, rheumatologist settings, latitudes (10° increments, south to north), longitudes (three regions), intracountry consistency, and countries' Inequality-adjusted Human Development Index (IHDI). Data from 2481 patients (82% females) were obtained from 126 rheumatologists in 77 cities of 41 countries. Worldwide mean age of RAO was 44 ± 14 years (95% CI 44-45). In 28% of patients, RA began before age 36 years and before age 46 years in 50% of patients. RAO was 8 years earlier around the Tropic of Cancer when compared with northern latitudes (p < 0.001, 95% CI 3.5-13). Multivariate analysis showed that females, western cities, and latitudes around the Tropic of Cancer are associated with younger age of RAO (R 2 0.045, p < 0.001). A positive correlation was found between the age of RAO and IHDI (r = 0.7, p < 0.01, R 2 0.5). RA often begins at an early age and onset varies across latitudes worldwide. We postulate that countries' developmental status and their geographical and geomagnetic location influence the age of RAO.
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25
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Zhao J, Liu T, Xu F, You S, Xu F, Li C, Gu Z. Anti-arthritic Effects of Total Flavonoids from Juniperus sabina on Complete Freund's Adjuvant Induced Arthritis in Rats. Pharmacogn Mag 2016; 12:178-83. [PMID: 27601846 PMCID: PMC4989791 DOI: 10.4103/0973-1296.186346] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Context: Twigs and leaves of Juniperus sabina L. have been traditionally used as the medicinal herb in China for the treatment of many ailments including rheumatoid arthritis (RA). Aims: To confirm the therapeutic effect of total flavonoids from J. sabina (JSTF) on RA-induced by Complete Freund's Adjuvant (CFA) in rats. Settings and Design: Wistar rats (200 ± 20 g) were immunized by intradermal injection of 0.1 mL of CFA into the right hind metatarsal footpad. JSTF was administered orally at the dose of 125,250 and 500 mg/kg on 14 days after the induction of adjuvant arthritis. Tripterygium glycoside (20 mg/kg) was used as a positive control. Paw swelling, arthritic score, body weight loss, serum cytokines, inflammatory mediators, and histological change were measured. Results: We found that JSTF could ameliorate paw swelling of CFA rats, and significantly inhibit arthritic score (P < 0.05). The overproduction of tumor necrosis factor alpha and interleukin 1beta were remarkably suppressed in the serum of JSTF (125,500 mg/kg) treated rats (P < 0.05). Histopathological studies also showed a marked decrease of synovial inflammatory infiltration and synovial lining hyperplasia in the joints of JSTF-treated animals. Six flavonoids were isolated and from JSTF by various chromatographic methods and identified as follows: Catechin, quercitrin, isoquercitrin, isoscutellarein 7-O-β-D-xylopyranoside, isoscutellarein 7-O-β-D-xylopyranose-(1 → 3)-α-L-rhamnoside, and rutin. Conclusions: These results suggest the potential therapeutically effect of JSTF as an anti-arthritis agent toward CFA-induced arthritis in rats, and verified therapeutic applications of J. sabina on RA in folk medicine. SUMMARY Twigs and leaves of Juniperus sabina L. have been traditionally used as the medicinal herb in China for the treatment of rheumatoid arthritis JSTF could ameliorate paw swelling of CFA rats, and significantly inhibit arthritic score Histopathological studies showed a marked decrease of synovial inflammatory infiltration and synovial lining hyperplasia in the joints of JSTF-treated animals Six flavonoids were isolated and from JSTF including: Catechin, quercitrin, isoquercitrin, isoscutellarein 7-O-β-D-xylopyranoside, isoscutellarein 7-O-β-D-xylopyranose-(1 → 3)-α-L- rhamnoside, and rutin.
Abbreviations used: JSTF: Total flavonoids from Juniperus sabina; CFA: Complete Freund's Adjuvant; TG: Tripterygium glycoside; TNF-α: Tumor necrosis factor alpha; IL-1β: Interleukin 1beta; IL-6: Interleukin 6; H and E: Hematoxylin and eosin.
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Affiliation(s)
- Jun Zhao
- Xinjiang Key Laboratory Uighur Medicine, Institute of Materia Medica of Xinjiang, Urumqi, 830004, China
| | - Tao Liu
- Department of Toxicology, College of Public Health, Xinjiang Medical University, Urumqi, 830011, China
| | - Fang Xu
- Department of Toxicology, College of Public Health, Xinjiang Medical University, Urumqi, 830011, China
| | - Shuping You
- Department of Toxicology, College of Public Health, Xinjiang Medical University, Urumqi, 830011, China
| | - Fang Xu
- Xinjiang Key Laboratory Uighur Medicine, Institute of Materia Medica of Xinjiang, Urumqi, 830004, China
| | - Chenyang Li
- Xinjiang Key Laboratory Uighur Medicine, Institute of Materia Medica of Xinjiang, Urumqi, 830004, China
| | - Zhengyi Gu
- Xinjiang Key Laboratory Uighur Medicine, Institute of Materia Medica of Xinjiang, Urumqi, 830004, China
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Abstract
Epidemiological data suggests that the prevalence of musculoskeletal and neuropathic pain increases with age until at least late mid-life, though the pattern is somewhat unclear beyond this point. And though the prevalence of some types of pain may peak in late midlife, pain is still a substantial and common complaint even in the oldest age groups. This article provides an overview of later-life pain and includes a brief review of its epidemiology, describes commonly encountered barriers to its management, and discusses guidelines and recommended approaches to its assessment and management.
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Affiliation(s)
- Steven M Savvas
- Clinical Division, National Ageing Research Institute, 34-48 Poplar Road, Parkville, Victoria 3052, Australia.
| | - Stephen J Gibson
- Clinical Division, National Ageing Research Institute, 34-48 Poplar Road, Parkville, Victoria 3052, Australia
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27
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Corker E, Henderson RC, Lempp H, Brown JSL. Internalised stigma in people with rheumatoid arthritis: a cross sectional study to establish the psychometric properties of the ISMI-RA. BMC Musculoskelet Disord 2016; 17:244. [PMID: 27256290 PMCID: PMC4890287 DOI: 10.1186/s12891-016-1089-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/19/2016] [Indexed: 01/29/2023] Open
Abstract
Background Internalised stigma is theorized to be the internalisation and legitimisation of stereotypes of the diagnosis held in society and has not been quantified within patients with Rheumatoid Arthritis. This study aimed to: validate a modified version of a measure of internalised stigma, (the Internalised Stigma of Mental Illness scale, ISMI) for use in a group of patients diagnosed with rheumatoid arthritis; establish the consistency of the construct being measured, and to explore the levels of internalised stigma within this group. Methods A cross-sectional survey was conducted in London, UK with participants receiving out-patient treatment for Rheumatoid Arthritis. Participants completed the ISMI-Rheumatoid Arthritis (ISMI-RA) and a measure of self-esteem. Results One hundred respondents were interviewed by phone. The ISMI-RA was found to be reliable using a measure of internal consistency (α = 0.85) showed concurrent validity with the Index of Self Esteem (r = 0.58, p < 0.01) and discriminant validity with no association with gender (t = 1.43, p = 0.61). A quarter of respondents reported internalised stigma to a ‘severe’ level. Acceptability and feasibility were established. A confirmatory factor analysis provided some support for the model of internalised stigma. Conclusions The application of the ISMI-RA among the Rheumatoid Arthritis population looks promising. Internalised stigma was found to be present within this group. More research is needed to generalize these results and to explore the effects of internalised stigma on treatment adherence and quality of life.
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Affiliation(s)
- Elizabeth Corker
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
| | - R Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Heidi Lempp
- Academic Rheumatology, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - June S L Brown
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
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28
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Venkatesha SH, Astry B, Nanjundaiah SM, Kim HR, Rajaiah R, Yang Y, Tong L, Yu H, Berman BM, Moudgil KD. Control of autoimmune arthritis by herbal extracts and their bioactive components. Asian J Pharm Sci 2016. [DOI: 10.1016/j.ajps.2016.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Pozsgay J, Szarka E, Huber K, Babos F, Magyar A, Hudecz F, Sarmay G. Synthetic Peptide-Based ELISA and ELISpot Assay for Identifying Autoantibody Epitopes. Methods Mol Biol 2016; 1352:223-233. [PMID: 26490479 DOI: 10.1007/978-1-4939-3037-1_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Enzyme-linked immunosorbent assay (ELISA) is an invaluable diagnostic tool to detect serum autoantibody binding to target antigen. To map the autoantigenic epitope(s), overlapping synthetic peptides covering the total sequence of a protein antigen are used. A large set of peptides synthesized on the crown of pins can be tested by Multipin ELISA for fast screening. Next, to validate the results, the candidate epitope peptides are resynthesized by solid-phase synthesis, coupled to ELISA plate directly, or in a biotinylated form, bound to neutravidin-coated surface and the binding of autoantibodies from patients' sera is tested by indirect ELISA. Further, selected epitope peptides can be applied in enzyme-linked immunospot assay to distinguish individual, citrullinated peptide-specific autoreactive B cells in a pre-stimulated culture of patients' lymphocytes.
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Affiliation(s)
- Judit Pozsgay
- Department of Immunology, Eötvös Loránd University, Pázmány Péter sétány 1/c, Budapest, 1117, Hungary
| | - Eszter Szarka
- Department of Immunology, Eötvös Loránd University, Pázmány Péter sétány 1/c, Budapest, 1117, Hungary
| | - Krisztina Huber
- Department of Immunology, Eötvös Loránd University, Pázmány Péter sétány 1/c, Budapest, 1117, Hungary
| | - Fruzsina Babos
- MTA-ELTE Research Group of Peptide Chemistry, Hungarian Academy of Sciences, Budapest, Hungary
| | - Anna Magyar
- MTA-ELTE Research Group of Peptide Chemistry, Hungarian Academy of Sciences, Budapest, Hungary
| | - Ferenc Hudecz
- Department of Organic Chemistry, Eötvös Loránd University, Budapest, Hungary
- MTA-ELTE Research Group of Peptide Chemistry, Hungarian Academy of Sciences, Budapest, Hungary
| | - Gabriella Sarmay
- Department of Immunology, Eötvös Loránd University, Pázmány Péter sétány 1/c, Budapest, 1117, Hungary.
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30
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Su B, Ma Q, Edwards CJ, Williams M, Adams J. Characteristics of hand involvement in a comparative study of two early RA cohorts from the UK and China. Int J Rheum Dis 2015; 20:1426-1436. [DOI: 10.1111/1756-185x.12573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Bowen Su
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Qing Ma
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine; Shanghai University of Traditional Chinese Medicine; Shanghai China
| | - Christopher J. Edwards
- NIHR Wellcome Trust Clinical Research Facility; University Hospital Southampton NHS Foundation Trust; Southampton & Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); UK
| | - Mark Williams
- Nuffield Department of Orthopaedics; Rheumatology and Musculoskeletal Sciences (NDORMS); University of Oxford; Oxford UK
| | - Jo Adams
- Faculty of Health Sciences; University of Southampton; Southampton UK
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31
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van Vollenhoven RF, Østergaard M, Leirisalo-Repo M, Uhlig T, Jansson M, Larsson E, Brock F, Franck-Larsson K. Full dose, reduced dose or discontinuation of etanercept in rheumatoid arthritis. Ann Rheum Dis 2015; 75:52-8. [PMID: 25873634 PMCID: PMC4717401 DOI: 10.1136/annrheumdis-2014-205726] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 03/25/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the Dose Reduction or Discontinuation of Etanercept in Methotrexate-Treated Rheumatoid Arthritis Patients Who Have Achieved a Stable Low Disease Activity-State study was to investigate the effect of etanercept (ETN) dose maintenance, reduction or withdrawal on patients with rheumatoid arthritis (RA) who had already achieved stable low disease activity (LDA) on ETN 50 mg+methotrexate (MTX). METHODS Patients with RA (n=91) and stable LDA with ETN 50 mg once weekly (QW)+MTX were included. After 8 weeks with unchanged treatment, 73 patients were randomised in a double-blind design to ETN 50 mg QW+MTX (ETN50), ETN 25 mg QW+MTX (ETN25) or placebo QW+MTX (PBO) for 48 weeks. Patients who flared were declared failures and treated with open-label ETN50 until week 48. The primary outcome was the proportion of patients on ETN50 versus PBO who were non-failures after 48 weeks. RESULTS The proportion of non-failure patients was significantly lower with ETN50 (52%; p=0.007) and ETN25 (44%; p=0.044) versus PBO (13%). Median time to failure was significantly shorter with PBO (6 weeks) compared with ETN50 (48 weeks; p=0.001) and ETN25 (36 weeks; p<0.001). The majority of patients who flared regained LDA with open-label ETN50 quickly. Adverse events were consistent with the known side effect profiles of these medications. CONCLUSIONS In patients with established RA who have achieved stable LDA on ETN50+MTX, continuing both is superior to PBO+MTX. Reduced dose ETN was also more effective than PBO in maintaining a favourable response, suggesting that a maintenance strategy with reduced dose ETN may be possible in a number of patients with established RA. TRIAL REGISTRATION NUMBER NCT00858780.
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Affiliation(s)
- Ronald F van Vollenhoven
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), the Karolinska Institute, Stockholm, Sweden Rheumatology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Mikkel Østergaard
- Faculty of Health Sciences, Copenhagen Center for Arthritis Research, Centre for Rheumatology and Spine Diseases, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Marjatta Leirisalo-Repo
- Helsinki University Central Hospital, and Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Fiona Brock
- Statistical Consultancy, Quanticate, Hitchin, UK
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Afifi MA, Jiman-Fatani AA, El Saadany S, Fouad MA. Parasites-allergy paradox: Disease mediators or therapeutic modulators. J Microsc Ultrastruct 2015; 3:53-61. [PMID: 30023182 PMCID: PMC6014186 DOI: 10.1016/j.jmau.2015.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/09/2015] [Indexed: 02/07/2023] Open
Abstract
The noticeable phenomenon of an increased frequency of immune-inflammatory disorders, in the industrialized world, has led to the implication of parasitic infections in the pathophysiology of these diseases. Most of the studies investigated the infection connection to allergy have centered on helminthes. Parasitic helminthes are a group of metazoans that are evolutionary diverse, yet converge to evolve common modes of immunomodulation. Helminth immunoregulation is mainly mediated by a regulatory response including Treg and Breg cells with alternatively-activated macrophages. There is increasing evidence for a causal relationship between helminth infection and allergic hyporesponsiveness, however, conflicting data are still generating. The helminth immunoregulation seems to be species-specific and phase-specific. It depends on the stage of the clinical disease which correlates with a corresponding parasitic stage (egg, larva or mature adult). Here, we review the cellular and molecular mechanisms utilized by helminthes to manipulate the immune system and the consequent bystander immunomodulatory responses toward environmental allergens. We especially focus on parasitic species and molecules involved in the modulation of allergic disorders and summarize the experimental and clinical trials using them as therapeutic agents. We also discuss the potentials and obstacles, for helminthes and/or their derived molecules, to emerge as novel therapeutic modalities.
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Affiliation(s)
- Mohammed A. Afifi
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Corresponding author at: Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, P.O. Box 80205, Jeddah 21589, Saudi Arabia. Tel.: +966 569722590. E-mail address: (M.A. Afifi)
| | - Asif A. Jiman-Fatani
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sherif El Saadany
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmoud A. Fouad
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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McLaughlin M, Östör A. Safety of subcutaneous versus intravenous tocilizumab in combination with traditional disease-modifying antirheumatic drugs in patients with rheumatoid arthritis. Expert Opin Drug Saf 2015; 14:429-37. [PMID: 25553607 DOI: 10.1517/14740338.2015.998198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Tocilizumab (TCZ), a humanized anti-IL-6 receptor (IL-6R) monoclonal antibody, has demonstrated efficacy and tolerability in several large randomized, controlled trials for the treatment of rheumatoid arthritis (RA). AREAS COVERED This article compares the safety profile of the newer, subcutaneous (SC) formulation of TCZ with the original intravenous (IV) formulation, in combination with traditional disease-modifying antirheumatic drugs (DMARDs) in patients with RA. Several pivotal clinical trials are included, highlighting data from: i) trials of TCZ-IV; ii) trials of TCZ-SC; and iii) trials comparing IV to SC TCZ. TCZ use in pediatric populations is beyond the scope of this review. EXPERT OPINION The efficacy and safety of TCZ-IV in the treatment of RA has been demonstrated in multiple clinical trials, both as monotherapy and in combination with traditional DMARDs. The data for TCZ-SC is similar, albeit with a higher frequency of injection site reactions (ISRs). With careful patient selection, the benefit: risk ratio is favorable, offering patients a rapid and sustained reduction in disease activity, improved function and reduced structural damage. Given that most patients prefer SC to IV medication, TCZ-SC will likely become a mainstay, along with other biologic agents, for the treatment of RA patients who have failed traditional non-biologic DMARDs.
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Affiliation(s)
- Maeve McLaughlin
- Addenbrooke's Hospital, Rheumatology Research Unit , Box 204, Cambridge Biomedical Campus, Hills Road, Cambridge , UK
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Fina-Aviles F, Medina-Peralta M, Mendez-Boo L, Hermosilla E, Elorza JM, Garcia-Gil M, Ramos R, Bolibar B, Javaid MK, Edwards CJ, Cooper C, Arden NK, Prieto-Alhambra D. The descriptive epidemiology of rheumatoid arthritis in Catalonia: a retrospective study using routinely collected data. Clin Rheumatol 2014; 35:751-7. [PMID: 25344777 DOI: 10.1007/s10067-014-2801-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/01/2014] [Accepted: 10/12/2014] [Indexed: 10/24/2022]
Abstract
Information on the epidemiology of rheumatoid arthritis (RA) in Southern Europe is scarce. We estimated the age- and gender-adjusted incidence and prevalence of RA in Catalonia using routinely collected primary care records. We identified incident (2009-2012) and prevalent (on 31 December 2012) cases of RA in the SIDIAP database using ICD-10 codes. SIDIAP contains anonymized data from computerized primary care records for about five million adults (>80 % of the population). We estimated age- (5-year groups) and gender-specific, and directly standardized incidence and prevalence of RA and confidence intervals (95% CIs) assuming a Poisson distribution. A total of 20,091 prevalent (among whom 5,796 incident) cases of RA were identified among 4,796,498 study participants observed for up to 4 years. Rates of RA increased with age in both genders, peaking at the age of 65-70 years. Age- and gender-standardized incidence and prevalence rates were 0.20/1,000 person-years (95% CI 0.19-0.20) and 4.17/1,000 (4.11-4.23) respectively. Rheumatoid factor was positive (≥10 IU/mL) in 1,833 (73.9 %) of 2,482 cases tested in primary care. The incidence and prevalence of RA in Catalonia are similar to those of other Southern European regions, and lower than those of northern areas. This data will inform health care planning and resource allocation.
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Affiliation(s)
- F Fina-Aviles
- Primary Care Department, Institut Català de la Salut, Av Gran Via de les Corts Catalanes 587, 3rd floor, 08007, Barcelona, Spain
| | - M Medina-Peralta
- Primary Care Department, Institut Català de la Salut, Av Gran Via de les Corts Catalanes 587, 3rd floor, 08007, Barcelona, Spain
| | - L Mendez-Boo
- Primary Care Department, Institut Català de la Salut, Av Gran Via de les Corts Catalanes 587, 3rd floor, 08007, Barcelona, Spain
| | - E Hermosilla
- IDIAP Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Av Gran Via de les Corts Catalanes 587, Atic, 08007, Barcelona, Spain
| | - J M Elorza
- IDIAP Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Av Gran Via de les Corts Catalanes 587, Atic, 08007, Barcelona, Spain
| | - M Garcia-Gil
- Primary Care Department, Institut Català de la Salut, Av Gran Via de les Corts Catalanes 587, 3rd floor, 08007, Barcelona, Spain.,IDIAP Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Av Gran Via de les Corts Catalanes 587, Atic, 08007, Barcelona, Spain
| | - R Ramos
- Primary Care Department, Institut Català de la Salut, Av Gran Via de les Corts Catalanes 587, 3rd floor, 08007, Barcelona, Spain.,IDIAP Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Av Gran Via de les Corts Catalanes 587, Atic, 08007, Barcelona, Spain
| | - B Bolibar
- IDIAP Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Av Gran Via de les Corts Catalanes 587, Atic, 08007, Barcelona, Spain
| | - M K Javaid
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, OX3 7LD, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, SO16 6YD, Southampton, UK
| | - C J Edwards
- Southampton General Hospital, Tremona Road, SO16 6YD, Southampton, UK
| | - C Cooper
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, OX3 7LD, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, SO16 6YD, Southampton, UK
| | - N K Arden
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, OX3 7LD, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, SO16 6YD, Southampton, UK
| | - D Prieto-Alhambra
- IDIAP Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Av Gran Via de les Corts Catalanes 587, Atic, 08007, Barcelona, Spain. .,Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, OX3 7LD, Oxford, UK. .,MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, SO16 6YD, Southampton, UK. .,SIDIAP Database, IDIAP Jordi Gol, Av Gran Via Corts Catalanes, 587, Atic, 08007, Barcelona, Spain.
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Shinde CG, Venkatesh MP, Kumar TMP, Shivakumar HG. Methotrexate: a gold standard for treatment of rheumatoid arthritis. J Pain Palliat Care Pharmacother 2014; 28:351-8. [PMID: 25322199 DOI: 10.3109/15360288.2014.959238] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Rheumatoid arthritis (RA) is a painful, debilitating disease characterized by inflammation of the joints, with the proliferation of the synovium and the progressive erosion of cartilage and bone. The treatment of RA is still unsatisfactory, but a number of powerful disease-modifying antirheumatic drugs have become available, such as methotrexate (MTX). Even in the current era of biological targeted therapies, MTX remains the initial preferred antirheumatic drug and is considered to be the gold standard for treatment of RA. The combination of its perceived efficacy, acceptable safety profile, and low cost, as well as decades of clinical experience, makes MTX the cornerstone of treatment for RA and the anchor drug in combination with various biological agents. In this review, the authors aim to summarize the research done in the field of drug delivery systems of MTX according to its routes of administration for treatment of RA. The last part of the review addresses combination therapy with MTX and future direction in the drug delivery of MTX. This review also provides the reader with a general overview of RA and its therapeutic strategies with respect of MTX, which may bring uniformity in medical practice for effective management of RA.
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Lisi S, D'Amore M, Sisto M. ADAM17 at the interface between inflammation and autoimmunity. Immunol Lett 2014; 162:159-69. [PMID: 25171914 DOI: 10.1016/j.imlet.2014.08.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/23/2014] [Accepted: 08/11/2014] [Indexed: 02/04/2023]
Abstract
The discovery of the disintegrin and metalloproteinase 17 (ADAM17), originally identified as tumor necrosis factor-a converting enzyme (TACE) for its ability as sheddase of TNF-α inspired scientists to attempt to elucidate the molecular mechanisms underlying ADAM17 implication in diseased conditions. In recent years, it has become evident that this protease can modify many non matrix substrates, such as cytokines (e.g. TNF-α), cytokine receptors (e.g. IL-6R and TNF-R), ligands of ErbB (e.g. TGF-α and amphiregulin) and adhesion proteins (e.g. Lselectin and ICAM-1). Several recent studies have described experimental model system to better understand the role of specific signaling molecules, the interplay of different signals and tissue interactions in regulating ADAM17-dependent cleavage of most relevant substrates in inflammatory diseases. The central question is whether ADAM17 can influence the outcome of inflammation and if so, how it performs this regulation in autoimmunity, since inflammatory autoimmune diseases are often characterized by deregulated metalloproteinase activities. This review will explore the latest research on the influence of ADAM17 on the progression of inflammatory processes linked to autoimmunity and its role as modulator of inflammation.
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Affiliation(s)
- Sabrina Lisi
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Section of Human Anatomy and Histology, Laboratory of Cell Biology, University of Bari Medical School, Bari, Italy.
| | - Massimo D'Amore
- Department of Interdisciplinary Medicine, Section of Rheumatology, University of Bari Medical School, Bari, Italy
| | - Margherita Sisto
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Section of Human Anatomy and Histology, Laboratory of Cell Biology, University of Bari Medical School, Bari, Italy.
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Snir O, Gomez-Cabrero D, Montes A, Perez-Pampin E, Gómez-Reino JJ, Seddighzadeh M, Klich KU, Israelsson L, Ding B, Catrina AI, Holmdahl R, Alfredsson L, Klareskog L, Tegnér J, Gonzalez A, Malmström V, Padyukov L. Non-HLA genes PTPN22, CDK6 and PADI4 are associated with specific autoantibodies in HLA-defined subgroups of rheumatoid arthritis. Arthritis Res Ther 2014; 16:414. [PMID: 25138370 PMCID: PMC4292996 DOI: 10.1186/s13075-014-0414-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/28/2014] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Genetic susceptibility to complex diseases has been intensively studied during the last decade, yet only signals with small effect have been found leaving open the possibility that subgroups within complex traits show stronger association signals. In rheumatoid arthritis (RA), autoantibody production serves as a helpful discriminator in genetic studies and today anti-citrullinated cyclic peptide (anti-CCP) antibody positivity is employed for diagnosis of disease. The HLA-DRB1 locus is known as the most important genetic contributor for the risk of RA, but is not sufficient to drive autoimmunity and additional genetic and environmental factors are involved. Hence, we addressed the association of previously discovered RA loci with disease-specific autoantibody responses in RA patients stratified by HLA-DRB1*04. METHODS We investigated 2178 patients from three RA cohorts from Sweden and Spain for 41 genetic variants and four autoantibodies, including the generic anti-CCP as well as specific responses towards citrullinated peptides from vimentin, alpha-enolase and type II collagen. RESULTS Our data demonstrated different genetic associations of autoantibody-positive disease subgroups in relation to the presence of DRB1*04. Two specific subgroups of autoantibody-positive RA were identified. The SNP in PTPN22 was associated with presence of anti-citrullinated enolase peptide antibodies in carriers of HLA-DRB1*04 (Cochran-Mantel-Haenszel test P = 0.0001, P corrected <0.05), whereas SNPs in CDK6 and PADI4 were associated with anti-CCP status in DRB1*04 negative patients (Cochran-Mantel-Haenszel test P = 0.0004, P corrected <0.05 for both markers). Additionally we see allelic correlation with autoantibody titers for PTPN22 SNP rs2476601 and anti-citrullinated enolase peptide antibodies in carriers of HLA-DRB1*04 (Mann Whitney test P = 0.02) and between CDK6 SNP rs42041 and anti-CCP in non-carriers of HLA-DRB1*04 (Mann Whitney test P = 0.02). CONCLUSION These data point to alternative pathways for disease development in clinically similar RA subgroups and suggest an approach for study of genetic complexity of disease with strong contribution of HLA.
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Raghu H, Jone A, Cruz C, Rewerts CL, Frederick MD, Thornton S, Degen JL, Flick MJ. Plasminogen is a joint-specific positive or negative determinant of arthritis pathogenesis in mice. Arthritis Rheumatol 2014; 66:1504-16. [PMID: 24574269 DOI: 10.1002/art.38402] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/06/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE A fundamental metric in the diagnosis of arthropathies is the pattern of joint involvement, including differences in proximal versus distal joints and patterns of symmetric or asymmetric disease. The basis for joint selectivity among arthritides and/or within a defined disease such as rheumatoid arthritis remains enigmatic. Coagulation and fibrinolytic activity are observed in both experimental animals with inflammatory joint disease and patients with inflammatory arthritis. However, the contribution of specific hemostatic factors to joint disease is not fully defined. We sought to determine the contribution of the fibrinolytic protease, plasminogen, to tumor necrosis factor α (TNFα)-driven arthritis in distinct joints in mice. METHODS The impact of plasminogen and/or fibrinogen genetic deficiencies on arthritis progression was evaluated in Tg197 mice genetically predisposed to spontaneous, nonabating, and erosive polyarthritis due to exuberant human TNFα expression. RESULTS Elimination of plasminogen in Tg197 mice significantly exacerbated the incidence and severity of arthritis within the paw joints, but simultaneously and dramatically diminished the entire spectrum of pathologies within the knee joints of the same animals. These opposing outcomes were both mechanistically linked to fibrin(ogen), in that superimposing fibrinogen deficiency reversed both the proarthritic phenotype in the paws and arthritis resistance in the knees of plasminogen-deficient mice. Intriguingly, the change in disease severity in the knees, but not the paws, was associated with a plasminogen-dependent reduction in matrix metalloproteinase 9 activity. CONCLUSION Plasminogen is a key molecular determinant of inflammatory joint disease capable of simultaneously driving or ameliorating arthritis pathogenesis in distinct anatomic locations in the same subject.
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Affiliation(s)
- Harini Raghu
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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[Demographic and clinical features of patients with rheumatoid arthritis in Piauí, Brazil--evaluation of 98 patients]. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 54:360-5. [PMID: 25627299 DOI: 10.1016/j.rbr.2014.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 01/29/2014] [Accepted: 02/10/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Brazilian epidemiological studies on rheumatoid arthritis are scarce, mainly in the northeast; thus many data currently available originate from the international literature. OBJECTIVES To describe demographic, clinical and serological characteristics of patients with rheumatoid arthritis (RA) followed-up by the same physician, in state of Piauí, Brazil. PATIENTS AND METHODS Data were collected between August 2010 and March 2013, in three health services of Piauí that provided health care in Rheumatology: a university-affiliated hospital, a public outpatient clinic and a private clinic. RESULTS The numbers represent mean ± SD or percentage: 47.5±11.03 years-old non-Caucasian woman, non-smoker (59.2%), low educational level, mean disease duration of 7.7 years ± 7.6, and major extra-articular manifestations were rheumatoid nodules (19.4%) and sicca syndrome (46.9%). CONCLUSION Features of rheumatoid arthritis obtained in this study are similar to those found in some national and international studies, but we observed higher female preponderance and illiteracy rate, in addition to a moderately severe erosive disease on average, with frequent sicca and other extra-articular manifestations.
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Characteristics of rheumatoid arthritis in Algeria: a multicenter study. Rheumatol Int 2014; 34:1235-9. [PMID: 24633899 DOI: 10.1007/s00296-014-2981-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Abstract
The aim of this study was to compare the epidemiology of rheumatoid arthritis (RA) in North Africa to that of Western countries. We have enrolled in a cross-sectional study all consecutive patients presenting with the diagnosis of RA according to the 1987 ACR criteria, and during a 5-month period, patients were included in 11 centers across northern Algeria. Demographics, clinical data, and health assessment questionnaires (HAQ) were collected for each patient. We have estimated means, standard deviations, and 95 % confidence intervals for all parameters. Of the 249 patients (213 females and 36 males) enrolled in the study, 10 (4 %) had juvenile onset of the disease. The mean age was 50.1 ± 14.5 years, and the mean duration of RA was 8.4 ± 7.8 years. In terms of comorbidities, 18.9 % of patients reported hypertension and 5.2 % had diabetes. The mean DAS28 at inclusion was 4.3 (95 % CI 4.1-4.5); 14.0 % were in remission (DAS28 ≤ 2.6). The mean HAQ score was 0.81 ± 0.82. Rheumatoid factor was positive in 78.5 % of cases, and anti-citrullinated protein/peptide antibodies, when measured, was positive in 69.0 % of cases. Seronegative patients were older and had a relatively less severe disease. For treatment, 89.7 % of patients were taking disease-modifying anti-rheumatic drugs and only 4 % were taking biologics (rituximab); 90.8 % of patients were taking glucocorticoids, and none of the patients satisfied the recommended calcium intake guidelines. RA in Algeria is more common in women. Compared to reports from Western countries, RA in Algeria appears to be less aggressive, with more dominant seronegative oligoarthritis forms. The remission rate is comparable to that of Western populations.
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Could biomarkers of bone, cartilage or synovium turnover be used for relapse prediction in rheumatoid arthritis patients? Mediators Inflamm 2014; 2014:537324. [PMID: 24744505 PMCID: PMC3972914 DOI: 10.1155/2014/537324] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/10/2014] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this review is to clarify the usefulness of bone, cartilage, and synovial biomarker in the management of rheumatoid arthritis (RA) therapy in remission. SYNOVIAL BIOMARKERS: High MMP-3 levels are associated with joint progression in RA patients, but there is no data about their utility in clinical remission. IIINys and Glc-Gal-PYD seem to be more specific to synovium, but more studies are required. CARTILAGE BIOMARKERS: Unbalance between cartilage break-down biomarkers (urinary CTX II and COMP) and cartilage formation biomarker (PIIANP) was described. This unbalance is also associated with joint destruction and prognosis of destruction. No data are available on patients in remission. BONE BIOMARKERS: RA activity is correlated with an increase of bone resorption markers such as CTX I, PYD, and TRACP 5b and a decrease of bone formation markers such as OC and BALP. RA therapies seem to improve bone turnover in limiting bone resorption. There is no study about bone marker utility in remission. CONCLUSION Biomarkers seem to correlate with RA activity and progression. They also could be used to manage RA therapies, but we need more data on RA remission to predict relapse.
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Kourilovitch M, Galarza-Maldonado C, Ortiz-Prado E. Diagnosis and classification of rheumatoid arthritis. J Autoimmun 2014; 48-49:26-30. [DOI: 10.1016/j.jaut.2014.01.027] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
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Fischer S, Agmon-Levin N, Shapira Y, Porat Katz BS, Graell E, Cervera R, Stojanovich L, Gómez Puerta JA, Sanmartí R, Shoenfeld Y. Toxoplasma gondii: bystander or cofactor in rheumatoid arthritis. Immunol Res 2014; 56:287-92. [PMID: 23553228 DOI: 10.1007/s12026-013-8402-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Parasitic infections may induce variable immunomodulatory effects and control of autoimmune disease. Toxoplasma gondii (T. gondii) is a ubiquitous intracellular protozoan that was recently associated with autoimmunity. This study was undertaken to investigate the seroprevalence and clinical correlation of anti-T. gondii antibodies in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We evaluated sera from European patients with RA (n = 125) and SLE (n = 164) for the prevalence of anti-T. gondii IgG antibodies (ATXAb), as well as other common infections such as Cytomegalovirus, Epstein-Barr, and Rubella virus. The rates of seropositivity were determined utilizing the LIAISON chemiluminescent immunoassays (DiaSorin, Italy). Our results showed a higher seroprevalence of ATXAb in RA patients, as compared with SLE patients [63 vs. 36 %, respectively (p = 0.01)]. The rates of seropositivity of IgG against other infectious agents were comparable between RA and SLE patients. ATXAb-seropositivity was associated with older age of RA patients, although it did not correlate with RA disease activity and other manifestations of the disease. In conclusion, our data suggest a possible link between exposure to T. gondii infection and RA.
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Affiliation(s)
- Svetlana Fischer
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 52621, Tel HaShomer, Israel
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Won S, Sung YK, Cho SK, Choi CB, Koh EM, Kim SK, Kim J, Kim TH, Kim HA, Nah SS, Bang SY, Suh CH, Shim SC, Yoo DH, Yoon BY, Lee SH, Lee SW, Lee SS, Lee YA, Lee J, Lee J, Lee HS, Lim MK, Jun JB, Jeon CH, Jung YO, Chung WT, Cha HS, Choe JY, Hong SJ, Bae SC. Prediction for TNF Inhibitor Users in RA Patients According to Reimbursement Criteria Based on DAS28. JOURNAL OF RHEUMATIC DISEASES 2014. [DOI: 10.4078/jrd.2014.21.2.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Soyoung Won
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Yoon-Kyoung Sung
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Soo-Kyung Cho
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Chan-Bum Choi
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Eun-Mi Koh
- Department of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Seong-Kyu Kim
- Department of Rheumatology, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Jinseok Kim
- Department of Rheumatology, Jeju National University Hospital, Jeju, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Hyoun Ah Kim
- Department of Rheumatology, Ajou University Hospital, Suwon, Korea
| | - Seong-Su Nah
- Department of Rheumatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - So-Young Bang
- Department of Rheumatology, Hanyang University Guri Hospital, Guri, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University Hospital, Suwon, Korea
| | - Seung Cheol Shim
- Department of Rheumatology, Chungnam National University Hospital, Daejeon, Korea
| | - Dae-Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Bo Young Yoon
- Department of Rheumatology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang-Hoon Lee
- Department of Rheumatology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sung Won Lee
- Department of Rheumatology, Dong-A University Hospital, Busan, Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Yeon-Ah Lee
- Department of Rheumatology, Kyung Hee University Hospital, Seoul, Korea
| | - Jaejoon Lee
- Department of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Jisoo Lee
- Department of Rheumatology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hye-Soon Lee
- Department of Rheumatology, Hanyang University Guri Hospital, Guri, Korea
| | - Mi Kyoung Lim
- Department of Rheumatology, Eulji University Hospital, Daejeon, Korea
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Chan Hong Jeon
- Department of Rheumatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young Ok Jung
- Department of Rheumatology, Hallym University College of Medicine, Seoul, Korea
| | - Won Tae Chung
- Department of Rheumatology, Dong-A University Hospital, Busan, Korea
| | - Hoon-Suk Cha
- Department of Rheumatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Jung-Yoon Choe
- Department of Rheumatology, Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Seung-Jae Hong
- Department of Rheumatology, Kyung Hee University Hospital, Seoul, Korea
| | - Sang-Cheol Bae
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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PADI4 haplotypes in association with RA Mexican patients, a new prospect for antigen modulation. Clin Dev Immunol 2013; 2013:383681. [PMID: 24454473 PMCID: PMC3881379 DOI: 10.1155/2013/383681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/05/2013] [Accepted: 09/23/2013] [Indexed: 01/08/2023]
Abstract
Peptidyl arginine deiminase IV (PAD 4) is the responsible enzyme for a posttranslational modification called citrullination, originating the antigenic determinant recognized by anti-cyclic citrullinated peptide antibodies (ACPA). Four SNPs (single nucleotide polymorphisms) have been described in PADI4 gene to form a susceptibility haplotype for rheumatoid arthritis (RA); nevertheless, results in association studies appear contradictory in different populations. The aim of the study was to analyze if the presence of three SNPs in PADI4 gene susceptibility haplotype (GTG) is associated with ACPA positivity in patients with RA. This was a cross-sectional study that included 86 RA patients and 98 healthy controls. Polymorphisms PADI4_89, PADI4_90, and PADI4_92 in the PADI4 gene were genotyped. The susceptibility haplotype (GTG) was more frequent in RA patients; interestingly, we found a new haplotype associated with RA with a higher frequency (GTC). There were no associations between polymorphisms and high scores in Spanish HAQ-DI and DAS-28, but we did find an association between RARBIS index and PADI4_89, PADI4_90 polymorphisms. We could not confirm an association between susceptibility haplotype presence and ACPA positivity. Further evidence about proteomic expression of this gene will determine its participation in antigenic generation and autoimmunity.
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Borbély É, Hajna Z, Sándor K, Kereskai L, Tóth I, Pintér E, Nagy P, Szolcsányi J, Quinn J, Zimmer A, Stewart J, Paige C, Berger A, Helyes Z. Role of tachykinin 1 and 4 gene-derived neuropeptides and the neurokinin 1 receptor in adjuvant-induced chronic arthritis of the mouse. PLoS One 2013; 8:e61684. [PMID: 23626716 PMCID: PMC3634005 DOI: 10.1371/journal.pone.0061684] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/13/2013] [Indexed: 12/19/2022] Open
Abstract
Objective Substance P, encoded by the Tac1 gene, is involved in neurogenic inflammation and hyperalgesia via neurokinin 1 (NK1) receptor activation. Its non-neuronal counterpart, hemokinin-1, which is derived from the Tac4 gene, is also a potent NK1 agonist. Although hemokinin-1 has been described as a tachykinin of distinct origin and function compared to SP, its role in inflammatory and pain processes has not yet been elucidated in such detail. In this study, we analysed the involvement of tachykinins derived from the Tac1 and Tac4 genes, as well as the NK1 receptor in chronic arthritis of the mouse. Methods Complete Freund’s Adjuvant was injected intraplantarly and into the tail of Tac1−/−, Tac4−/−, Tacr1−/− (NK1 receptor deficient) and Tac1−/−/Tac4−/− mice. Paw volume was measured by plethysmometry and mechanosensitivity using dynamic plantar aesthesiometry over a time period of 21 days. Semiquantitative histopathological scoring and ELISA measurement of IL-1β concentrations of the tibiotarsal joints were performed. Results Mechanical hyperalgesia was significantly reduced from day 11 in Tac4−/− and Tacr1−/− animals, while paw swelling was not altered in any strain. Inflammatory histopathological alterations (synovial swelling, leukocyte infiltration, cartilage destruction, bone damage) and IL-1β concentration in the joint homogenates were significantly smaller in Tac4−/− and Tac1−/−/Tac4−/− mice. Conclusions Hemokinin-1, but not substance P increases inflammation and hyperalgesia in the late phase of adjuvant-induced arthritis. While NK1 receptors mediate its antihyperalgesic actions, the involvement of another receptor in histopathological changes and IL-1β production is suggested.
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MESH Headings
- Animals
- Arthritis, Experimental/chemically induced
- Arthritis, Experimental/genetics
- Arthritis, Experimental/metabolism
- Arthritis, Experimental/pathology
- Edema/chemically induced
- Edema/genetics
- Edema/metabolism
- Edema/pathology
- Freund's Adjuvant
- Gene Expression Regulation
- Hyperalgesia/chemically induced
- Hyperalgesia/genetics
- Hyperalgesia/metabolism
- Hyperalgesia/pathology
- Inflammation
- Interleukin-1beta/biosynthesis
- Joints/metabolism
- Joints/pathology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Plethysmography
- Protein Precursors/deficiency
- Protein Precursors/genetics
- Receptors, Neurokinin-1/deficiency
- Receptors, Neurokinin-1/genetics
- Signal Transduction
- Substance P/deficiency
- Substance P/genetics
- Tachykinins/deficiency
- Tachykinins/genetics
- Tarsus, Animal/metabolism
- Tarsus, Animal/pathology
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Affiliation(s)
- Éva Borbély
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Zsófia Hajna
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Katalin Sándor
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - László Kereskai
- Department of Pathology, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - István Tóth
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Erika Pintér
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Péter Nagy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - János Szolcsányi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - John Quinn
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine Liverpool University, Liverpool, United Kingdom
| | - Andreas Zimmer
- Laboratory of Molecular Neurobiology, Department of Psychiatry, University of Bonn, Bonn, Germany
| | - James Stewart
- School of Infection and Host Defense, University of Liverpool, Liverpool, United Kingdom
| | - Christopher Paige
- Ontario Cancer Institute, University Health Network, Toronto, Canada
- Department of Immunology, University of Toronto, Toronto, Canada
| | - Alexandra Berger
- Ontario Cancer Institute, University Health Network, Toronto, Canada
- Department of Immunology, University of Toronto, Toronto, Canada
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Pécs, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
- * E-mail:
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Sung YK, Cho SK, Choi CB, Bae SC. Prevalence and incidence of rheumatoid arthritis in South Korea. Rheumatol Int 2012; 33:1525-32. [PMID: 23255140 DOI: 10.1007/s00296-012-2590-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
Several studies of rheumatoid arthritis (RA) incidence and prevalence indicate that occurrence of the disease varies significantly among different populations. We aimed to estimate the prevalence and incidence of RA in South Korea. We used Korean National Health Insurance (NHI) claims data to estimate the prevalence of RA in 2007-2009 and the incidence of RA in 2008. On the basis of our previous validation study, the presence of RA was defined by the diagnostic code for RA with biologic or non-biologic disease-modifying anti-rheumatic drugs in the same claim in each year. To estimate the incidence of RA, we identified cases of RA in 2008 and set the 12-month period prior to 2008 as a disease-free period. Among the incident case of 2008, only patients who continued treatment in 2009 were defined as true incident case of RA in 2008. The corresponding prevalence estimates were 0.26 % (95 % CI 0.25-0.27) in 2006, 0.27 % (95 % CI 0.26-0.28) in 2007, and 0.27 % (95 % CI 0.26-0.28) in 2008. The incidence of RA in 2008 was estimated at 42/100,000 (95 % CI 29.3-54.7) in the general population of South Korea. Data gathered nationwide through the NHI yielded estimates of RA prevalence and incidence in South Korea. This study is the first report of nationwide prevalence and incidence of South Korea and those are comparable to values for other countries in Asia.
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Affiliation(s)
- Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul 133-792, South Korea
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Dowman B, Campbell RM, Zgaga L, Adeloye D, Chan KY. Estimating the burden of rheumatoid arthritis in Africa: A systematic analysis. J Glob Health 2012; 2:020406. [PMID: 23289081 PMCID: PMC3529310 DOI: 10.7189/jogh.02.020406] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) has an estimated worldwide prevalence of 1%. It is one of the leading causes of chronic morbidity in the developed world, but little is known about the disease burden in Africa. RA is often seen as a minor health problem and has been neglected in research and resource allocation throughout Africa despite potentially fatal systemic manifestations. This review aims to identify all relevant epidemiological literature pertaining to the occurrence of RA in Africa and calculate the prevalence and burden of disease. METHODS A systematic literature review of Medline, Embase and Global Health Library retrieved a total of 335 publications, of which 10 population studies and 11 hospital studies met pre-defined minimum criteria for relevance and quality. Data on prevalence was extracted, analysed and compared between population and hospital studies. Differences between genders were also analysed. FINDINGS The estimated crude prevalence of RA in Africa based on the available studies was 0.36% in 1990, which translates to a burden of 2.3 million affected individuals in 1990. Projections for the African population in 2010 based on the same prevalence rates would suggest a crude prevalence of 0.42% and the burden increased to 4.3 million. Only 2 population studies have been conducted after 1990, so projections for 2010 are uncertain. Hospital-based studies under-report the prevalence by about 6 times in comparison to population-based studies. CONCLUSION The availability of epidemiological information on RA in Africa is very limited. More studies need to be conducted to estimate the true burden and patterns of RA before appropriate health policies can be developed.
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Affiliation(s)
- Ben Dowman
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Ruth M. Campbell
- Toronto General Hospital, University Health Network, Toronto, Canada
| | - Lina Zgaga
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Davies Adeloye
- Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - Kit Yee Chan
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Centre, Beijing, China
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Hernandez JLR, Leung G, McKay DM. Cestode regulation of inflammation and inflammatory diseases. Int J Parasitol 2012; 43:233-43. [PMID: 23058631 DOI: 10.1016/j.ijpara.2012.09.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 12/13/2022]
Abstract
Helminth parasites are masters of immune regulation; a likely prerequisite for long-term survival by circumventing their hosts' attempt to eradicate them. From a translational perspective, knowledge of immune events as a response to infection with a helminth parasite could be used to reduce the intensity of unwanted inflammatory reactions. Substantial data have accumulated showing that inflammatory reactions that promote a variety of auto-inflammatory diseases are dampened as a consequence of infection with helminth parasites, via either the mobilization of an anti-worm spectrum of immune events or by the direct effect of secretory/excretory bioactive immunomodulatory molecules released from the parasite. However, many issues are outstanding in the definition of the mechanism(s) by which infection with helminth parasites can affect the outcome, positively or negatively, of concomitant disease. We focus on a subgroup of this complex group of metazoan parasites, the cestodes, summarizing studies from rodent models that illustrate if, and by what mechanisms, infection with tapeworms ameliorate or exaggerate disease in their host. The ability of infection with cestodes, or other classes of helminth, to worsen a disease course or confer susceptibility to intracellular pathogens should be carefully considered in the context of 'helminth therapy'. In addition, poorly characterised cestode extracts can regulate murine and human immunocyte function, yet the impact of these in the context of autoimmune or allergic diseases is poorly understood. Thus, studies with cestodes, as representative helminths, have helped cement the concept that infection with parasitic helminths can inhibit concomitant disease; however, issues relating to long-term effects, potential side-effects, mixed pathogen infections and purification of immunomodulatory molecules from the parasite remain as challenges that need to be addressed in order to achieve the use of helminths as anti-inflammatory agents for human diseases.
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Affiliation(s)
- Jose-Luis Reyes Hernandez
- Gastrointestinal Research Group, Department of Physiology and Pharmacology, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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