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Seringec Akkececi N, Ciftcioglu M, Okyar B, Yildirim Cetin G. Relationship of immature granulocytes with disease activity in rheumatoid arthritis. Int J Rheum Dis 2024; 27:e15216. [PMID: 38873756 DOI: 10.1111/1756-185x.15216] [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: 03/28/2024] [Revised: 05/03/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
AIM To determine whether the IG count (#) and IG percentage (%) are associated with disease activity in rheumatoid arthritis (RA). METHODS This retrospective study included 65 RA patients and 65 healthy controls. Clinical and demographic characteristics of controls and RA patients (at active period and when the patients achieved remission) were obtained from medical records. Disease activity was defined by disease activity score 28 (DAS28). Furthermore, the clinical disease activity index (CDAI), and simple disease activity index (SDAI) were calculated. For the differential diagnosis of RA patients from healthy controls, the cut-off value was estimated by making receiver-operator curves (ROC). RESULTS In active RA patients, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), IG#, and IG% levels were significantly higher compared to the healthy controls (p < .001, for all). When the patients achieved remission, DAS28, CDAI, SDAI, ESR, CRP, IG#, and IG% values were significantly decreased (p < .001, for all). IG# and IG% were significantly positively correlated with DAS28, CDAI, SDAI, ESR, and CRP (p = .024, p = .008, p = .003, p < .001, p < .001, respectively). According to ROC curve analysis, IG% and IG# were the biomarkers to have a significant diagnostic value for RA with the area under the curve of 0.853 and 0.865 (p < .001, for all). CONCLUSION The present study demonstrated that two novel inflammatory markers, IG# and IG%, can be useful for monitoring RA patients' disease activity. Furthermore, IG# and IG% can also be used as fast, inexpensive, and easily available complementary diagnostic markers to diagnose RA patients.
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Affiliation(s)
- Nurten Seringec Akkececi
- Department of Physiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Muhammed Ciftcioglu
- Department of Internal Medicine, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Burak Okyar
- Department of Rheumatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Gozde Yildirim Cetin
- Department of Rheumatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Sagerfors M, Reiser D. Massive Osteolysis and Pseudotumor Formation following Maestro Total Wrist Arthroplasty. Case Rep Orthop 2024; 2024:1301778. [PMID: 38469075 PMCID: PMC10927346 DOI: 10.1155/2024/1301778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/27/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
Metallosis is a known complication of arthroplasty and has been reported for the hip, knee, and shoulder joints. Metallosis pseudotumors have been linked to an increased risk of implant failure. We report a case of pseudotumor with massive bone loss following total wrist arthroplasty (TWA) using the Maestro implant. Revision to arthrodesis is possible, but issues with bone loss have to be addressed. We recommend caution in offering TWA to young patients with high functional demands.
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Affiliation(s)
- Marcus Sagerfors
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
| | - Daniel Reiser
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
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Shimizu Y, Ntege EH, Azuma C, Uehara F, Toma T, Higa K, Yabiku H, Matsuura N, Inoue Y, Sunami H. Management of Rheumatoid Arthritis: Possibilities and Challenges of Mesenchymal Stromal/Stem Cell-Based Therapies. Cells 2023; 12:1905. [PMID: 37508569 PMCID: PMC10378234 DOI: 10.3390/cells12141905] [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: 05/06/2023] [Revised: 06/28/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Rheumatoid arthritis (RA) is a highly prevalent, chronic, and progressive autoimmune disorder primarily affecting joints and muscles. The associated inflammation, pain, and motor restriction negatively impact patient quality of life (QOL) and can even contribute to premature mortality. Further, conventional treatments such as antiinflammatory drugs are only symptomatic. Substantial progress has been made on elucidating the etiopathology of overt RA, in particular the contributions of innate and adaptive immune system dysfunction to chronic inflammation. Although the precise mechanisms underlying onset and progression remain elusive, the discovery of new drug targets, early diagnosis, and new targeted treatments have greatly improved the prognosis and QOL of patients with RA. However, a sizable proportion of patients develop severe adverse effects, exhibit poor responses, or cannot tolerate long-term use of these drugs, necessitating more effective and safer therapeutic alternatives. Mounting preclinical and clinical evidence suggests that the transplantation of multipotent adult stem cells such as mesenchymal stromal/stem cells is a safe and effective treatment strategy for controlling chronic inflammation and promoting tissue regeneration in patients with intractable diseases, including RA. This review describes the current status of MSC-based therapies for RA as well as the opportunities and challenges to broader clinical application.
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Affiliation(s)
- Yusuke Shimizu
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara 903-0215, Japan
| | - Edward Hosea Ntege
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara 903-0215, Japan
| | - Chinatsu Azuma
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara 903-0215, Japan
| | - Fuminari Uehara
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara 903-0215, Japan
| | - Takashi Toma
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara 903-0215, Japan
| | - Kotaro Higa
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara 903-0215, Japan
| | - Hiroki Yabiku
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara 903-0215, Japan
| | - Naoki Matsuura
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara 903-0215, Japan
| | - Yoshikazu Inoue
- Department of Plastic and Reconstructive Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Hiroshi Sunami
- Center for Advanced Medical Research, School of Medicine, University of the Ryukyus, Nishihara 903-0215, Japan
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Tužil J, Mlčoch T, Závada J, Svoboda M, Pavelka K, Doležal T. Time in remission as an alternative outcome measure for rheumatoid arthritis: a 10-year prospective study of 2618 new users of anti-TNF. Rheumatology (Oxford) 2022; 61:2295-2306. [PMID: 34599798 DOI: 10.1093/rheumatology/keab737] [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: 06/28/2021] [Revised: 09/20/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Achieving targeted disease activity (DA) is the primary therapeutic strategy in RA. Point measurements of DA are done at out-patient visits, however true DA between visits remains unobserved. This study sought to describe and validate a new outcome measure, i.e. time in remission (TIR). METHODS Patients were enrolled in the Czech ATTRA-RA registry. TIR was calculated using linear interpolation of the DAS28-ESR determined at outpatient visits. Correlation coefficients were computed between TIR and DAS28-CRP, HAQ, Simple Disease Activity Index (SDAI), patient global assessment (PGA) and physician global assessment (PhGA). Using logistic regression, TIR was used as a predictor of remission (SDAI ≤3.3) and non-disability (HAQ <0.5). The predictive value of TIR was compared with point and sustained remission using the cross-validated area under receiver-operating curves. RESULTS Since 2010, 2618 RA patients started anti-TNF therapy and were followed until 2020 or until treatment discontinuation. During the first 6 months of therapy, 56% of patients had no remission (TIR = 0), and 22% of patients reached sustained remission (TIR = 1), while 22% of patients had point remissions with 0 < TIR < 1. EULAR good responders and moderate/non-responders spent 64 ± 42% and 6 ± 18% of time in remission, respectively. The mean TIR grew during the follow-up and was correlated with DAS28-CRP, SDAI, HAQ, PGA, and PhGA (P < 0.0001). TIR at 3 and 6 months predicted remission (SDAI ≤3.3) and non-disability (HAQ <0.5) at 13 and 19 months better than point or sustained remission. CONCLUSIONS TIR is an intuitive way of estimating unobserved DA between scheduled visits; its calculation only requires two consecutive DA values (https://www.medevio.cz/tir-calculator/). TIR is a valid predictor of RA outcomes.
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Affiliation(s)
- Jan Tužil
- Institute of Health Economics and Technology Assessment.,1st Faculty of Medicine, Charles University in Prague
| | - Tomáš Mlčoch
- Institute of Health Economics and Technology Assessment
| | - Jakub Závada
- 1st Faculty of Medicine, Charles University in Prague.,Institute of Rheumatology, Prague
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Ltd, Spinoff Company of the Faculty of Medicine of the Masaryk University, Brno
| | - Karel Pavelka
- 1st Faculty of Medicine, Charles University in Prague.,Institute of Rheumatology, Prague
| | - Tomáš Doležal
- Institute of Health Economics and Technology Assessment.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Brooks R, Baker JF, Yang Y, Roul P, Kerr GS, Reimold AM, Kunkel G, Wysham KD, Singh N, Lazaro D, Monach PA, Poole JA, Ascherman DP, Mikuls TR, England BR. The impact of disease severity measures on survival in U.S. veterans with rheumatoid arthritis-associated interstitial lung disease. Rheumatology (Oxford) 2022; 61:4667-4677. [PMID: 35377443 PMCID: PMC9960484 DOI: 10.1093/rheumatology/keac208] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/26/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To determine whether RA and interstitial lung disease (ILD) severity measures are associated with survival in patients with RA-ILD. METHODS We studied US veterans with RA-ILD participating in a multicentre, prospective RA cohort study. RA disease activity (28-joint DAS [DAS28-ESR]) and functional status (multidimensional HAQ [MDHAQ]) were collected longitudinally while pulmonary function tests (forced vital capacity [FVC], diffusing capacity for carbon monoxide) were obtained from medical records. Vital status and cause of death were determined from the National Death Index and administrative data. Predictors of death were assessed using multivariable Cox regression models adjusting for age, sex, smoking status, ILD duration, comorbidity burden and medications. RESULTS We followed 227 RA-ILD participants (93% male and mean age of 69 years) over 1073 person-years. Median survival after RA-ILD diagnosis was 8.5 years. Respiratory diseases (28%) were the leading cause of death, with ILD accounting for 58% of respiratory deaths. Time-varying DAS28-ESR (adjusted hazard ratio [aHR] 1.21; 95% CI: 1.03, 1.41) and MDHAQ (aHR 1.85; 95% CI: 1.29, 2.65) were separately associated with mortality independent of FVC and other confounders. Modelled together, the presence of either uncontrolled disease activity (moderate/high DAS28-ESR) or FVC impairment (<80% predicted) was significantly associated with mortality risk. Those with a combination of moderate/high disease activity and FVC <80% predicted had the highest risk of death (aHR 4.43; 95% CI: 1.70, 11.55). CONCLUSION Both RA and ILD disease severity measures are independent predictors of survival in RA-ILD. These findings demonstrate the prognostic value of monitoring the systemic features of RA-ILD.
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Affiliation(s)
- Rebecca Brooks
- VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Joshua F Baker
- Corporal Michael J. Crescenz VA and Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | - Yangyuna Yang
- VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Punyasha Roul
- VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Gail S Kerr
- Division of Rheumatology, Washington DC VA, Howard University and Georgetown University, Washington, DC
| | - Andreas M Reimold
- Dallas VA and Division of Rheumatic Diseases, University of Texas Southwestern, Dallas, TX
| | - Gary Kunkel
- VA Salt Lake City and Division of Rheumatology, University of Utah, Salt Lake City, UT
| | - Katherine D Wysham
- VA Puget Sound Health Care System and Division of Rheumatology, University of Washington, Seattle, WA
| | - Namrata Singh
- VA Puget Sound Health Care System and Division of Rheumatology, University of Washington, Seattle, WA
| | | | | | - Jill A Poole
- Division of Allergy & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Dana P Ascherman
- Pittsburgh VA and Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ted R Mikuls
- VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, Omaha, NE
| | - Bryant R England
- Correspondence to: Bryant R. England, VA Nebraska-Western Iowa Health Care System and Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA. E-mail:
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Onder ME, Orucoglu N, Omar F, Canataroglu A. C-Reactive Protein-to-Albumin Ratio: A Novel Inflammatory Marker and
Disease Activity Sign in Early Rheumatoid Arthritis. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1653-1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Objective A novel inflammation-based score, C-reactive protein
(CRP)-to-albumin ratio (CAR), has been shown to have an association with the
inflammatory status in several diseases. We aimed to analyse the association
between CAR and disease activity in patients with early rheumatoid arthritis
(RA) and to determine the cut-off value of CAR in early and established RA.
Methods A total of 177 patients with RA and 111 age and gender-matched
healthy controls were included in this study. Cases with a disease duration of
less than 1 year were classified as early RA. Serum albumin, CRP, erythrocyte
sedimentation rate (ESR), Disease Activity Score-28 (DAS-28-ESR), Clinical
Disease Activity Index (CDAI) and Health Assessment Questionnaire (HAQ) scores
were recorded.
Results CAR was 2.44 (0.21–30.83) in the RA group and 0.45
(0.21–10.47) in the control group (p<0.001). Eighty-seven
(49.15%) of the RA cases were classified as early RA. The analyses
indicated that the ESR, CRP and CAR values were higher in patients with early RA
than in those with established RA and controls. CAR was correlated with albumin,
CRP, ESH, DAS-28 and HAQ scores in both early RA and established RA groups. The
receiver operating characteristic curves revealed a CAR cut-off value of 2.67
(80% sensitivity and 85% specificity) and 1.63 (77%
sensitivity and 72% specificity) for the prediction of early and
established RA, respectively.
Conclusion CAR, a formulated ratio, has been described as a predictor for
disease activity in patients with early RA as well as in those with established
RA. However, CAR has higher sensitivity and specificity for early RA than for
established RA.
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Affiliation(s)
| | - Nurdan Orucoglu
- Rheumatology, Mersin University Faculty of Medicine, Mersin,
Turkey
| | - Firat Omar
- Rheumatology, Mersin University Faculty of Medicine, Mersin,
Turkey
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Rydholm M, Wikström I, Hagel S, Jacobsson LTH, Turesson C. The Relation Between Disease Activity, Patient-Reported Outcomes, and Grip Force Over Time in Early Rheumatoid Arthritis. ACR Open Rheumatol 2019; 1:507-515. [PMID: 31777832 PMCID: PMC6857997 DOI: 10.1002/acr2.11062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/08/2019] [Indexed: 12/28/2022] Open
Abstract
Objective The objective of this study is to identify early predictors of future reduced grip force in patients with rheumatoid arthritis (RA) and to identify early predictors of grip force over time. Methods In a structured follow‐up of an inception cohort of patients with early RA, average grip force values of the dominant hand were evaluated and compared with the expected based on age‐ and sex‐specific reference values. Potential predictors of reduced grip force (less than 50% of expected) at 5 years were examined using logistic regression. Differences in percentage of expected grip force values over the study period and differences in change over time, by baseline disease parameters, were estimated using mixed linear‐effects models. Results Among 200 patients with early RA, 44% had reduced grip force 5 years after diagnosis. Baseline characteristics that predicted reduced grip force at 5 years included high scores for the Health Assessment Questionnaire Disability Index (odds ratio 1.54 per SD; 95% confidence interval 1.13‐2.11), high scores for pain and patient global assessment, and low grip force. C‐reactive protein levels, the erythrocyte sedimentation rate, the 28‐joint Disease Activity Score (DAS28), rheumatoid factor, anti–cyclic citrullinated peptide antibodies, joint counts, and synovitis of individual joints in the dominant upper extremity did not predict reduced grip force. Patients with baseline synovitis of the wrist or metacarpophalangeal joints or patients with a high DAS28 had lower estimated grip force at inclusion but also greater improvement of grip force over time. Conclusion Patient‐reported outcomes predicted reduced grip strength 5 years after diagnosis. This underlines the prognostic importance of disability in early RA. Joint counts and synovitis in individual joints may change rapidly in early RA and appear to be less predictive of long‐term hand function.
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Affiliation(s)
- Maria Rydholm
- Lund University and Skåne University Hospital, Malmö, Sweden
| | | | - Sofia Hagel
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Lennart T H Jacobsson
- Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden, and Lund University, Malmö, Sweden
| | - Carl Turesson
- Lund University and Skåne University Hospital, Malmö, Sweden
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