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Qiang F, Xuan D, Li Z, Chen L, Wang L, Sheng J. Causal association between rheumatoid arthritis and risk of stroke: A Mendelian randomization study. Clin Neurol Neurosurg 2024; 244:108465. [PMID: 39059285 DOI: 10.1016/j.clineuro.2024.108465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/20/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Active rheumatoid arthritis (RA) may damage vascular endothelial cells, thereby increasing the likelihood of adverse cardiovascular events. However, it is not yet clearly established whether RA also increases the risk of adverse cerebrovascular events, particularly stroke. OBJECTIVE This study was designed to evaluate the likelihood of a causal association between RA and stroke. METHOD A two-sample Mendelian randomization (MR) analysis was performed using the inverse variance-weighted (IVW) average, weighted median, and MR-Egger regression methods. The analysis utilized publicly available summary statistics datasets from Genome-wide association studies (GWAS) meta-analyses for RA in individuals of European descent (total n = 484,598; case = 5427, control = 479,171) as the exposure cohort, and from GWAS meta-analyses for "vascular/heart problems diagnosed by doctor: stroke" in individuals included in the UK Biobank (total n = 461,880; case = 7055, control = 454,825, MRC-IEU consortium) as the outcome cohort. RESULTS Eight single-nucleotide polymorphisms with genome-wide significance were selected from the GWASs on RA as the instrumental variables. The results of the MR-Egger and weighted median analyses showed no causal association between RA and stroke (OR = 1.081, 95 % CI [0.943-1.240], P = 0.304) vs. OR = 1.079, 95 % CI [0.988-1.179], P = 0.091), respectively. However, the inverse variance-weighted (IVW) analysis results revealed a causal association between RA and stroke (OR = 1.115, 95 % CI [1.040-1.194], P = 0.002). Cochran's Q test and MR-Egger regression revealed no evidence of heterogeneity and horizontal pleiotropy. CONCLUSION The MR analysis results indicated that rheumatoid arthritis (RA) may be causally associated with an increased risk of stroke.
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Affiliation(s)
- Fuyong Qiang
- Department of Rheumatism and Immunology, The First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, Anhui 241001, China
| | - Dan Xuan
- Department of Rheumatism and Immunology, The First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, Anhui 241001, China
| | - Zhi Li
- Department of Rheumatism and Immunology, The First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, Anhui 241001, China
| | - Lanfang Chen
- Department of Rheumatism and Immunology, The First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, Anhui 241001, China
| | - Li Wang
- Department of Rheumatism and Immunology, The First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, Anhui 241001, China
| | - Jun Sheng
- Department of Rheumatism and Immunology, The First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu, Anhui 241001, China.
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Li DT, Yang Q, Xia CY, Zhang YF, Cai Y, Wu SQ, Jiang Q, Hu P. The changes of coagulation profiles in Kawasaki disease and its associations with clinical classification, intravenous immunoglobulin responsiveness and coronary artery involvement. Clin Exp Med 2024; 24:177. [PMID: 39105936 PMCID: PMC11303485 DOI: 10.1007/s10238-024-01430-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024]
Abstract
Coagulation disorders are common in Kawasaki disease (KD). The main objectives of the present study were to probe the associations of coagulation profiles with clinical classification, IVIG responsiveness, coronary artery abnormalities (CAAs) in the acute episode of KD. A total of 313 KD children were recruited and divided into six subgroups, including complete KD (n = 217), incomplete KD (n = 96), IVIG-responsive KD (n = 293), IVIG-nonresponsive KD (n = 20), coronary artery noninvolvement KD (n = 284) and coronary artery involvement KD (n = 29). Blood samples were collected within 24-h pre-IVIG therapy and 48-h post-IVIG therapy. Coagulation profiles, conventional inflammatory mediators and blood cell counts were detected. Echocardiography was performed during the period from 2- to 14-day post-IVIG infusion. In addition, 315 sex- and age-matched healthy children were enrolled as the controls. (1) Before IVIG therapy, coagulation disorders were more prone to appear in KD patients than in healthy controls, and could be overcome by IVIG therapy. FIB and DD significantly increased in the acute phase of KD, whereas reduced to normal levels after IVIG therapy. (2) PT and APTT were significantly longer in patients with complete KD when compared with their incomplete counterparts after IVIG therapy. (3) The larger δDD, δFDP and the smaller δPT, δINR predicted IVIG nonresponsiveness. (4) The higher δDD and δFDP correlated with a higher risk for CAAs (DD: r = -0.72, FDP: r = -0.54). Coagulation disorders are correlated with complete phenotype, IVIG nonresponsiveness and CAA occurrence in the acute episode of KD, and can be rectified by synergistic effects of IVIG and aspirin.
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Affiliation(s)
- Dao Ting Li
- Department of Paediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Qian Yang
- Department of Paediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Cai Yun Xia
- Department of Paediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Yan Fang Zhang
- Department of Paediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Ying Cai
- Department of Paediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Shu Qi Wu
- Department of Paediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Qi Jiang
- Department of Paediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022, Anhui Province, People's Republic of China
| | - Peng Hu
- Department of Paediatrics, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022, Anhui Province, People's Republic of China.
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Zinellu A, Mangoni AA. A systematic review and meta-analysis of the association between the D-dimer and rheumatic diseases. Immun Inflamm Dis 2024; 12:e1349. [PMID: 39056561 PMCID: PMC11273555 DOI: 10.1002/iid3.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/30/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION There is good evidence that specific autoimmune rheumatic diseases (RDs), for example, rheumatoid arthritis and systemic lupus erythematosus (SLE), are associated with a state of hypercoagulability and an increased risk of venous thromboembolism (VTE). However, limited information regarding this association is available for other autoimmune or autoinflammatory RDs. We sought to address this issue by conducting a systematic review and meta-analysis of the association between the d-dimer, an established marker of hypercoagulability and VTE, and RDs and the possible clinical and demographic factors mediating this association. METHODS We searched the electronic databases PubMed, Web of Science, and Scopus from inception to January 31, 2024. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. RESULTS In 31 studies selected for analysis (2724 RD patients and 3437 healthy controls), RD patients had overall significantly higher d-dimer concentrations when compared to controls (standard mean difference = 0.93, 95% CI 0.76-1.10, p < .001; I2 = 86.1%, p < .001; moderate certainty of evidence). The results were stable in a sensitivity analysis. Significant associations were observed between the effect size of the between-group differences in d-dimer concentration and age, specific RD and RD category, RD duration, fibrinogen, plasminogen activator inhibitor, C-reactive protein, and erythrocyte sedimentation rate. CONCLUSIONS Overall, patients with RDs have significantly higher d-dimer concentrations when compared with healthy controls, indicating a state of hypercoagulability. The alterations in d-dimer concentrations are mediated by age, specific RD and RD category, RD duration, and markers of anticoagulation and inflammation. Further research is warranted to investigate d-dimer concentrations across the spectrum of RDs and their utility in predicting and managing VTE in these patients (PROSPERO registration number: CRD42024517712).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical SciencesUniversity of SassariSassariItaly
| | - Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public HealthFlinders UniversityAdelaideAustralia
- Department of Clinical PharmacologyFlinders Medical Centre, Southern Adelaide Local Health NetworkAdelaideAustralia
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Geng Q, Xu J, Cao X, Wang Z, Jiao Y, Diao W, Wang X, Wang Z, Zhang M, Zhao L, Yang L, Deng T, Fan B, Xu Y, Jia L, Xiao C. PPARG-mediated autophagy activation alleviates inflammation in rheumatoid arthritis. J Autoimmun 2024; 146:103214. [PMID: 38648706 DOI: 10.1016/j.jaut.2024.103214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease characterized by joint inflammation and bone damage, that not only restricts patient activity but also tends to be accompanied by a series of complications, seriously affecting patient prognosis. Peroxisome proliferator-activated receptor gamma (PPARG), a receptor that controls cellular metabolism, regulates the function of immune cells and stromal cells. Previous studies have shown that PPARG is closely related to the regulation of inflammation. However, the role of PPARG in regulating the pathological processes of RA is poorly understood. MATERIALS AND METHODS PPARG expression was examined in the synovial tissues and peripheral blood mononuclear cells (PBMCs) from RA patients and the paw of collagen-induced arthritis (CIA) model rats. Molecular biology experiments were designed to examine the effect of PPARG and cannabidiol (CBD) on RAW264.7 cells and CIA rats. RESULTS The results reveal that PPARG accelerates reactive oxygen species (ROS) clearance by promoting autophagy, thereby inhibiting ROS-mediated macrophage polarization and NLRP3 inflammasome activation. Notably, CBD may be a promising candidate for understanding the mechanism by which PPARG regulates autophagy-mediated inflammation. CONCLUSIONS Taken together, these findings indicate that PPARG may have a role for distinguishing between RA patients and healthy control, and for distinguishing RA activity; moreover, PPARG could be a novel pharmacological target for alleviating RA through the mediation of autophagy. CBD can act as a PPARG agonist that alleviates the inflammatory progression of RA.
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Affiliation(s)
- Qishun Geng
- China-Japan Friendship Clinical Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100029, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jiahe Xu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 100029, China
| | - Xiaoxue Cao
- China-Japan Friendship Clinical Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100029, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhaoran Wang
- China-Japan Friendship Clinical Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100029, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yi Jiao
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China; Beijing University of Chinese Medicine, China-Japan Friendship Hospital Clinical Medicine, Beijing, 100029, China
| | - Wenya Diao
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China; Beijing University of Chinese Medicine, China-Japan Friendship Hospital Clinical Medicine, Beijing, 100029, China
| | - Xing Wang
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China; Beijing University of Chinese Medicine, China-Japan Friendship Hospital Clinical Medicine, Beijing, 100029, China
| | - Zihan Wang
- Beijing University of Chinese Medicine, China-Japan Friendship Hospital Clinical Medicine, Beijing, 100029, China; Department of TCM Rheumatology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Mengxiao Zhang
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lu Zhao
- China-Japan Friendship Hospital, Capital Medical University, Beijing, 100029, China
| | - Lei Yang
- Department of Pathology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Tingting Deng
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Bifa Fan
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yuan Xu
- Department of TCM Rheumatology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lansi Jia
- Department of Anorectal, China-Japan Friendship Hospital, Beijing, 100029, China.
| | - Cheng Xiao
- China-Japan Friendship Clinical Medical College, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100029, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China; Department of Emergency, China-Japan Friendship Hospital, Beijing, 100029, China.
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Jiang W, Jia W, Dong C. Under the dual effect of inflammation and pulmonary fibrosis, CTD-ILD patients possess a greater susceptibility to VTE. Thromb J 2024; 22:34. [PMID: 38576023 PMCID: PMC10993540 DOI: 10.1186/s12959-024-00599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
As an autoimmune disease, the persistent systemic inflammatory response associated with connective tissue disease (CTD) is involved in the development of venous thromboembolism (VTE). However, clinical data showed that the risk of VTE in patients differed between subtypes of CTD, suggesting that different subtypes may have independent mechanisms to promote the development of VTE, but the specific mechanism lacks sufficient research at present. The development of pulmonary fibrosis also contributes to the development of VTE, and therefore, patients with CTD-associated interstitial lung disease (CTD-ILD) may be at higher risk of VTE than patients with CTD alone or patients with ILD alone. In addition, the activation of the coagulation cascade response will drive further progression of the patient's pre-existing pulmonary fibrosis, which will continue to increase the patient's risk of VTE and adversely affect prognosis. Currently, the treatment for CTD-ILD is mainly immunosuppressive and antirheumatic therapy, such as the use of glucocorticoids and janus kinase-inhibitors (JAKis), but, paradoxically, these drugs are also involved in the formation of patients' coagulation tendency, making the clinical treatment of CTD-ILD patients with a higher risk of developing VTE challenging. In this article, we review the potential risk factors and related mechanisms for the development of VTE in CTD-ILD patients to provide a reference for clinical treatment and prevention.
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Affiliation(s)
- Wenli Jiang
- Department of Pulmonary and Critical Care Medicine, Second Hospital, Jilin University, 130041, Changchun, China
| | - Wenhui Jia
- Department of Pulmonary and Critical Care Medicine, Second Hospital, Jilin University, 130041, Changchun, China
| | - Chunling Dong
- Department of Pulmonary and Critical Care Medicine, Second Hospital, Jilin University, 130041, Changchun, China.
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Kanno Y. The Roles of Fibrinolytic Factors in Bone Destruction Caused by Inflammation. Cells 2024; 13:516. [PMID: 38534360 DOI: 10.3390/cells13060516] [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: 01/26/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
Chronic inflammatory diseases, such as rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, Crohn's disease, periodontitis, and carcinoma metastasis frequently result in bone destruction. Pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, and IL-17 are known to influence bone loss by promoting the differentiation and activation of osteoclasts. Fibrinolytic factors, such as plasminogen (Plg), plasmin, urokinase-type plasminogen activator (uPA), its receptor (uPAR), tissue-type plasminogen activator (tPA), α2-antiplasmin (α2AP), and plasminogen activator inhibitor-1 (PAI-1) are expressed in osteoclasts and osteoblasts and are considered essential in maintaining bone homeostasis by regulating the functions of both osteoclasts and osteoblasts. Additionally, fibrinolytic factors are associated with the regulation of inflammation and the immune system. This review explores the roles of fibrinolytic factors in bone destruction caused by inflammation.
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Affiliation(s)
- Yosuke Kanno
- Department of Molecular Pathology, Faculty of Pharmaceutical Science, Doshisha Women's College of Liberal Arts, 97-1 Kodo Kyotanabe, Kyoto 610-0395, Japan
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Mori S, Soejima H, Hokamaki J, Tsujita K. Clinical disease activity is a major determinant of plasma D-dimer elevation in outpatients with rheumatoid arthritis: A hospital-based cross-sectional study. Mod Rheumatol 2024; 34:313-321. [PMID: 36726243 DOI: 10.1093/mr/road018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To identify factors associated with plasma D-dimer levels in outpatients with rheumatoid arthritis (RA). METHODS We consecutively recruited 460 RA patients who visited our hospital for routine follow-ups between June and October 2021. Plasma D-dimer, RA-related characteristics, comorbidities, and cardiovascular and venous thromboembolism (VTE) risk factors were examined at enrolment. Patients with elevated D-dimer levels underwent whole-leg venous ultrasonography to diagnose deep vein thrombosis (DVT). RESULTS Participants had no DVT signs or symptoms. Among them, 252 (54.8%) were positive for plasma D-dimer (≥0.5 μg/ml) and 40 (8.7%) had high D-dimer levels (≥3 μg/ml). The mean was 1.07 μg/ml. After adjustments, age [odds ratio (OR) 1.88 per additional 10 years, P = .003], high and moderate clinical disease activity index (OR 8.79, P < .001), and the presence of comorbidities or cardiovascular/VTE risk factors (OR 2.94, P = .017) were identified as the factors independently associated with high D-dimer levels. Among patients with D-dimer levels ≥3 μg/ml, 10 (25%) had DVT in their lower limbs, and D-dimer levels were significantly higher in patients with DVT compared with those without it (mean 6.0 vs. 4.1 μg/ml, P < .001). CONCLUSIONS Clinical disease activity is a major contributor to plasma D-dimer elevation in RA outpatients.
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, National Hospital Organization Kumamoto Saishun Medical Center, Kohshi, Kumamoto, Japan
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences and Health Care Center, Kumamoto University, Kumamoto, Japan
| | - Jun Hokamaki
- Department of Cardiovascular Medicine, National Hospital Organization Kumamoto Saishun Medical Center, Kohshi, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences and Center of Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto, Japan
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Qiao Y, Xiao J, He T, Wang R, Xu Y, Wei Y, Wang J, Hu R, Li Z. Predictive value of coagulation function, alpha-fetoprotein and placental growth factor in patients with perilous placenta previa. Am J Transl Res 2024; 16:567-576. [PMID: 38463595 PMCID: PMC10918133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/15/2023] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To analyze the predictive value of coagulation function, alpha-fetoprotein (AFP) and placental growth factor (PIGF) for postpartum hemorrhage in patients with perilous placenta previa (PPP). METHODS The clinical data of 104 PPP patients were retrospectively analyzed. The patients were divided into a hemorrhage group (n=68) and a non-hemorrhage group (n=36). A total of 55 healthy pregnant women were recruited as controls. The coagulation function, AFP and PIGF were compared between the three groups. Multivariate logistic regression was performed to determine independent risk factors for hemorrhage. RESULTS PT, TT, APTT, FIB and AFP were significantly higher while PIGF was lower in the PPP group than the control group (all P<0.05). Placental adhesion (OR 3.924, 95% CI 1.389-11.083, P=0.01), anterior placenta (OR 4.583, 95% CI 1.589-13.22, P=0.005), AFP (OR 0.208, 95% CI 0.068-0.635, P=0.006) and PIGF (OR 3.963, 95% CI 1.385-11.34, P=0.01) were independent risk factors for hemorrhage. CONCLUSION Coagulation function, AFP and PIGF could predict postpartum hemorrhage in PPP patients.
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Affiliation(s)
- Yuan Qiao
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s HospitalNo. 1616 Yanxiang Road, Xi’an 710061, Shaanxi, China
| | - Jin Xiao
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s HospitalNo. 1616 Yanxiang Road, Xi’an 710061, Shaanxi, China
| | - Tongqiang He
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s HospitalNo. 1616 Yanxiang Road, Xi’an 710061, Shaanxi, China
| | - Rui Wang
- Department of Obstetrics, Northwest Women’s and Children’s HospitalNo. 1616 Yanxiang Road, Xi’an 710061, Shaanxi, China
| | - Yehong Xu
- Department of Obstetrics, Northwest Women’s and Children’s HospitalNo. 1616 Yanxiang Road, Xi’an 710061, Shaanxi, China
| | - Yang Wei
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s HospitalNo. 1616 Yanxiang Road, Xi’an 710061, Shaanxi, China
| | - Jun Wang
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s HospitalNo. 1616 Yanxiang Road, Xi’an 710061, Shaanxi, China
| | - Rui Hu
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women’s and Children’s HospitalNo. 1616 Yanxiang Road, Xi’an 710061, Shaanxi, China
| | - Zhibin Li
- Department of Obstetrics, Northwest Women’s and Children’s HospitalNo. 1616 Yanxiang Road, Xi’an 710061, Shaanxi, China
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Yu R, Kong X, Li Y. Optimizing the Diagnostic Algorithm for Pulmonary Embolism in Acute COPD Exacerbation Using Fuzzy Rough Sets and Support Vector Machine. COPD 2023; 20:1-8. [PMID: 36594682 DOI: 10.1080/15412555.2022.2139671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Aiming to optimize the diagnosis of pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), we conducted a retrospective study enrolling 185 AECOPD patients, of whom 90 were diagnosed with PE based on computed tomography pulmonary angiography (CTPA). Ten characteristic indicators and 27 blood indicators were extracted for each patient. First, we quantified the importance of each indicator for diagnosing PE in AECOPD using fuzzy rough sets (FRS) and selected the more important indicators to construct a support vector machine (SVM) diagnosis model called FRS-SVM. The performance of the proposed diagnosis model on the test sets was compared to that of the logistic regression model. The average accuracy and area under the curve (AUC) of the proposed model for the test sets in 10 independent trials were 94.67% and 0.944, respectively, compared to 80.41% and 0.809 for the logistic regression model. Thus, we validated the higher accuracy and stability of the FRS-SVM for PE diagnosis in patients with AECOPD. This model improved the prediction probability before CTPA and can be used in clinical practice to help doctors make decisions.
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Affiliation(s)
- Rui Yu
- Department of the Fifth Tuberculosis, Chongqing Public Health Medical Center, Chongqing, China
| | - Xianghua Kong
- Department of the Fifth Tuberculosis, Chongqing Public Health Medical Center, Chongqing, China
| | - Youlun Li
- Department of Pulmonary and Critical care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Xie Y, Zhang T, Su R, Liu L, Jiang L, Xue H, Gao C, Li X, Wang C. Increased serum soluble interleukin-2 receptor levels in dermatomyositis are associated with Th17/Treg immune imbalance. Clin Exp Med 2023; 23:3605-3617. [PMID: 37528249 DOI: 10.1007/s10238-023-01155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
Dermatomyositis (DM) represents a multifaceted chronic inflammatory myopathy, primarily manifesting as progressive deterioration of muscular and cutaneous tissues. Despite an incomplete comprehension of DM's etiology and pathogenesis, current evidence implicates the involvement of T lymphocyte infiltration, extensive cytokine release, myositis-specific antibodies, and myositis-associated antibodies in disease development. Serum soluble interleukin-2 receptor (sIL-2R) frequently serves as a marker for T cell activation; however, its role remains elusive. Consequently, this investigation sought to elucidate the association between sIL-2R levels, peripheral blood lymphocyte subset counts, and related cytokines in DM patients, with the aim of uncovering the intricate mechanisms underlying DM and establishing a theoretical foundation for the implementation of precise, targeted, individualized immunomodulatory therapy. In this study, a cohort of 60 dermatomyositis (DM) patients, comprising 32 with inactive DM and 28 with active DM, was enrolled and stratified into inactive and active groups based on the Myositis Disease Activity Visual Analogue Scale (MYOACT). Flow cytometry was employed to quantify the absolute counts of peripheral lymphocyte subsets and CD4+T cell subsets in each group, while a flow cytometry bead array was utilized to measure serum cytokine levels. In a comparative analysis between healthy individuals and patients diagnosed with DM, we observed a marked elevation in serum sIL-2R concentrations (P < 0.001) and T-helper 17 cell/regulatory T cell (Th17/Treg) ratios (P < 0.01) within the latter group. A positive correlation was identified between serum sIL-2R levels and various parameters, including ESR, CRP, VAS, AST, CKMB, LDH, HBDH, PT, APTT, DDi, IL-6, IL-10, and IFN-γlevels (P < 0.05). In contrast, serum sIL-2R levels demonstrated a negative correlation with LY, HGB, ALB, Th17 cell populations, and Th17/Treg cell ratios (P < 0.05). Employing multivariate logistic regression, we identified serum sIL-2R concentrations as an independent risk factor for both disease activity and hepatic involvement in DM patients. Moreover, receiver operating characteristic (ROC) curve analyses revealed that serum sIL-2R levels significantly contributed to the differentiation of disease activity and the detection of liver involvement in DM patients, with areas under the ROC curve (AUC) of 0.757 (95% CI 0.630-0.884, P = 0.001) and 0.826 (95% CI 0.717-0.935, P < 0.001), respectively. This study highlights the potential utility of serum sIL-2R levels as a valuable biomarker for assessing disease activity and liver involvement in dermatomyositis. Elevated serum concentrations of sIL-2R were observed in patients with DM, exhibiting significant associations with Th17 cell populations and Th17/ Treg ratios. These findings indicate that sIL-2R may be implicated in the immunopathogenesis of DM, thereby warranting further investigation to elucidate its role in the disease process.
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Affiliation(s)
- Yuhuan Xie
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Immunomicroecology, Taiyuan, Shanxi, China
| | - Tingting Zhang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Immunomicroecology, Taiyuan, Shanxi, China
| | - Rui Su
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Immunomicroecology, Taiyuan, Shanxi, China
| | - Lu Liu
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Immunomicroecology, Taiyuan, Shanxi, China
| | - Lei Jiang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Immunomicroecology, Taiyuan, Shanxi, China
| | - Hongwei Xue
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Immunomicroecology, Taiyuan, Shanxi, China
| | - Chong Gao
- Pathology, Joint Program in Transfusion Medicine, Brigham and Women's Hospital/Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xiaofeng Li
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Shanxi Key Laboratory of Immunomicroecology, Taiyuan, Shanxi, China
| | - Caihong Wang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
- Shanxi Key Laboratory of Immunomicroecology, Taiyuan, Shanxi, China.
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11
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Xiao J, Zhou F, Zhao Z, Cao F, Xiao H, Zhang L, Chen H, Wang K, Zhang A. PDCD5 as a Potential Biomarker for Improved Prediction of the Incidence and Remission for Patients with Rheumatoid Arthritis. Rheumatol Ther 2023; 10:1369-1383. [PMID: 37528307 PMCID: PMC10468452 DOI: 10.1007/s40744-023-00587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) often involves an altered T-cell subpopulation, higher levels of inflammatory cytokines, and auto-antibodies. This study investigated whether PDCD5 could be a biomarker to predict the incidence and remission of RA so as to guide the therapeutic management of clinical RA. METHODS One hundred fifty-two patients (41 being in both active status and stable remission status) who were newly diagnosed with RA and 38 healthy controls were enrolled. Basic clinical data were collected before using blood samples remaining in the clinic after routine complete blood count. The ability of PDCD5 and important indicators to predict the remission of RA was estimated based on receiver operating characteristic curve (ROC) analysis. RESULTS PDCD5 expression was found to be significantly increased in RA patients in active status in comparison with healthy controls or those in stable remission status. Compared with anti-CCP, ESR and DAS28 score, PDCD5 was of better predictive value with an AUC of 0.846 (95% CI 0.780-0.912) for RA remission. The incidence risk of RA increased with higher levels of PDCD5 (OR = 1.73, 95% CI = 1.45-1.98, P = 0.005) in multiple logistic regression analysis, with the risk increasing by 2.94-times for high-risk group in comparison with low-risk group (OR = 2.94, 95% CI = 2.35-4.62, P < 0.001). The association between PDCD5 and RA remission showed a similar result. For correlation analysis, significant associations were eventually found between PDCD5 and indicated genes (FOXP3, TNF-α, IL-17A, IFN-γ and IL-6) as well as several important clinical parameters including IgG, RF, CRP, ESR, anti-CCP and DAS28 score. CONCLUSIONS This study suggested that increased PDCD5 expression was significantly linked to the incidence and remission of RA. PDCD5 may be used as a novel biomarker for the prediction of RA incidence and remission, especially due to its potential involvement in the development of the condition.
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Affiliation(s)
- Juan Xiao
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Medical College, Hubei University of Arts and Science, 296 Longzhong Road, Xiangyang, 441053, Hubei, China
| | - Fengqiao Zhou
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Medical College, Hubei University of Arts and Science, 296 Longzhong Road, Xiangyang, 441053, Hubei, China
| | - Zhenwang Zhao
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Medical College, Hubei University of Arts and Science, 296 Longzhong Road, Xiangyang, 441053, Hubei, China
| | - Fengsheng Cao
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Medical College, Hubei University of Arts and Science, 296 Longzhong Road, Xiangyang, 441053, Hubei, China
| | - Hong Xiao
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Medical College, Hubei University of Arts and Science, 296 Longzhong Road, Xiangyang, 441053, Hubei, China
| | - Lu Zhang
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Medical College, Hubei University of Arts and Science, 296 Longzhong Road, Xiangyang, 441053, Hubei, China
| | - Huabo Chen
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Medical College, Hubei University of Arts and Science, 296 Longzhong Road, Xiangyang, 441053, Hubei, China
| | - Ke Wang
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
- Medical College, Hubei University of Arts and Science, 296 Longzhong Road, Xiangyang, 441053, Hubei, China.
| | - Anbing Zhang
- Department of Rheumatology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, 136 Jinzhou Street, Xiangyang, 441021, Hubei, China.
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12
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Gerencer M, McGuffin LJ. Are the integrin binding motifs within SARS CoV-2 spike protein and MHC class II alleles playing the key role in COVID-19? Front Immunol 2023; 14:1177691. [PMID: 37492575 PMCID: PMC10364474 DOI: 10.3389/fimmu.2023.1177691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/22/2023] [Indexed: 07/27/2023] Open
Abstract
The previous studies on the RGD motif (aa403-405) within the SARS CoV-2 spike (S) protein receptor binding domain (RBD) suggest that the RGD motif binding integrin(s) may play an important role in infection of the host cells. We also discussed the possible role of two other integrin binding motifs that are present in S protein: LDI (aa585-587) and ECD (661-663), the motifs used by some other viruses in the course of infection. The MultiFOLD models for protein structure analysis have shown that the ECD motif is clearly accessible in the S protein, whereas the RGD and LDI motifs are partially accessible. Furthermore, the amino acids that are present in Epstein-Barr virus protein (EBV) gp42 playing very important role in binding to the HLA-DRB1 molecule and in the subsequent immune response evasion, are also present in the S protein heptad repeat-2. Our MultiFOLD model analyses have shown that these amino acids are clearly accessible on the surface in each S protein chain as monomers and in the homotrimer complex and bind to HLA-DRB1 β chain. Therefore, they may have the identical role in SARS CoV-2 immune evasion as in EBV infection. The prediction analyses of the MHC class II binding peptides within the S protein have shown that the RGD motif is present in the core 9-mer peptide IRGDEVRQI within the two HLA-DRB1*03:01 and HLA-DRB3*01.01 strong binding 15-mer peptides suggesting that RGD motif may be the potential immune epitope. Accordingly, infected HLA-DRB1*03:01 or HLA-DRB3*01.01 positive individuals may develop high affinity anti-RGD motif antibodies that react with the RGD motif in the host proteins, like fibrinogen, thrombin or von Willebrand factor, affecting haemostasis or participating in autoimmune disorders.
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Affiliation(s)
| | - Liam J. McGuffin
- School of Biological Sciences, University of Reading, Reading, United Kingdom
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13
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Wang Q, Dai SM. An interaction between the inflammatory condition and the hypercoagulable condition occurs in primary Sjögren syndrome. Clin Rheumatol 2023; 42:1107-1112. [PMID: 36622518 DOI: 10.1007/s10067-022-06498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023]
Abstract
This study aimed to assess the D-dimer level in patients with primary Sjögren syndrome (pSS), uncover its relationship with clinical symptoms, and appraise its predictive value in discriminating disease activity. The laboratory parameters of 101 consecutive patients with pSS and 101 healthy controls were analyzed and compared. Patients were divided into two subgroups according to their D-dimer levels, for the comparison of clinical features. Pearson's correlations were used to measure the relationships between D-dimer levels and other variables. The area under the curve (AUC) was calculated to predict disease activity. The erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hsCRP) level, and D-dimer level were each higher in patients with pSS than in healthy controls. Compared with the low-D-dimer-level patients, those with elevated D-dimer levels exhibited higher ESRs (p < 0.0001) and higher levels of hsCRP (p < 0.0001), fibrinogen (p < 0.0001), and immunoglobulin A (p = 0.002). Cases with elevated D-dimer levels were prone to be more severe, based on ESSDAI evaluation (p < 0.0001). Patients with higher D-dimer levels had more articular involvement (p < 0.0001), which was significantly correlated with both the ESR (r = 0.21, p = 0.03) and hsCRP level (r = 0.56, p = 0.001). The D-dimer level may help to discriminate low disease activity from moderate/high disease activity (AUC = 0.754). The D-dimer level was correlated positively with both the ESR and hsCRP level in patients with pSS. The ESR and levels of hsCRP, fibrinogen, and disease activity were higher in the elevated D-dimer level group. The D-dimer level was demonstrated to have predictive value in differentiating pSS disease activity. Key Points •D-Dimer was higher in patients with pSS. •D-Dimer may help for predicting the disease activity in patients with pSS.
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Affiliation(s)
- Qian Wang
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medcine, 600 Yishan Road, 200233, Shanghai, China
| | - Sheng-Ming Dai
- Department of Rheumatology and Immunology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medcine, 600 Yishan Road, 200233, Shanghai, China.
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14
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Prada P, Brunel B, Moulin D, Rouillon L, Netter P, Loeuille D, Slimano F, Bouche O, Peyrin-Biroulet L, Jouzeau JY, Piot O. Identification of circulating biomarkers of Crohn's disease and spondyloarthritis using Fourier transform infrared spectroscopy. JOURNAL OF BIOPHOTONICS 2023; 16:e202200200. [PMID: 36112612 DOI: 10.1002/jbio.202200200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 06/15/2023]
Abstract
Crohn's disease (CD) and spondyloarthritis (SpA) are two inflammatory diseases sharing many common features (genetic polymorphism, armamentarium). Both diseases lack diagnostic markers of certainty. While the diagnosis of CD is made by a combination of clinical, and biological criteria, the diagnosis of SpA may take several years to be confirmed. Based on the hypothesis that CD and SpA alter the biochemical profile of plasma, the objective of this study was to evaluate the analytical capability of Fourier transform infrared spectroscopy (FTIR) in identifying spectral biomarkers. Plasma from 104 patients was analyzed. After data processing of the spectra by Extended Multiplicative Signal Correction and linear discriminant analysis, we demonstrated that it was possible to distinguish CD and SpA from controls with an accuracy of 97% and 85% respectively. Spectral differences were mainly associated with proteins and lipids. This study showed that FTIR analysis is efficient to identify plasma biosignatures specific to CD or SpA.
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Affiliation(s)
- Pierre Prada
- EA7506-BioSpectroscopie Translationnelle (BioSpecT), Université de Reims Champagne-Ardenne, Reims, France
| | - Benjamin Brunel
- EA7506-BioSpectroscopie Translationnelle (BioSpecT), Université de Reims Champagne-Ardenne, Reims, France
- FEMTO-ST Institute, CNRS UMR-6174, Université de Bourgogne Franche-Comté, Besançon, France
| | - David Moulin
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, Université de Lorraine et Hôpital Universitaire de Nancy, Nancy, France
| | - Lise Rouillon
- EA7506-BioSpectroscopie Translationnelle (BioSpecT), Université de Reims Champagne-Ardenne, Reims, France
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, Université de Lorraine et Hôpital Universitaire de Nancy, Nancy, France
| | - Damien Loeuille
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, Université de Lorraine et Hôpital Universitaire de Nancy, Nancy, France
| | - Florian Slimano
- EA7506-BioSpectroscopie Translationnelle (BioSpecT), Université de Reims Champagne-Ardenne, Reims, France
| | - Olivier Bouche
- EA7506-BioSpectroscopie Translationnelle (BioSpecT), Université de Reims Champagne-Ardenne, Reims, France
| | - Laurent Peyrin-Biroulet
- Département de Gastroentérologie, Hôpital Universitaire de Nancy-Brabois, Vandœuvre-lès-Nancy, France
| | - Jean-Yves Jouzeau
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, Université de Lorraine et Hôpital Universitaire de Nancy, Nancy, France
| | - Olivier Piot
- EA7506-BioSpectroscopie Translationnelle (BioSpecT), Université de Reims Champagne-Ardenne, Reims, France
- Plateforme d'Imagerie Cellulaire ou Tissulaire (PICT), Université de Reims Champagne-Ardenne, Reims, France
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15
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Shao Y, Du J, Song Y, Li Y, Jing L, Gong Z, Duan R, Yao Y, Jia Y, Jiao S. Elevated plasma D-dimer levels in patients with anti-N-methyl-D-aspartate receptor encephalitis. Front Neurol 2022; 13:1022785. [PMID: 36457866 PMCID: PMC9707621 DOI: 10.3389/fneur.2022.1022785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/02/2022] [Indexed: 05/22/2024] Open
Abstract
PURPOSE We aimed to explore the difference in coagulation function between healthy individuals and patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis and its relationship with disease severity. METHODS We retrospectively compared coagulation function in 161 patients with first-attack anti-NMDAR encephalitis and 178 healthy individuals. The association between D-dimer levels and disease severity was analyzed using binary logistic regression. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of D-dimer levels for the severity of anti-NMDAR encephalitis. RESULTS Compared to control individuals, patients with anti-NMDAR encephalitis had higher D-dimer levels (median 0.14 vs. 0.05 mg/L, p < 0.001), blood white blood cell (WBC) count (median 8.54 vs. 5.95 × 109/L, p < 0.001), and neutrophil count (median 6.14 vs. 3.1 × 109/L, p < 0.001). D-dimers (median 0.22 vs. 0.10 mg/L, p < 0.001), blood WBC count (median 9.70 vs. 7.70 × 109/L, p < 0.001), neutrophil count (median 7.50 vs. 4.80 × 109/L, p < 0.001), and C-reactive protein (median 2.61 vs. 1.50 mg/l, p = 0.017) were higher; however, eosinophils (median 0.02 vs. 0.06 × 109/L, p < 0.001), and blood calcium (median 2.26 vs. 2.31 mmol/L, p = 0.003) were lower in patients with severe forms of anti-NMDAR encephalitis than in those with mild to moderate forms, and were associated with initial modified Rankin Scale scores. Multivariate analysis showed that D-dimer levels were significantly associated with severity [odds ratio =2.631, 95% confidence interval (CI) = 1.018-6.802, p = 0.046]. The ROC curve was used to analyze the predictive value of D-dimer levels for disease severity. The area under the curve was 0.716 (95% CI = 0.64-0.80, p < 0.001), and the best cut-off value was D-dimer = 0.147 mg/L (sensitivity 0.651; specificity, 0.705). CONCLUSION Serum D-dimer and neutrophil levels were independent predictors of disease severity in patients with first-attack anti-NMDAR encephalitis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shujie Jiao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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16
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Weitz JI, Szekanecz Z, Charles-Schoeman C, Vranic I, Sahin B, Paciga SA, Wang Z, Hyde C, Martin DA. Biomarkers to predict risk of venous thromboembolism in patients with rheumatoid arthritis receiving tofacitinib or tumour necrosis factor inhibitors. RMD Open 2022; 8:rmdopen-2022-002571. [PMID: 36323490 PMCID: PMC9639150 DOI: 10.1136/rmdopen-2022-002571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE In the ORAL (Oral Rheumatoid Arthritis triaL) Surveillance study of patients with rheumatoid arthritis aged ≥50 years with ≥1 additional cardiovascular risk factor, incidence of pulmonary embolism was higher with tofacitinib 10 mg two times per day than with tumour necrosis factor inhibitors (TNFi). This exploratory post hoc analysis examined whether biomarkers explained the associations of tofacitinib versus TNFi with venous thromboembolism (VTE). METHODS ORAL Surveillance was a prospective, open-label, event-driven, non-inferiority, postauthorisation safety study. Patients were randomised 1:1:1 to receive tofacitinib 5 mg or 10 mg two times per day or a TNFi. For this analysis, 294 soluble, proteomic, genetic and antibody biomarkers (of which 79 had a known role in inflammation, coagulation, vascular biology or Janus kinase signalling) were quantified in serum collected at baseline, month 12 and study end. RESULTS Overall, 4362 patients were randomised and treated. The exploratory biomarker data set included 285 patients (57 VTE cases; 228 matched controls). D-dimer was quantified in 3732 patients (54 VTE cases; 3678 controls). No biomarker demonstrated a clear mechanistic association with the increased risk of VTE for tofacitinib versus TNFi. Month 12 D-dimer levels were positively associated with risk of a subsequent VTE within the tofacitinib 5 mg and 10 mg two times per day arms. CONCLUSIONS Overall, this post hoc analysis did not identify biomarkers that explained the increased VTE risk for tofacitinib versus TNFi. Individual VTE risk should be considered when making decisions about initiation or maintenance of tofacitinib treatment. TRIAL REGISTRATION NUMBER NCT02092467; ClinicalTrials.gov.
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Affiliation(s)
- Jeffrey I Weitz
- McMaster University, Hamilton, Ontario, Canada,The Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Christina Charles-Schoeman
- Division of Rheumatology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Burak Sahin
- Immunology & Inflammation Medical Affairs, Pfizer Inc, Istanbul, Turkey
| | | | - Zhenyu Wang
- Immunology & Inflammation Research, Pfizer Inc, Cambridge, Massachusetts, USA
| | - Craig Hyde
- Biostatistics, Pfizer Inc, Groton, Connecticut, USA
| | - David A Martin
- Immunology & Inflammation Research, Pfizer Inc, Cambridge, Massachusetts, USA
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17
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Chen S, Zheng H, Zhang L, Xu Q, Lin C. Case report: Joint deformity associated with systemic lupus erythematosus. Immun Inflamm Dis 2022; 10:e717. [PMID: 36169251 PMCID: PMC9517061 DOI: 10.1002/iid3.717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Typically, Jaccoud arthropathy (JA) is characterized by joint deformation without bone erosion. However, some recent studies have shown that bone erosion also occurs in JA; however, this remains controversial. To date, there have been no unified diagnostic standards for JA. Herein, we report a case of systemic lupus erythematosus complicated with JA without bone erosion. METHODS A 27-year-old woman was admitted to our department with a 2-year history of pain, swelling, and progressive deformities of her hands and feet. She was diagnosed with systemic lupus erythematosus and class V lupus nephritis 5 years prior. Upon examination, her erythrocyte sedimentation rate and C-reactive protein levels were found to be increased. She was positive for antinuclear antibodies, antidouble stranded DNA antibodies, and antiextractable nuclear antigen antibodies, with a decreased complement C3 and C4. Radiography and magnetic resonance imaging revealed no bone erosion. The patient was diagnosed with JA. She was treated with oral prednisone (10 mg daily), tofacitinib (5 mg twice daily), methotrexate (10 mg weekly), and celecoxib (0.2 g twice daily). RESULTS The patient's joint symptoms improved after treatment. No further progress was observed during the 4-month follow-up period. CONCLUSION We believe that bone erosion is the key to distinguish rhupus syndrome from JA. However, this needs to be confirmed with further long-term follow-up studies. We found that the use tofacitinib, MTX, and celecoxib in combination with prednisone may be an effective regimen for the treatment of JA.
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Affiliation(s)
- Shu‐Lin Chen
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Hui‐Juan Zheng
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Li‐Yu Zhang
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Qiang Xu
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
| | - Chang‐Song Lin
- Department of RheumatologyThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
- The First Clinical Medicine SchoolGuangzhou University of Chinese MedicineGuangzhouChina
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