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Sebastiani M, Manfredi A, Croci S, Faverio P, Cassone G, Vacchi C, Salvarani C, Luppi F. Rheumatoid arthritis extra-articular lung disease: new insights on pathogenesis and experimental drugs. Expert Opin Investig Drugs 2024; 33:815-827. [PMID: 38967534 DOI: 10.1080/13543784.2024.2376567] [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: 12/31/2023] [Accepted: 07/02/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Pulmonary involvement is one of the most common extra-articular manifestations of rheumatoid arthritis (RA), a systemic inflammatory disease characterized by joint swelling and tenderness. All lung compartments can be interested in the course of RA, including parenchyma, airways, and, more rarely, pleura and vasculature. AREAS COVERED The aim of this paper is to review the main RA lung manifestations, focusing on pathogenesis, clinical and therapeutic issues of RA-related interstitial lung disease (ILD). Despite an increasing number of studies in the last years, pathogenesis of RA-ILD remains largely debated and the treatment of RA patients with lung involvement is still challenging in these patients. EXPERT OPINION Management of RA-ILD is largely based on expert-opinion. Due to the broad clinical manifestations, including both joints and pulmonary involvement, multidisciplinary discussion, including rheumatologist and pulmonologist, is essential, not only for diagnosis, but also to evaluate the best therapeutic approach and follow-up. In fact, the coexistence of different lung manifestations may influence the treatment response and safety. The identification of biomarkers and risk-factors for an early identification of RA patients at risk of developing ILD remains a need that still needs to be fulfilled, and that will require further investigation in the next years.
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Affiliation(s)
- Marco Sebastiani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Rheumatology Unit, AUSL Piacenza, Piacenza, Italy
| | - Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paola Faverio
- Respiratory Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giulia Cassone
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Caterina Vacchi
- Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Reggio Emilia, Italy
- Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Luppi
- Respiratory Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Chung C, Kim H, Han K, Jung J, Eun Y, Lee H, Park J, Shin DW, Lee SW. Does Rheumatoid Arthritis Increase the Risk of COPD?: A Nationwide Retrospective Cohort Study. Chest 2024; 165:1362-1371. [PMID: 38365176 DOI: 10.1016/j.chest.2024.02.014] [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: 10/07/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Most reports of pulmonary manifestations in rheumatoid arthritis (RA) have been related to interstitial lung diseases. RA and COPD are both chronic inflammatory systemic diseases. RESEARCH QUESTION Does RA increase the risk of developing COPD? Is there a difference between seropositive and seronegative RA in the risk of COPD? STUDY DESIGN AND METHODS Using the Korean National Health Insurance Database, we screened individuals diagnosed with RA between 2010 and 2017. We identified 46,030 patients with RA (32,608 with seropositive RA and 13,422 with seronegative RA) and 230,150 matched control individuals; we monitored them until December 2019. We used multivariate Cox proportional hazard models to estimate the adjusted hazard ratio (aHR) of risk factors for the development of COPD. RESULTS The incidence of COPD among patients with RA was 5.04 per 1,000 person-years; it was 2.23 per 1,000 person-years in the control group. Patients with RA showed a higher risk of developing COPD (aHR, 2.11; 95% CI, 1.96-2.28) compared with the control group. Although both seropositive RA and seronegative RA were associated with an increased risk of COPD, patients with seropositive RA had a higher risk for the development of COPD (aHR, 1.26; 95% CI, 1.09-1.46) than patients with seronegative RA. In the subgroup analyses, smoking history did not demonstrate significant interactions between RA and COPD development. INTERPRETATION RA was shown to be associated with an increased risk of COPD development, augmented by seropositivity. Physicians should monitor respiratory symptoms and pulmonary function carefully in patients with RA.
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Affiliation(s)
- Chiwook Chung
- Department of Pulmonary and Critical Care Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung
| | - Hyungjin Kim
- Departments of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Department of Medical Humanites, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul
| | - Jinhyoung Jung
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul
| | - Yeonghee Eun
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul
| | - Junhee Park
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Bermas BL, Gerber DE. The Joint Problem of Rheumatoid Arthritis and Lung Cancer. J Thorac Oncol 2024; 19:196-198. [PMID: 38325979 DOI: 10.1016/j.jtho.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 02/09/2024]
Affiliation(s)
- Bonnie L Bermas
- Division of Rheumatology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David E Gerber
- Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas.
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Cho MH, Cho JH, Eun Y, Han K, Jung J, Cho IY, Yoo JE, Lee H, Kim H, Park SY, Shin DW. Rheumatoid Arthritis and Risk of Lung Cancer: A Nationwide Cohort Study. J Thorac Oncol 2024; 19:216-226. [PMID: 37838085 DOI: 10.1016/j.jtho.2023.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION There has been an increasing interest in the risk of lung cancer related to rheumatoid arthritis (RA). We investigated the association between RA and the risk of lung cancer with consideration of key confounding factors, including RA serostatus and smoking status. METHODS Using a nationwide database, we identified 51,899 patients with newly diagnosed RA between 2010 and 2017, which were matched by sex and age at a 1:5 ratio with 259,495 non-RA population. The association of lung cancer and RA was investigated using Cox regression analyses. Stratified analyses by smoking status, sex, age, and comorbidity of interstitial lung disease were conducted using the same Cox modeling. RESULTS During 4.5 years of follow-up, the adjusted hazard ratio of lung cancer in the patients with RA was 1.49 (95% confidence interval: 1.34-1.66). Compared with the patients with seronegative RA, an increased risk of lung cancer was not considerable in the patients with seropositive RA. In the stratified analyses, the increased risk of lung cancer was more prominent in current or previous heavy smokers with RA (interaction p value of 0.046) and male patients (interaction p < 0.001), whereas there was no substantial effect associated with age or interstitial lung disease status. CONCLUSIONS Patients with RA had an increased risk of lung cancer compared with the non-RA group, and the risk did not differ by RA serostatus. There is a need for increased awareness of smoking cessation and potentially for regular lung cancer screening with proper risk stratification in patients with RA.
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Affiliation(s)
- Mi Hee Cho
- Samsung C&T Medical Clinic, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeonghee Eun
- Division of Rheumatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jinhyoung Jung
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - In Young Cho
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyungjin Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Medical Humanities, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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Holz F, Can E, Grehn C, Klotsche J, Materne B, Kruppa J, Kallinich T, Schwarz C. Manifestation and staging of arthropathy in cystic fibrosis. Defining different stages of cystic fibrosis arthropathy using ultrasound imaging and clinical scoring. J Cyst Fibros 2023; 22:980-988. [PMID: 37150649 DOI: 10.1016/j.jcf.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The true prevalence of cystic fibrosis arthropathy (CFA) remains unclear and may be significantly higher than previously reported. In recent studies, joint symptoms have been reported in up to 30% of adults with CF. This underlines the importance of CFA as a rising and clinically relevant co-morbidity. A clear definition of CFA is yet missing and its pathogenesis remains unclear. We investigated the clinical manifestation of CFA particularly via ultrasound (US) examination to define and implement a staging for clinical assessment. METHODS In a prospective cohort study between March 2018 and February 2020 a total of 98 consecutively recruited, adult cystic fibrosis (CF) patients underwent joint-US examination according to a newly developed ultrasound score (US-CFA). A clinical assessment including rheumatological scores (DAS28, HAQ) has been conducted as well as a specially designed questionnaire. Investigation on clinical and microbiological data, as well as a comprehensive laboratory analysis, were carried out. Cluster analysis has been performed to detect patterns defining different CFA stages based on disease activity. RESULTS US imaging has shown a considerable incidence of mild to moderate effusion as sign of joint inflammation/(teno-)synovitis. K-means clustering was used to distinguish 3 different stages of CFA based on the intensity of the detected effusion. These stages showed a significant association with disease activity (DAS28, p = 0.0004) as well as with patient-reported symptoms such as total weeks of CFA per year (p = 0.004), acute CFA (p = 0.015), chronic CFA (p = 0.016), disease burden (p = 0.04). Based on the US-CFA, 16% of patients suffered from severe CFA (II), 51% from intermediate CFA (I) and 33% did not present detectable arthritis. Positive serology for Chlamydophilia pneumoniae (IgA, IgG) and Chlamydia trachomatis (IgA, IgG) significantly correlated with the US-CFA. CONCLUSIONS The results of this study show that a definition and categorization for the clinical manifestation of CFA can be described through US examination, which is able to detect disease activity concordant with the DAS28 as a validated clinical score on arthritis. Defining these stages will lead to a better understanding of the clinical phenotype of the disease and will optimize diagnosis, therapy and research on CFA in the future.
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Affiliation(s)
- F Holz
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin, Berlin, Germany.
| | - E Can
- Department of Radiology including Pediatric Radiology, Charité - Universitätsmedizin, Berlin, Germany
| | - C Grehn
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin, Berlin, Germany
| | - J Klotsche
- German Rheumatism Research Centre, Berlin, Germany
| | - B Materne
- Department of Biostatistics and Clinical Epidemiology, Charité - Universitätsmedizin, Berlin, Germany
| | - J Kruppa
- Hochschule Osnabrück, University of Applied Sciences, Germany
| | - T Kallinich
- German Rheumatism Research Centre, Berlin, Germany; Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Division of Rheumatology, Charité - Universitätsmedizin, Berlin, Germany
| | - C Schwarz
- Division Cystic Fibrosis, CF Center Westbrandenburg, Clinic Westbrandenburg, Potsdam, Germany; HMU Health and Medical University, Potsdam, Germany
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Harrington R, Harkins P, Conway R. Targeted Therapy in Rheumatoid-Arthritis-Related Interstitial Lung Disease. J Clin Med 2023; 12:6657. [PMID: 37892795 PMCID: PMC10607625 DOI: 10.3390/jcm12206657] [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: 10/02/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune multisystem inflammatory disease in which lung involvement is the most common extra-articular manifestation. Parenchymal lung involvement or interstitial lung disease (ILD) is a significant cause of morbidity and mortality and there is a paucity of evidence-based guidance on how to best treat RA-ILD. This review article aims to evaluate the evidence from cohort studies and best real word data from registries. Extensive discussion of the relative merits and drawbacks of glucocorticoids, various biologics, small molecules and anti-fibrotics is presented. The limited available guidelines in RA-ILD are also discussed and a rational treatment algorithm is offered.
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Mena-Vázquez N, Godoy-Navarrete FJ, Lisbona-Montañez JM, Redondo-Rodriguez R, Manrique-Arija S, Rioja J, Mucientes A, Ruiz-Limón P, Garcia-Studer A, Ortiz-Márquez F, Oliver-Martos B, Cano-García L, Fernández-Nebro A. Inflammatory Biomarkers in the Diagnosis and Prognosis of Rheumatoid Arthritis-Associated Interstitial Lung Disease. Int J Mol Sci 2023; 24:ijms24076800. [PMID: 37047772 PMCID: PMC10095191 DOI: 10.3390/ijms24076800] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
This study aimed to identify inflammatory factors and soluble cytokines that act as biomarkers in the diagnosis and prognosis of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). We performed a nested prospective observational case-control study of patients with RA-ILD matched by sex, age, and time since the diagnosis of RA. All participants underwent pulmonary function testing and high-resolution computed tomography. ILD was defined according to the criteria of the American Thoracic Society/European Respiratory Society; the progression of lung disease was defined as the worsening of FVC > 10% or DLCO > 15%. Inflammation-related variables included the inflammatory activity measured using the DAS28-ESR and a multiplex cytokine assay. Two Cox regression models were run to identify factors associated with ILD and the progression of ILD. The study population comprised 70 patients: 35 patients with RA-ILD (cases) and 35 RA patients without ILD (controls). A greater percentage of cases had higher DAS28-ESR (p = 0.032) and HAQ values (p = 0.003). The variables associated with RA-ILD in the Cox regression analysis were disease activity (DAS28) (HR [95% CI], 2.47 [1.17-5.22]; p = 0.017) and high levels of ACPA (HR [95% CI], 2.90 [1.24-6.78]; p = 0.014), IL-18 in pg/mL (HR [95% CI], 1.06 [1.00-1.12]; p = 0.044), MCP-1/CCL2 in pg/mL (HR [95% CI], 1.03 [1.00-1.06]; p = 0.049), and SDF-1 in pg/mL (HR [95% CI], 1.00 [1.00-1.00]; p = 0.010). The only variable associated with the progression of ILD was IL-18 in pg/mL (HR [95% CI], 1.25 [1.07-1.46]; p = 0.004). Our data support that the inflammatory activity was higher in patients with RA-ILD than RA patients without ILD. Some cytokines were associated with both diagnosis and poorer prognosis in patients with RA-ILD.
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Affiliation(s)
- Natalia Mena-Vázquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | | | - Jose Manuel Lisbona-Montañez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Málaga, Spain
| | - Rocío Redondo-Rodriguez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Málaga, Spain
| | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Málaga, Spain
| | - José Rioja
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Málaga, Spain
| | - Arkaitz Mucientes
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Patricia Ruiz-Limón
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Endocrinología y Nutrición, Hospital Clínico Virgen de la Victoria, 29010 Málaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Aimara Garcia-Studer
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Fernando Ortiz-Márquez
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Málaga, Spain
| | - Begoña Oliver-Martos
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Neurociencias, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Laura Cano-García
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
| | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, 29010 Málaga, Spain
- UGC de Reumatología, Hospital Regional Universitario de Málaga, 29009 Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, 29010 Málaga, Spain
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Selldén T, Mårdh CK, Joelsson M, Vikgren J, Johnsson Å, Larsson G, Glinatsi D, Stubendorff K, Svensson K, Gjertsson I, Rudin A, Lundell AC, Ekwall AKH. Radiographic airway abnormalities in untreated early rheumatoid arthritis are associated with peripheral neutrophil activation. Arthritis Res Ther 2023; 25:44. [PMID: 36941690 PMCID: PMC10026468 DOI: 10.1186/s13075-023-03019-5] [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: 12/09/2022] [Accepted: 02/22/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND The role of the lung for the initiation and progression of rheumatoid arthritis (RA) is still unclear. Up to 10% of RA patients develop interstitial lung disease which remains a clinical challenge. Understanding early disease mechanisms is of great importance. The objective of this study was to determine whether there is an association between peripheral neutrophil phenotypes and presence of pulmonary abnormalities (PA) on chest high-resolution computed tomography (HRCT) in untreated early RA (ueRA). METHODS Clinical data and blood were collected, and HRCT performed at diagnosis on 30 consecutive anti-citrullinated protein antibody (ACPA) and/or rheumatoid factor (RF) positive ueRA patients. HRCTs were evaluated for the presence of RA-associated parenchymal, airway and/or pleural abnormalities. Expression of phenotype markers on neutrophils were determined by flow cytometry. Levels of calprotectin, ACPA and RF were measured using immunoassays. RESULTS The frequency of having any PA was 60%. Airway abnormalities were present in 50%, parenchymal nodules in 43% and interstitial lung abnormalities (ILA) in 10%. Unsupervised multivariate data analysis showed clustering of any PA with neutrophil activation, parameters of inflammation and RF titres. In univariate analysis, the patients with PA displayed significantly increased CD11b and decreased CD62L expression on neutrophils (1.2-fold, p = 0.014; 0.8-fold, p = 0.012) indicating activation and significantly increased RF IgM titre and CRP (5.7-fold, p = 0.0025; 2.3-fold, p = 0.0035) as compared to no PA. Titres of RF, but not ACPA, correlated with expression of the neutrophil activation marker CD11b. A stratified analysis demonstrated that airway involvement was the PA subtype with the strongest association with neutrophil activation. CONCLUSION We report a strong association between radiographic airway findings and activation of circulating neutrophils in early RA supporting a role of innate immunity and the lung at disease onset. Our results also indicate different contributions of RF and ACPA in the RA pathogenesis.
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Grants
- ALFGBG-942903, 943046 the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement
- ALFGBG-942903, 943046 the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement
- ALFGBG-942903, 943046 the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement
- ALFGBG-942903, 943046 the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement
- ALFGBG-942903, 943046 the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement
- R-940577 Swedish Rheumatism Association
- R-940577 Swedish Rheumatism Association
- R-940577 Swedish Rheumatism Association
- GLS-935160, 961518 Gothenburg Society of Medicine
- GLS-935160, 961518 Gothenburg Society of Medicine
- GLS-935160, 961518 Gothenburg Society of Medicine
- GLS-935160, 961518 Gothenburg Society of Medicine
- VGFOUREG-932185, 940809 Local Research and Development Council in Västra Götaland Region, Sweden
- VGFOUREG-932185, 940809 Local Research and Development Council in Västra Götaland Region, Sweden
- VGFOUREG-932185, 940809 Local Research and Development Council in Västra Götaland Region, Sweden
- VGFOUREG-932185, 940809 Local Research and Development Council in Västra Götaland Region, Sweden
- VGFOUREG-932185, 940809 Local Research and Development Council in Västra Götaland Region, Sweden
- VGFOUREG-932185, 940809 Local Research and Development Council in Västra Götaland Region, Sweden
- VGFOUREG-932185, 940809 Local Research and Development Council in Västra Götaland Region, Sweden
- VGFOUREG-932185, 940809 Local Research and Development Council in Västra Götaland Region, Sweden
- 2020-06193 Swedish Research Council
- 2020-06193 Swedish Research Council
- 2020-06193 Swedish Research Council
- 2020-06193 Swedish Research Council
- The Rune and Ulla Amlöv foundation
- University of Gothenburg
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Affiliation(s)
- Tilia Selldén
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, Gothenburg, SE-405 30, Sweden
| | - Carina Kärrman Mårdh
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, Gothenburg, SE-405 30, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Joelsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, Gothenburg, SE-405 30, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenny Vikgren
- Department of Radiology, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åse Johnsson
- Department of Radiology, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunilla Larsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, Gothenburg, SE-405 30, Sweden
| | - Daniel Glinatsi
- Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden
| | | | - Karin Svensson
- Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, Gothenburg, SE-405 30, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, Gothenburg, SE-405 30, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna-Carin Lundell
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, Gothenburg, SE-405 30, Sweden
| | - Anna-Karin Hultgård Ekwall
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, Gothenburg, SE-405 30, Sweden.
- Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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9
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Manifestaciones pulmonares de la artritis reumatoide, una revisión en tiempos de pandemia por SARS-CoV-2. REVISTA COLOMBIANA DE REUMATOLOGÍA 2022. [PMCID: PMC7934669 DOI: 10.1016/j.rcreu.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
La artritis reumatoide (AR) es una de las patologías crónicas de origen autoinmune más frecuentes. Su prevalencia varía del 0,5 al 1%, con un compromiso primario a nivel articular, generando gran discapacidad por las deformidades secundarias derivadas de un estado inflamatorio persistente. Considerando el alto impacto en la calidad de vida de quienes la padecen, sumado al alto costo de las intervenciones terapéuticas, se vuelve imperativo para el personal de salud sumar todos los esfuerzos para promover un diagnóstico temprano y reconocer las potenciales complicaciones con el fin de impactar positivamente en los desenlaces clínicos. Alrededor del 50% de los pacientes con AR pueden tener compromiso extraarticular, siendo el pulmón uno de los órganos más afectados. En época de pandemia por el virus SARS-CoV-2 es necesario recordar los tipos de compromiso pulmonar en pacientes con AR y tener en cuenta la susceptibilidad de estos pacientes a cuadros infecciosos que pueden generar una gran morbimortalidad.
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10
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Laria A, Lurati AM, Zizzo G, Zaccara E, Mazzocchi D, Re KA, Marrazza M, Faggioli P, Mazzone A. Interstitial Lung Disease in Rheumatoid Arthritis: A Practical Review. Front Med (Lausanne) 2022; 9:837133. [PMID: 35646974 PMCID: PMC9136053 DOI: 10.3389/fmed.2022.837133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disease, which primarily causes symmetric polyarthritis. An extrarticolar involvement is common, and the commonly involved organ is lungs. Although cardiac disease is responsible for most RA-related deaths, pulmonary disease is also a major contributor, accounting for ~10-20% of all mortality. Pulmonary disease is a common (60-80% of patients with RA) extra-articular complication of RA. Optimal screening, diagnostic, and treatment strategies of pulmonary disease remain uncertain, which have been the focus of an ongoing investigation. Clinicians should regularly assess patients with RA for the signs and symptoms of pulmonary disease and, reciprocally, consider RA and other connective tissue diseases when evaluating a patient with pulmonary disease of an unknown etiology. RA directly affects all anatomic compartments of the thorax, including the lung parenchyma, large and small airways, pleura, and less commonly vessels. In addition, pulmonary infection and drug-induced lung disease associated with immunosuppressive agents used for the treatment of RA may occur.
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Affiliation(s)
- Antonella Laria
- Asst Ovest Milanese–Rheumatology Unit, Magenta Hospital, Milan, Italy
| | | | - Gaetano Zizzo
- Asst Ovest Milanese–Internal Medicine Department, Cuggiono Hospital, Milan, Italy
| | - Eleonora Zaccara
- Asst Ovest Milanese–Internal Medicine Unit, Legnano Hospital, Milan, Italy
| | - Daniela Mazzocchi
- Asst Ovest Milanese–Rheumatology Unit, Magenta Hospital, Milan, Italy
| | - Katia Angela Re
- Asst Ovest Milanese–Rheumatology Unit, Magenta Hospital, Milan, Italy
| | | | - Paola Faggioli
- Asst Ovest Milanese–Internal Medicine Unit, Legnano Hospital, Milan, Italy
| | - Antonino Mazzone
- Asst Ovest Milanese–Internal Medicine Unit, Legnano Hospital, Milan, Italy
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11
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Ying D, Schmajuk G, Trupin L, Blanc PD. Inorganic Dust Exposure During Military Service as a Predictor of Rheumatoid Arthritis and Other Autoimmune Conditions. ACR Open Rheumatol 2021; 3:466-474. [PMID: 34085777 PMCID: PMC8281049 DOI: 10.1002/acr2.11273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) and other autoimmune (AI) conditions are associated with inorganic dust exposure. Many military activities are likely to entail inorganic dust exposures. We wished to identify associations between prior military dust exposure and RA and other AI conditions. METHODS We studied persons from a roster of Army, Navy, Air Force, or Marine Corps personnel who had served in Operation Enduring Freedom and Operations Iraqi Freedom and New Dawn. We linked military occupational codes to a job exposure matrix assigning dust exposure likelihood. We used the Veterans Affairs Health Care System (VAHCS) electronic health care records to identify cases of RA, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), vasculitis, and inflammatory myositis. Generalized estimating equations modeled risk of RA and other AI conditions associated with dust exposure, taking into account military service branch, age at first VAHCS encounter, sex, race/ethnicity, smoking status, and years of military service. RESULTS Of 438 086 veterans (68% ever-smokers), 44% were classified with likely or somewhat likely dust exposure. Cases included 1139 cases with RA, 467 cases with SLE, and 180 cases with other AI diseases (SSc, vasculitis, or inflammatory myositis). Military dust exposure was associated with increased odds of RA (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.003-1.20) and increased odds of SSc, vasculitis, or inflammatory myositis (OR = 1.23; 95% CI = 1.14-1.34) but was protective for SLE (OR = 0.81; 95% CI = 0.76-0.88). CONCLUSION Dust exposure during past military service comprises an occupational and environmental risk factor for RA and other AI diseases. This is potentially relevant for prevention activities.
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Affiliation(s)
- David Ying
- San Francisco Veterans Affairs Health Care System, San Francisco, California, John Muir Health, Walnut Creek, California, and University of California at San Francisco
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
| | | | - Paul D. Blanc
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
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12
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Jiao Y, Xu J, Chen H, Guo Q, Deng X, Zhang T, Zhang J, Shi C, Wang P. Identification of the Main Active Components and Mechanism of Wang Bi Tablet in Treating Rheumatoid Arthritis Based on Integrative Pharmacology. Front Pharmacol 2021; 12:669551. [PMID: 34149422 PMCID: PMC8213436 DOI: 10.3389/fphar.2021.669551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Wang Bi tablet (WBT) is used to treat rheumatoid arthritis (RA) in China. We employed integrative pharmacology, including rapid analysis of chemical composition, pharmacological experiment, and network pharmacology analysis, to elucidate the active components and mechanism underlying the effect of WBT against RA. The chemical fingerprint of WBT was revealed by UPLC-QTOF-MS/MS, and the chemical composition was identified. The anti-inflammatory effect of WBT was evaluated in TNF-α-stimulated RAW264.7 cells by ELISA and transcriptome sequencing. Network pharmacology analysis, functional enrichment analysis, and network visualization were performed. A total of 293 chemical constituents were preliminarily identified or tentatively characterized in WBT extract, and they effectively inhibited inflammatory response in TNF-α-stimulated RAW264.7 cells. Forty-eight key active constituents were identified based on high-frequency binding to hub targets and their corresponding targets number. Next, 135 corresponding hub genes, which may be the putative targets of WBT in treating RA, were selected. Functionally, the putative targets were significantly associated with the inflammatory immune response regulation module, energy metabolism regulation module, and cell function regulation module, corresponding to the traditional efficacy of WBT. In summary, this study revealed, for the first time using integrative pharmacology, that WBT may attenuate RA through the inflammation-immune regulation system.
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Affiliation(s)
- Yuanyuan Jiao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China.,College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jia Xu
- Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Hong Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China.,College of Traditional Chinese Medicine, Shenyang Pharmaceutical University, Shenyang, China
| | - Qiuyan Guo
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaofang Deng
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingbo Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chenjing Shi
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ping Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
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13
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Jung JH, Lim JH, Bang CH, Seok H, Song GG, Choi SJ. Prevalence of chronic obstructive pulmonary disease in patients with rheumatoid arthritis: A cross-sectional study. Int J Rheum Dis 2021; 24:774-780. [PMID: 34036753 DOI: 10.1111/1756-185x.14129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/29/2021] [Accepted: 05/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) and chronic obstructive pulmonary disease (COPD) are both chronic inflammatory diseases; the prevalence of COPD in RA patients is known to be high. However, the prevalence of both RA and COPD differs according to sex; the relationship between RA and COPD may also vary according to sex. Therefore, we investigated the prevalence of COPD and its association in patients with RA in Korea by sex. METHODS We conducted a nationwide cross-sectional study using data from the Korea National Health and Nutrition Examination Survey. A total of 12 417 men and 15 878 women were included. In this study, RA was defined as physician diagnosed or currently under RA treatment. COPD was defined based on spirometry results, chronic symptoms, and smoking history. Multivariable logistic regression models were employed and we calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for COPD prevalence in patients with RA. RESULTS The prevalence of COPD was 15.5% in men with RA, 3.5% in women with RA, 7.8% in men without RA, and 2.2% in women without RA. After adjustment for potential confounding variables, including smoking status, RA was significantly associated with COPD in men (OR 2.16, 95% CI 1.06-4.40), but not in women (OR 1.58, 95% CI 0.81-3.10). CONCLUSIONS In Korea, the prevalence of COPD was high in patients with RA of both sexes; RA and COPD was significantly likely to be associated in men, but not in women.
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Affiliation(s)
- Jae Hyun Jung
- Korea University College of Medicine, Seoul, Korea.,Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Korea
| | - Ji Hyun Lim
- Korea University College of Medicine, Seoul, Korea.,Soksiwon Clinic, Incheon, Korea
| | - Cho Hee Bang
- Ewha Womans University College of Nursing, Seoul, Korea
| | - Hongdeok Seok
- Department of Occupational and Environmental Medicine, Busan Adventist Hospital, Sahmyook Medical Centre, Busan, Korea
| | - Gwan Gyu Song
- Korea University College of Medicine, Seoul, Korea.,Division of Rheumatology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Sung Jae Choi
- Korea University College of Medicine, Seoul, Korea.,Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Korea
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14
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Palugan MJA, Assis ACB, Bessa EJC, Ferreira AS, Lopes AJ. Predictors of functional capacity as measured by the Glittre activities of daily living test in women with rheumatoid arthritis. ACTA ACUST UNITED AC 2021; 54:e10040. [PMID: 33729387 PMCID: PMC7959171 DOI: 10.1590/1414-431x202010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 12/18/2020] [Indexed: 08/19/2023]
Abstract
Although pulmonary involvement is the most common extra-articular manifestation of rheumatoid arthritis (RA), traditional pulmonary function tests (PFTs) do not show a good correlation with the field tests usually performed in these patients. In recent decades, measurement of ventilation distribution heterogeneity through the nitrogen single-breath washout (N2SBW) test and evaluation of functional capacity during exercise using the Glittre activities of daily living test (GA-T) have been increasingly used. Therefore, the objective of this study was to evaluate predictors of GA-T outcomes in women with RA considering demographic, anthropometric, clinical, functional variables, and chest computed tomography (CT) findings. Forty-three women with RA underwent the GA-T, the N2SBW test, spirometry, measurement of the diffusing capacity for carbon monoxide (DLco), measurement of respiratory muscle strength, and evaluation of physical function of the lower and upper limbs through the Health Assessment Questionnaire Disability Index (HAQ-DI). Chest CT scans were analyzed retrospectively. The GA-T time showed significant correlations with the DLco (rs=-0.397, P=0.008), forced vital capacity/DLco (rs=0.307, P=0.044), phase III slope of the N2SBW test (SIIIN2, rs=0.644, P<0.0001), and the HAQ-DI (rs=0.482, P=0.001). Disease extent as assessed by chest CT was associated with the GA-T time. On multiple regression analysis, the SIIIN2 and HAQ-DI were the only predictors of the GA-T time, explaining 40% of its variability. Thus, ventilation distribution heterogeneity and worse physical function substantially explain the variability in GA-T time in women with RA and varying extents of disease on chest CT.
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Affiliation(s)
- M J A Palugan
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - A C B Assis
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - E J C Bessa
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - A S Ferreira
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil
| | - A J Lopes
- Programa de Pós-Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Rio de Janeiro, RJ, Brasil.,Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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15
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Inhalants other than personal cigarette smoking and risk for developing rheumatoid arthritis. Curr Opin Rheumatol 2021; 32:279-288. [PMID: 32141952 DOI: 10.1097/bor.0000000000000705] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The current review summarizes the current evidence on inhalants other than personal cigarette smoking and risk for developing rheumatoid arthritis (RA). RECENT FINDINGS Personal cigarette smoking has been implicated as an environmental risk factor for seropositive RA, perhaps by inducing autoimmunity at pulmonary mucosa. Since many patients with RA are nonsmokers, other inhalants are being investigated as potential RA risk factors. Recent case-control and cohort studies have investigated passive cigarette smoking, air pollution, inhalant-related occupations, silica, pesticides, household environment, and allergic inhalants as inhalant exposures for RA risk. Inhalant-related occupations and silica inhalants have the most consistent evidence for associations with increased RA risk. However, most studies relied on retrospective designs and had limited ability to adjust for personal cigarette smoking or investigate associations among nonsmokers. SUMMARY Several inhalants other than personal cigarette smoking may be associated with increased risk for developing RA. These results support the hypothesis that inhalants, pulmonary mucosal inflammation, and RA pathogenesis may be linked. Future studies are needed to firmly establish the independence of these findings from personal cigarette smoking and to determine the specific inhalants and biologic mechanisms related to RA pathogenesis.
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16
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Cassone G, Sebastiani M, Vacchi C, Erre GL, Salvarani C, Manfredi A. Efficacy and safety of mycophenolate mofetil in the treatment of rheumatic disease-related interstitial lung disease: a narrative review. Drugs Context 2021; 10:dic-2020-8-8. [PMID: 33505480 PMCID: PMC7813435 DOI: 10.7573/dic.2020-8-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
Mycophenolate mofetil (MMF) is an antimetabolite with a potent inhibitory effect on proliferation of T and B lymphocytes used since the early 1990s for the prevention of acute allograft rejection after organ transplant. MMF is also widely used for the treatment of a variety of rheumatic diseases (RDs) and their pulmonary involvement. Interstitial lung disease (ILD) is a heterogeneous group of progressive fibrotic diseases of the lung, which is often secondary to RD and represents a major cause of morbidity and mortality. MMF is considered the main alternative to cyclophosphamide as a first-line agent to treat RD-related ILD or as possible maintenance therapy after cyclophosphamide, with a lower rate of side-effects. However, as for other immunosuppressive agents, the use of MMF in RD-ILD is supported by poor scientific evidence. In this narrative review, we describe the available data and recent advances on the effectiveness and safety of MMF for the treatment of ILD related to RD, including rheumatoid arthritis, systemic sclerosis, primary Sjögren syndrome, systemic lupus erythematosus, idiopathic inflammatory myopathies, undifferentiated connective tissue disease, interstitial pneumonia with autoimmune features and antineutrophil cytoplasmic antibody-associated vasculitis.
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Affiliation(s)
- Giulia Cassone
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy.,Rheumatology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Sebastiani
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Caterina Vacchi
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Gian Luca Erre
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Carlo Salvarani
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy.,Rheumatology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andreina Manfredi
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
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17
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Groner LK, Green DB, Weisman SV, Legasto AC, Toy D, Gruden JF, Escalon JG. Thoracic Manifestations of Rheumatoid Arthritis. Radiographics 2021; 41:32-55. [PMID: 33411607 DOI: 10.1148/rg.2021200091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Rheumatoid arthritis (RA) is one of the most common chronic systemic inflammatory diseases and the most common chronic inflammatory arthritis. Classically a progressive symmetric polyarthritis, RA is characterized by inflammation, erosions, bone loss, and joint destruction. Up to half of patients with RA exhibit extra-articular manifestations (EAMs), which may precede articular disease and are more common in patients with seropositive RA (patients with detectable serum levels of rheumatoid factor and/or anticitrullinated peptide antibodies). Cardiovascular and pulmonary EAMs are the largest contributors to morbidity and mortality in RA and may be especially devastating. Imaging has a significant role in diagnosing these EAMs and assessing response to treatment. Although treatment with disease-modifying antirheumatic drugs has redefined the natural history of RA and helped many patients achieve low disease activity, patients are at risk for treatment-related complications, as well as infections. The clinical features of drug-induced lung disease and infection can overlap considerably with those of EAMs, presenting a diagnostic challenge. Radiologists, by recognizing the imaging characteristics and evolution of these various processes, are essential in diagnosing and distinguishing among EAMs, treatment-related complications, and unrelated processes and formulating an appropriate differential diagnosis. Moreover, recognizing these disease processes at imaging and contextualizing imaging findings with clinical information and laboratory and pathologic findings can facilitate definitive diagnosis and proper treatment. The authors review the articular and extra-articular thoracic imaging manifestations of RA, including cardiovascular, respiratory, and pleural diseases, as well as treatment-related complications and common infections. ©RSNA, 2021.
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Affiliation(s)
- Lauren K Groner
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Daniel B Green
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Stacey V Weisman
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Alan C Legasto
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Dennis Toy
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - James F Gruden
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Joanna G Escalon
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
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18
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Conforti A, Di Cola I, Pavlych V, Ruscitti P, Berardicurti O, Ursini F, Giacomelli R, Cipriani P. Beyond the joints, the extra-articular manifestations in rheumatoid arthritis. Autoimmun Rev 2020; 20:102735. [PMID: 33346115 DOI: 10.1016/j.autrev.2020.102735] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/18/2020] [Indexed: 12/24/2022]
Abstract
Rheumatoid arthritis (RA) is an inflammatory disease typically affecting the joints, but the systemic inflammatory process may involve other tissues and organs. Many extra-articular manifestations are recognized, which are related to worse long outcomes. Rheumatoid nodules are the most common extra-articular feature, found in about 30% of patients. Secondary Sjögren's syndrome and pulmonary manifestations are observed in almost 10% of patients, also in the early disease. Active RA with high disease activity has been associated with an increased risk of such features. Male gender, smoking habit, severe joint disease, worse function, high pro-inflammatory markers levels, high titer of rheumatoid factor, and HLA-related shared epitope have been reported as clinical predictors of occurrence of these rheumatoid complications. In addition, there is a little evidence deriving from randomized controlled trials in this field, thus the therapeutic strategy is mainly empiric and based on small case series and retrospective studies. However, considering that these extra-articular manifestations are usually related to the more active and severe RA, an aggressive therapeutic strategy is usually employed in view of the poor outcomes of these patients. The extra-articular features of RA remain, despite the improvement of joint damage, a major diagnostic and therapeutic challenge, since these are associated with a poor prognosis and need to be early recognized and promptly managed.
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Affiliation(s)
- Alessandro Conforti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ilenia Di Cola
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Viktoriya Pavlych
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Piero Ruscitti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Onorina Berardicurti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Ursini
- IRRCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Roberto Giacomelli
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Cipriani
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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19
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Shen P, Jiao Y, Miao L, Chen J, Momtazi‐Borojeni AA. Immunomodulatory effects of berberine on the inflamed joint reveal new therapeutic targets for rheumatoid arthritis management. J Cell Mol Med 2020; 24:12234-12245. [PMID: 32969153 PMCID: PMC7687014 DOI: 10.1111/jcmm.15803] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/21/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory syndrome designated by synovial joint inflammation leading to cartilage degradation and bone damage as well as progressive disability. Synovial inflammation is promoted through the infiltration of mononuclear immune cells, dominated by CD4+ T cells, macrophages and dendritic cells (DCs), together with fibroblast-like synoviocytes (FLS), into the synovial compartment. Berberine is a bioactive isoquinoline alkaloid compound showing various pharmacological properties that are mainly attributed to immunomodulatory and anti-inflammatory effects. Several lines of experimental study have recently investigated the therapeutic potential of berberine and its underlying mechanisms in treating RA condition. The present review aimed to clarify determinant cellular and molecular targets of berberine in RA and found that berberine through modulating several signalling pathways involved in the joint inflammation, including PI3K/Akt, Wnt1/β-catenin, AMPK/lipogenesis and LPA/LPA1 /ERK/p38 MAPK can inhibit inflammatory proliferation of FLS cells, suppress DC activation and modulate Th17/Treg balance and thus prevent cartilage and bone destruction. Importantly, these molecular targets may explore new therapeutic targets for RA treatment.
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Affiliation(s)
- Peng Shen
- Department of StomatologyClinical Department of Aerospace CityNorthern Beijing Medical DistrictChinese PLA General HospitalBeijingChina
| | - Yang Jiao
- Department of StomatologyThe 7th Medical CenterChinese PLA General HospitalBeijingChina
- Outpatient Department of PLA Macao GarrisonMacaoChina
| | - Li Miao
- Department of StomatologyThe 7th Medical CenterChinese PLA General HospitalBeijingChina
| | - Ji‐hua Chen
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology & Shaanxi Key Laboratory of Oral DiseasesDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical UniversityXi'anChina
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20
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Manfredi A, Cassone G, Furini F, Gremese E, Venerito V, Atzeni F, Arrigoni E, Della Casa G, Cerri S, Govoni M, Petricca L, Iannone F, Salvarani C, Sebastiani M. Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study. Intern Med J 2020; 50:1085-1090. [DOI: 10.1111/imj.14670] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/29/2019] [Accepted: 10/20/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Andreina Manfredi
- Rheumatology Unit University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena Modena Italy
| | - Giulia Cassone
- Rheumatology Unit University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena Modena Italy
- Clinical and Experimental Medicine PhD Program University of Modena and Reggio Emilia Modena Italy
- Rheumatology Unit IRCCS Arcispedale Santa Maria Nuova, Universitary Hospital Policlinico of Modena Reggio Emilia Italy
| | - Federica Furini
- Department of Medical Sciences, Division of Rheumatology Santa Anna University Hospital Ferrara Italy
| | - Elisa Gremese
- Division of Rheumatology, Institute of Rheumatology Catholic University of the Sacred Heart Rome Italy
| | | | | | - Eugenio Arrigoni
- Rheumatology Unit ERI Medicine, Hospital of Piacenza Piacenza Italy
| | | | - Stefania Cerri
- Respiratory Disease Unit University of Modena and Reggio Emilia, Universitary Hospital Policlinico of Modena Modena Italy
| | - Marcello Govoni
- Department of Medical Sciences, Division of Rheumatology Santa Anna University Hospital Ferrara Italy
| | - Luca Petricca
- Division of Rheumatology, Institute of Rheumatology Catholic University of the Sacred Heart Rome Italy
| | | | - Carlo Salvarani
- Rheumatology Unit University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena Modena Italy
- Rheumatology Unit IRCCS Arcispedale Santa Maria Nuova, Universitary Hospital Policlinico of Modena Reggio Emilia Italy
| | - Marco Sebastiani
- Rheumatology Unit University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena Modena Italy
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21
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Beers-Tas MV, Nielen MM, Twisk JWR, Korevaar J, van Schaardenburg D. Increased primary care use for musculoskeletal symptoms, infections and comorbidities in the years before the diagnosis of inflammatory arthritis. RMD Open 2020; 6:rmdopen-2019-001163. [PMID: 32641448 PMCID: PMC7425115 DOI: 10.1136/rmdopen-2019-001163] [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: 12/15/2019] [Revised: 03/10/2020] [Accepted: 04/09/2020] [Indexed: 01/10/2023] Open
Abstract
Objectives Little is known about relevant events in the at-risk phase of rheumatoid arthritis before the development of clinically apparent inflammatory arthritis (IA). The present study assessed musculoskeletal symptoms, infections and comorbidity in future IA patients. Methods In a nested case–control study using electronic health records of general practitioners, the frequency and timing of 192 symptoms or diseases were evaluated before a diagnosis of IA, using the International Classification of Primary Care coding system. Cases were 2314 adults with a new diagnosis IA between 2012 and 2016; controls were matched 1:2. The frequency of primary care visits was compared using logistic regression. Results The frequency of visits for musculoskeletal symptoms (mostly of shoulders, wrists, fingers and knees) and carpal tunnel syndrome was significantly higher in IA patients vs controls within the final 1.5 years before diagnosis, with ORs of 3.2 (95% CI 2.8 to 3.5), 2.8 (95% CI 2.5 to 3.1) and 2.5 (95% CI 2.2 to 2.8) at 6, 12 and 18 months before diagnosis, respectively. Also, infections (notably of the genital and urinary tracts), IA-comorbidities and chronic diseases were more prevalent in cases than controls, but more evenly spread out over the whole 6-year period before IA. A decision tree was created including all symptoms and diseases. Conclusion There was an increased frequency of primary care visits for musculoskeletal symptoms, infections and comorbidities prior to the diagnosis of IA. This diverging trend is present for 4–6 years, but becomes statistically significant 1.5 years before the diagnosis. Validation of these results is warranted.
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Affiliation(s)
- Marian van Beers-Tas
- Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Markus Mj Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Joke Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - D van Schaardenburg
- Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands.,Rheumatology, Amsterdam Rheumatology & immunology Center, Amsterdam University Medical Center location AMC, Amsterdam, The Netherlands
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22
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Feng X, Hao X, Shi R, Xia Z, Huang L, Yu Q, Zhou F. Detection and Comparative Analysis of Methylomic Biomarkers of Rheumatoid Arthritis. Front Genet 2020; 11:238. [PMID: 32292416 PMCID: PMC7119472 DOI: 10.3389/fgene.2020.00238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 02/28/2020] [Indexed: 01/05/2023] Open
Abstract
Rheumatoid arthritis (RA) is a common autoimmune disorder influenced by both genetic and environmental factors. To investigate possible contributions of DNA methylation to the etiology of RA with minimum confounding genetic heterogeneity, we investigated genome-wide DNA methylation in disease-discordant monozygotic twin pairs. This study hypothesized that methylomic biomarkers might facilitate accurate RA detection. A comprehensive series of biomarker detection algorithms were utilized to find the best methylomic biomarkers for detecting RA patients using the methylomic data of the peripheral blood samples. The best model achieved 100.00% in accuracy (Acc) with 81 methylomic biomarkers and a 10-fold cross-validation (10FCV) strategy. Some of the methylomic biomarkers were experimentally confirmed to be associated with the onset or development of RA. It is also interesting to observe that many of the detected biomarkers were from chromosome Y, supporting the knowledge that RA has a significant gender discrepancy.
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Affiliation(s)
- Xin Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.,Jilin Institute of Chemical Technology, Jilin, China.,BioKnow Health Informatics Lab, College of Computer Science and Technology, and Key Laboratory of Symbolic Computation and Knowledge Engineering of Ministry of Education, Jilin University, Changchun, China
| | - Xubing Hao
- BioKnow Health Informatics Lab, College of Software, and Key Laboratory of Symbolic Computation and Knowledge Engineering of Ministry of Education, Jilin University, Changchun, China
| | - Ruoyao Shi
- BioKnow Health Informatics Lab, College of Life Sciences, Jilin University, Changchun, China
| | - Zhiqiang Xia
- BioKnow Health Informatics Lab, College of Computer Science and Technology, and Key Laboratory of Symbolic Computation and Knowledge Engineering of Ministry of Education, Jilin University, Changchun, China
| | - Lan Huang
- College of Computer Science and Technology, and Key Laboratory of Symbolic Computation and Knowledge Engineering of Ministry of Education, Jilin University, Changchun, China
| | - Qiong Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Fengfeng Zhou
- BioKnow Health Informatics Lab, College of Computer Science and Technology, and Key Laboratory of Symbolic Computation and Knowledge Engineering of Ministry of Education, Jilin University, Changchun, China
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23
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Demoruelle MK, Wilson TM, Deane KD. Lung inflammation in the pathogenesis of rheumatoid arthritis. Immunol Rev 2020; 294:124-132. [DOI: 10.1111/imr.12842] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 12/21/2022]
Affiliation(s)
| | - Timothy M. Wilson
- Division of Rheumatology University of Colorado Denver Aurora CO USA
| | - Kevin D. Deane
- Division of Rheumatology University of Colorado Denver Aurora CO USA
- Denver Veterans Affairs Medical Center Denver CO USA
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24
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Duarte AC, Porter J, Leandro MJ. Bronchiectasis in rheumatoid arthritis. A clinical appraisial. Joint Bone Spine 2020; 87:419-424. [PMID: 32007647 DOI: 10.1016/j.jbspin.2019.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Bronchiectasis is defined as irreversibly damaged and dilated bronchi and is one of the most common pulmonary manifestations in patients with rheumatoid arthritis (RA). The model of RA-associated autoimmunity induced in some individuals by chronic bacterial infection in bronchiectasis is becoming increasingly acceptable, although a genetic predisposition to RA-associated bronchiectasis has also been demonstrated. Bronchiectasis should be suspected in RA patients with chronic cough and sputum production or frequent respiratory infections and the diagnosis must be confirmed by thoracic high-resolution computed tomography. Management of patients with RA-associated bronchiectasis includes a multimodal treatment approach. Similar to all patients with non-cystic fibrosis bronchiectasis, patients with RA-associated bronchiectasis benefit from a pulmonary rehabilitation program, including an exercise/muscle strengthening program and an education program with a specific session on airway clearance techniques. Prophylactic antibiotics are recommended for patients with frequent (3 or more infective exacerbations per year) or severe infections requiring hospitalization/intravenous antibiotics and inhaled corticosteroids and long-acting β2-agonists should be used in patients with non-cystic fibrosis bronchiectasis and associated airway hyper-responsiveness. In patients with RA-associated bronchiectasis the use of immunomodulatory drugs has to be carefully considered, as they are essential to control disease activity, despite being associated with an increased infectious risk. Pneumococcal and influenza vaccines are advised to all patients with RA-associated bronchiectasis in order to reduce the risk of infection. Patients with RA-associated bronchiectasis have a poorer prognosis than those with either RA or bronchiectasis alone and require regular follow-up, under the joint care of a rheumatologist and a pulmonologist.
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Affiliation(s)
- Ana Catarina Duarte
- Rheumatology department, Hospital Garcia de Orta EPE, Avenida Torrado da Silva, 2805-267 Almada, Portugal.
| | - Joanna Porter
- UCL Respiratory, University College London Hospitals NHS Foundation Trust, 235, Euston Road, Bloomsbury, NW1 2BU London, United Kingdom; Center for Interstitial Lung Disease, University College London Hospitals NHS Foundation Trust, 235, Euston Road, Bloomsbury, NW1 2BU London, United Kingdom
| | - Maria José Leandro
- Center for Rheumatology, University College London Hospitals NHS Foundation Trust, 235, Euston Road, Bloomsbury, NW1 2BU London, United Kingdom
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25
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Abstract
Rheumatoid arthritis is a heterogeneous disease, which can be, based on data combining genetic risk factors and autoantibodies, sub-classified into ACPA-positive and -negative RA. Presence of ACPA and RF as well as rising CRP-levels in some patients years before onset of clinical symptoms indicate that relevant immune responses for RA development are initiated very early. ACPA are highly specific for RA, whereas RF can also be found among healthy (elderly) individuals and patients with other autoimmune diseases or infection. The most important genetic risk factor for RA development, the shared epitope alleles, resides in the MHC class II region. Shared epitope alleles, however, only predispose to the development of ACPA-positive RA. Smoking is thus far the most important environmental risk factor associated with the development of RA. Studies on synovitis have shown the importance not only of adaptive but also of innate immune responses. In summary of the various results from immunological changes in blood and synovial tissue, the extension of the immune response from a diffuse myeloid to a lympho-myeloid inflammation appears to be associated with a more successful therapeutic response to biologics. With respect to advances in synovitis research, new targets for treatment against pathological subsets of immune cells or fibroblasts are already on the horizon. However, alternative strategies involving the microbiome may play an important role as well and research in this field is growing rapidly.
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26
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Cassone G, Manfredi A, Atzeni F, Venerito V, Vacchi C, Picerno V, Furini F, Erre GL, Tomietto P, Fedele AL, Della Casa G, Nucera V, Giannitti C, Salvarani C, Sebastiani M. Safety of Abatacept in Italian Patients with Rheumatoid Arthritis and Interstitial Lung Disease: A Multicenter Retrospective Study. J Clin Med 2020; 9:jcm9010277. [PMID: 31963908 PMCID: PMC7019755 DOI: 10.3390/jcm9010277] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Treatment of rheumatoid arthritis (RA)-related interstitial lung disease (ILD) is challenging, and many conventional and biologic disease-modifying anti-rheumatic drugs (DMARDs) have been associated with ILD development or progression. The aim of this multicentric retrospective study was to analyze the evolution of ILD in Italian RA-ILD patients treated with abatacept (ABA). Methods: All RA-ILD patients treated with ABA for at least six months were retrospectively evaluated. Serology, previous and concurrent therapies, chest high-resolution computer tomography (HRCT), forced vital capacity (FVC), and lung diffusion of carbon monoxide (CO, DLCO) were collected. Results: Forty-four patients were included; HRCT, FVC, and DLCO were analyzed at baseline, at one year, and at the end of follow-up. A remission or a low disease activity of RA was reached in 41/44 patients. Overall, FVC and DLCO remained stable or increased in 86.1% and 91.7% of patients, respectively, while HRCT was stable or improved in 81.4% of them. Previous and concurrent treatments, in particular, methotrexate, serology, age, sex, joint and lung disease duration were not associated with the outcome at univariate analysis. Conclusion: The management of RA-ILD patients remains a critical unmet medical need. Waiting for prospective controlled studies, ABA has shown a good safety profile in our cohort of Italian RA-ILD patients.
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Affiliation(s)
- Giulia Cassone
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.C.); (C.V.)
| | - Andreina Manfredi
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy (C.S.)
| | - Fabiola Atzeni
- Rheumatology Unit, University of Messina, 98121 Messina, Italy; (F.A.)
| | - Vincenzo Venerito
- Rheumatology Unit, Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy;
| | - Caterina Vacchi
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.C.); (C.V.)
| | - Valentina Picerno
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, 85100 Potenza, Italy;
| | - Federica Furini
- Department of Medical Sciences, Division of Rheumatology, Santa Anna University Hospital, 44100 Ferrara, Italy;
| | - Gian Luca Erre
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Sassari, 07010 Sassari, Italy;
| | - Paola Tomietto
- Department of Clinical Medicine, Rheumatology Unit, Azienda Sanitaria Universitaria Integrata di Trieste, 34121 Trieste, Italy;
| | - Anna Laura Fedele
- Rheumatology Unit, Policlinico Gemelli Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giovanni Della Casa
- Radiology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy
| | - Valeria Nucera
- Rheumatology Unit, University of Messina, 98121 Messina, Italy; (F.A.)
| | | | - Carlo Salvarani
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy (C.S.)
| | - Marco Sebastiani
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy (C.S.)
- Correspondence: ; Tel.: +39-059-4225636; Fax: +39-059-4223007
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27
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Fragoulis GE, Chatzidionysiou K. Lung cancer in rheumatoid arthritis. Is there a need for better risk assessment and screening? Clin Rheumatol 2019; 39:957-961. [DOI: 10.1007/s10067-019-04882-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022]
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28
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Yue M, Tao Y, Fang Y, Lian X, Zhang Q, Xia Y, Wei Z, Dai Y. The gut microbiota modulator berberine ameliorates collagen-induced arthritis in rats by facilitating the generation of butyrate and adjusting the intestinal hypoxia and nitrate supply. FASEB J 2019; 33:12311-12323. [PMID: 31425655 DOI: 10.1096/fj.201900425rr] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The commensal microbiota is one of the environmental triggers of rheumatoid arthritis (RA). Recent studies have identified the characteristics of the gut microbiota in patients with RA. However, it is still unclear how the microbiota can be modulated to slow down disease progression. In the present study, berberine, a modulator of gut microbiota with substantial anti-RA effect, was chosen to explore the mechanisms by which the microbiota modulators ameliorate RA. The results showed that oral administration of berberine alleviated collagen-induced arthritis (CIA) in rats in a gut microbiota-dependent manner. Berberine down-regulated the diversity and richness of the gut bacteria, reduced the abundance of Prevotella, and elevated the abundance of butyrate-producing bacteria in CIA rats as determined by the 16S rRNA gene sequence, which might function through limiting the generation of nitrate and stabilizing the physiologic hypoxia in the intestine. Moreover, berberine treatment significantly increased the intestinal butyrate level and promoted the expression and activity of butyryl-CoA:acetate-CoA transferase (BUT). The coadministration of a BUT inhibitor largely diminished the adjustment of intestinal environment and the antiarthritic effect of berberine. In conclusion, modulators of the gut microbiota might serve as therapeutic agents for RA by inducing the butyrate generation through promoting the expression and activity of BUT.-Yue, M., Tao, Y., Fang, Y., Lian, X., Zhang, Q., Xia, Y., Wei, Z., Dai, Y. The gut microbiota modulator berberine ameliorates collagen-induced arthritis in rats by facilitating the generation of butyrate and adjusting the intestinal hypoxia and nitrate supply.
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Affiliation(s)
- Mengfan Yue
- Department of Pharmacology of Chinese Materia Medica, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yu Tao
- Department of Pharmacology of Chinese Materia Medica, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yulai Fang
- Department of Pharmacology of Chinese Materia Medica, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xingpan Lian
- Department of Pharmacology of Chinese Materia Medica, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Qin Zhang
- Department of Pharmacology of Chinese Materia Medica, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yufeng Xia
- Department of Pharmacology of Chinese Materia Medica, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Zhifeng Wei
- Department of Pharmacology of Chinese Materia Medica, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yue Dai
- Department of Pharmacology of Chinese Materia Medica, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
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29
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Sparks JA, He X, Huang J, Fletcher EA, Zaccardelli A, Friedlander HM, Gill RR, Hatabu H, Nishino M, Murphy DJ, Iannaccone CK, Mahmoud TG, Frits ML, Lu B, Rosas IO, Dellaripa PF, Weinblatt ME, Karlson EW, Shadick NA, Doyle TJ. Rheumatoid Arthritis Disease Activity Predicting Incident Clinically Apparent Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Prospective Cohort Study. Arthritis Rheumatol 2019; 71:1472-1482. [PMID: 30951251 DOI: 10.1002/art.40904] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/02/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate rheumatoid arthritis (RA) disease activity and risk of RA-associated interstitial lung disease (RA-ILD). METHODS We investigated disease activity and risk of RA-ILD using the Brigham RA Sequential Study (BRASS, 2003-2016). All patients were diagnosed as having RA according to accepted criteria. Disease Activity Scores in 28 joints (DAS28) and covariate data were measured prospectively at annual study visits. Diagnosis of RA-ILD was determined by review of images from clinically indicated chest computed tomography scans. We analyzed patients without RA-ILD at baseline. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for RA-ILD, using annually updated DAS28 data, with adjustment for known RA-ILD risk factors (age, sex, smoking status, RA duration, and serologic status). We performed alternative analyses that did not censor at the time of missing DAS28 data and included adjustment for use of methotrexate, use of glucocorticoids, presence of bone erosions, and presence of rheumatoid nodules. RESULTS Among 1,419 participants, the mean ± SD age was 55.8 ± 14.2 years, and 68.6% were seropositive for either cyclic citrullinated peptide or rheumatoid factor. We identified 85 incident cases of RA-ILD during a mean ± SD follow-up duration of 8.9 ± 4.2 years per patient. The moderate/high disease activity group had a multivariable HR of 2.22 (95% CI 1.28-3.82) for RA-ILD compared to the remission/low disease activity group. Risk of RA-ILD increased across disease activity categories: multivariable HR 1.00 (reference) for remission, 1.41 (95% CI 0.61-3.28) for low disease activity, 2.08 (95% CI 1.06-4.05) for moderate disease activity, and 3.48 (95% CI 1.64-7.38) for high disease activity (P for trend = 0.001). For each unit increase in the DAS28, the risk of RA-ILD increased by 35% (95% CI 14-60%). Results were similar in analyses that included follow-up for missing DAS28 data and with adjustment for use of methotrexate, use of glucocorticoids, presence of bone erosions, or presence of rheumatoid nodules. CONCLUSION Active articular RA was associated with an increased risk of developing RA-ILD. These results suggest that decreasing systemic inflammation may alter the natural history of RA-ILD development.
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Affiliation(s)
- Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Xintong He
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Jie Huang
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Ritu R Gill
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hiroto Hatabu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mizuki Nishino
- Harvard Medical School, Brigham and Women's Hospital, and Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ivan O Rosas
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul F Dellaripa
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael E Weinblatt
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth W Karlson
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nancy A Shadick
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tracy J Doyle
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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30
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Sparks JA, Doyle TJ, He X, Pan B, Iannaccone C, Frits ML, Dellaripa P, Rosas IO, Lu B, Weinblatt ME, Shadick NA, Karlson EW. Incidence and predictors of dyspnea on exertion in a prospective cohort of patients with rheumatoid arthritis. ACR Open Rheumatol 2019; 1:4-15. [PMID: 30923795 PMCID: PMC6433160 DOI: 10.1002/acr2.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the incidence and predictors of dyspnea on exertion among subjects with rheumatoid arthritis (RA). METHODS We investigated dyspnea on exertion using a prospective cohort, the Brigham RA Sequential Study (BRASS). Clinically significant dyspnea on exertion was defined as a score of ≥3 (unable to ambulate without breathlessness or worse) on the validated Medical Research Council (MRC) scale (range 0-5). We analyzed subjects with MRC score <3 at BRASS baseline and ≥1 year of follow-up. The MRC scale was administered annually. We determined the incidence rate (IR) of dyspnea on exertion. We used Cox regression to estimate the HR for dyspnea on exertion occurring one year after potential predictors were assessed. RESULTS We analyzed 829 subjects with RA and no clinically significant dyspnea on exertion during mean follow-up of 3.0 years (SD 1.9). At baseline, mean age was 55.7 years (SD 13.6), 82.4% were female, and median RA duration was 8 years. During follow-up, 112 subjects (13.5%) developed incident dyspnea on exertion during 2,476 person-years of follow-up (IR 45.2 per 1000 person-years). Independent predictors of incident dyspnea on exertion were: older age (HR 1.03 per year, 95%CI 1.01-1.04), female sex (HR 2.22, 95%CI 1.14-4.29), mild dyspnea (HR 2.62, 95%CI 1.60-4.28), and worsened MDHAQ (HR 2.36 per unit, 95%CI 1.54-3.60). Methotrexate use, RA disease activity, and seropositivity were not associated with incident dyspnea on exertion. CONCLUSION Dyspnea on exertion occurred commonly in patients with RA. Older women with impaired physical function were especially vulnerable to developing dyspnea on exertion.
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Affiliation(s)
- Jeffrey A. Sparks
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Tracy J. Doyle
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Xintong He
- Brigham and Women’s HospitalBostonMassachusetts
| | | | | | | | - Paul F. Dellaripa
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Ivan O. Rosas
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Bing Lu
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Michael E. Weinblatt
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Nancy A. Shadick
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
| | - Elizabeth W. Karlson
- Brigham and Women’s Hospita, Boston, Massachusetts, and Harvard Medical SchoolBostonMassachusetts
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31
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Abstract
Rheumatoid arthritis (RA) is a common systemic inflammatory autoimmune disease characterized by painful, swollen joints that can severely impair physical function and quality of life. The presenting symptoms of musculoskeletal pain, swelling, and stiffness are common in clinical practice, so familiarity with diagnosing and managing RA is crucial. Patients with RA are at greater risk for serious infection, respiratory disease, osteoporosis, cardiovascular disease, cancer, and mortality than the general population. In recent years, early diagnosis, aggressive treatment, and expanded therapeutic options of disease-modifying antirheumatic drugs have markedly improved both the management and long-term prognosis of RA.
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Affiliation(s)
- Jeffrey A Sparks
- From Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. (J.A.S.)
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32
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Hutloff A. T Follicular Helper-Like Cells in Inflamed Non-Lymphoid Tissues. Front Immunol 2018; 9:1707. [PMID: 30083164 PMCID: PMC6064731 DOI: 10.3389/fimmu.2018.01707] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
T and B cell cooperation normally takes place in secondary lymphoid organs (SLO). However, both cell types are also frequently found in inflamed non-lymphoid tissues. Under certain conditions, these infiltrates develop into ectopic lymphoid structures, also known as tertiary lymphoid tissues, which structurally and functionally fully resemble germinal centers (GCs) in SLO. However, tertiary lymphoid tissue is uncommon in most human autoimmune conditions; instead, relatively unstructured T and B cell infiltrates are found. Recent studies have demonstrated that active T and B cell cooperation can also take place in such unstructured aggregates. The infiltrating cells contain a population of T follicular helper (Tfh)-like cells (also designated "peripheral T helper cells") lacking prototypic Tfh markers like CXCR5 and Bcl-6 but nevertheless expressing high levels of molecules important for B cell help like IL-21 and CD40L. Moreover, Tfh-like cells isolated from inflamed tissues can drive the differentiation of B cells into antibody-secreting cells in vitro. These findings are not restricted to experimental animal models but have been reproduced in rheumatoid arthritis and breast cancer patients. At this point, it is unclear whether T and B cell cooperation outside the ordered structure of the GC fully mirrors the reactions in SLO. However, Tfh-like cells in inflamed tissues are certainly important for the local differentiation of B cells into antibody-secreting cells, and should be considered as an important target for the treatment of autoimmune diseases.
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Affiliation(s)
- Andreas Hutloff
- Chronic Immune Reactions, German Rheumatism Research Centre Berlin (DRFZ), a Leibniz Institute, Berlin, Germany
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Sparks JA, Lin TC, Camargo CA, Barbhaiya M, Tedeschi SK, Costenbader KH, Raby BA, Choi HK, Karlson EW. Rheumatoid arthritis and risk of chronic obstructive pulmonary disease or asthma among women: A marginal structural model analysis in the Nurses' Health Study. Semin Arthritis Rheum 2018; 47:639-648. [PMID: 29037522 PMCID: PMC5857435 DOI: 10.1016/j.semarthrit.2017.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/25/2017] [Accepted: 09/13/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We investigated whether RA increases risk for chronic obstructive pulmonary disease (COPD) or asthma independent of factors occurring before RA onset or mediating these respiratory morbidities after diagnosis, such as cigarette smoking. METHODS Within the prospective Nurses' Health Study (n = 121,701 women; 1976-2014), we identified an incident RA cohort and matched each woman with RA to 10 comparators without RA by age and year at index date of RA diagnosis, excluding women with COPD or asthma at baseline. Data were obtained through biennial questionnaires and medical records. We used marginal structural models to determine the independent effect of RA on incident COPD or asthma adjusting for confounders and time-varying mediators through inverse probability weighting. RESULTS We identified 843 women with RA, matched to 8,399 comparators without RA. Mean age was 59.8 years and mean follow-up after index date was 18.6 years (SD = 9.0) for women with RA, and 18.8 years (SD = 9.5) for comparators. We identified 68 (8.1%) incident COPD and 40 (4.7%) asthma cases among women with RA, and 459 (5.5%) COPD and 268 (3.2%) asthma cases among comparators. RA was associated with increased risk of COPD (HR = 1.52, 95% CI: 1.17-1.97) and asthma (HR = 1.55, 95% CI: 1.11-2.16) compared to comparators adjusted for the matching factors of age and calendar year at index date. After further adjustment for confounders and time-varying mediators occurring after index date, including smoking, RA was significantly associated with COPD (HR = 1.68, 95% CI: 1.36-2.07), but not asthma (HR = 1.11, 95% CI: 0.59-2.09) compared to non-RA comparators. Women with seropositive RA (HR = 1.60, 95% CI: 1.17-2.19) and seronegative RA (HR = 1.62, 95% CI: 1.09-2.40) had similar increased risk for COPD compared to non-RA comparators. CONCLUSION In this prospective cohort study, RA was associated with increased risk for incident COPD, independent of lifestyle confounders and mediators after diagnosis, including smoking.
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Affiliation(s)
- Jeffrey A Sparks
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Tzu-Chieh Lin
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Carlos A Camargo
- Harvard Medical School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Medha Barbhaiya
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Sara K Tedeschi
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Karen H Costenbader
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Benjamin A Raby
- Harvard Medical School, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Hyon K Choi
- Harvard Medical School, Boston, MA; Division of Rheumatology, Massachusetts General Hospital, Boston, MA
| | - Elizabeth W Karlson
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Pollard KM, Christy JM, Cauvi DM, Kono DH. Environmental Xenobiotic Exposure and Autoimmunity. CURRENT OPINION IN TOXICOLOGY 2017; 10:15-22. [PMID: 29503968 DOI: 10.1016/j.cotox.2017.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Susceptibility to autoimmune diseases is dependent on multigenic inheritance, environmental factors, and stochastic events. Although there has been substantial progress in identifying predisposing genetic variants, a significant challenge facing autoimmune disease research is the identification of the specific events that trigger loss of tolerance, autoreactivity and ultimately autoimmune disease. Accordingly, studies have indicated that a wide range of extrinsic factors including drugs, chemicals, microbes, and other environmental factors can induce autoimmunity, particularly systemic autoimmune diseases such as lupus. This review describes a class of environmental factors, namely xenobiotics, epidemiologically linked to human autoimmunity. Mechanisms of xenobiotic autoimmune disease induction are discussed in terms of human and animal model studies with a focus on the role of inflammation and the innate immune response. We argue that localized tissue damage and chronic inflammation elicited by xenobiotic exposure leads to the release of self-antigens and damage-associated molecular patterns as well as the appearance of ectopic lymphoid structures and secondary lymphoid hypertrophy, which provide a milieu for the production of autoreactive B and T cells that contribute to the development and persistence of autoimmunity in predisposed individuals.
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Affiliation(s)
- K Michael Pollard
- Department of Molecular Medicine, MEM125, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, USA 92037
| | - Joseph M Christy
- Department of Molecular Medicine, MEM125, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, USA 92037
| | - David M Cauvi
- Department of Surgery, School of Medicine, University of California, San Diego, 9500 Gilman Drive #0739, La Jolla, CA, USA 92093
| | - Dwight H Kono
- Department of Immunology and Microbiology, IMM310, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA, USA 92037
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Clinical, Epidemiological, and Histopathological Features of Respiratory Involvement in Rheumatoid Arthritis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7915340. [PMID: 29238722 PMCID: PMC5697381 DOI: 10.1155/2017/7915340] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/22/2017] [Accepted: 10/10/2017] [Indexed: 12/12/2022]
Abstract
Although by definition rheumatoid arthritis (RA) is an articular disorder, it is a systemic disease, and 18–40% of patients experience extra-articular manifestations (EAMs). The involvement of the respiratory system occurs in about 30–40% of RA patients, and in about 10–20% of them it represents the first manifestation of RA. A wide range of pulmonary manifestations are detectable in RA patients, including pulmonary parenchymal disease, pleural involvement, and airway and pulmonary inflammation. The clinical, radiological, and histological spectra of respiratory manifestations in RA reflect chronic immune activation, increased susceptibility to infection (often related to immunosuppressive medications), or direct drug. The type and severity of pulmonary involvement influence the prognosis, ranging from mild self-limiting conditions to severe life-threatening complications. Herein, we reviewed the various manifestations of respiratory involvement in RA, providing an overview on epidemiological, histological, clinical, and radiological data.
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The Role of High-Mobility Group Box-1 and Its Crosstalk with Microbiome in Rheumatoid Arthritis. Mediators Inflamm 2017; 2017:5230374. [PMID: 29200665 PMCID: PMC5672636 DOI: 10.1155/2017/5230374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/16/2017] [Indexed: 02/06/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, definitely disabling, and potentially severe autoimmune disease. Although an increasing number of patients are affected, a key treatment for all patients has not been discovered. High-mobility group box-1 (HMGB1) is a nuclear protein passively and actively released by almost all cell types after several stimuli. HMGB1 is involved in RA pathogenesis, but a convincing explanation about its role and possible modulation in RA is still lacking. Microbiome and its homeostasis are altered in patients with RA, and the microbiota restoration has been proposed to patients with RA. The purpose of the present review is to analyze the available evidences regarding HMGB1 and microbiome roles in RA and the possible implications of the crosstalk between the nuclear protein and microbiome in understanding and possibly treating patients affected by this harmful condition.
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Lourido L, Blanco FJ, Ruiz-Romero C. Defining the proteomic landscape of rheumatoid arthritis: progress and prospective clinical applications. Expert Rev Proteomics 2017; 14:431-444. [PMID: 28425787 DOI: 10.1080/14789450.2017.1321481] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The heterogeneity of Rheumatoid Arthritis (RA) and the absence of clinical tests accurate enough to identify the early stages of this disease have hampered its management. Therefore, proteomics research is increasingly focused on the discovery of novel biological markers, which would not only be able make an early diagnosis, but also to gain insight into the different pathological mechanisms underlying the heterogeneity of RA and also to stratify patients, which is critical to enabling effective treatments. Areas covered: The proteomic approaches that have been utilised to provide knowledge about RA pathogenesis, and to identify biomarkers for RA diagnosis, prognosis, disease monitoring and prediction of response to therapy, are summarized. Expert commentary: Although each proteomic study is unique in its design, all of them have contributed to the understanding of RA pathogenesis and the discovery of promising biomarkers for patient stratification, which would improve clinical care of RA patients. Still, efforts need to be made to validate these findings and translate them into clinical practice.
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Affiliation(s)
- Lucía Lourido
- a Rheumatology Division, ProteoRed/ISCIII Proteomics Group , INIBIC - Hospital Universitario de A Coruña , A Coruña , Spain.,b RIER-RED de Inflamación y Enfermedades Reumáticas , INIBIC-CHUAC , A Coruña , Spain
| | - Francisco J Blanco
- a Rheumatology Division, ProteoRed/ISCIII Proteomics Group , INIBIC - Hospital Universitario de A Coruña , A Coruña , Spain.,b RIER-RED de Inflamación y Enfermedades Reumáticas , INIBIC-CHUAC , A Coruña , Spain
| | - Cristina Ruiz-Romero
- a Rheumatology Division, ProteoRed/ISCIII Proteomics Group , INIBIC - Hospital Universitario de A Coruña , A Coruña , Spain.,c CIBER-BBN Instituto de Salud Carlos III , INIBIC-CHUAC , A Coruña , Spain
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Wasén C, Turkkila M, Bossios A, Erlandsson M, Andersson KM, Ekerljung L, Malmhäll C, Brisslert M, Töyrä Silfverswärd S, Lundbäck B, Bokarewa MI. Smoking activates cytotoxic CD8 + T cells and causes survivin release in rheumatoid arthritis. J Autoimmun 2017; 78:101-110. [PMID: 28082047 DOI: 10.1016/j.jaut.2016.12.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/22/2016] [Accepted: 12/29/2016] [Indexed: 12/16/2022]
Abstract
CD8+ T cells have an emerging role in RA. Resent research indicates a causal relationship between the non-exhausted state of CD8+ T cells, defined by lost function of PD-1, and development of arthritis. We investigated how smoking contributes to the non-exhausted phenotype of CD8+ T cells and cause survivin release to serum. We compared serum survivin levels between smokers and non-smokers in 252 RA and 168 healthy subjects. Nicotine effects on CD8+ T cells were studied in peripheral blood of smoking women, bone marrow of nicotine treated mice and in sorted CD8 spleen cells in vitro using flow cytometry and quantitative PCR. Smoking increased the frequency of survivin release in serum of healthy women (OR 3.64, p = 0.025) and in RA patients (OR 1.98, p = 0.039). CD8+ T cells of smokers gained a non-exhausted PD-1 deficient phenotype. Expression of the cytotoxic marker CD107 correlated to survivin levels in serum. In the experimental setting, nicotine exposure led to an accumulation of non-exhausted PD-1-IL-7R+ CD8+ T cells in the bone marrow that is abundant with survivin producing cells. The production of the cytolytic protein perforin in bone marrow correlated to serum survivin levels. In vitro stimulation of nicotinic receptors on murine CD8+ T cells induced repressive transcription factors T-bet and Blimp-1 in support of the non-exhausted phenotype. We conclude that nicotine contributes to autoimmunity by supporting the non-exhausted state of CD8+ T cells resulting in the release of survivin. This presents a new mechanism by which smoking may contribute to the pathogenesis of RA.
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Affiliation(s)
- Caroline Wasén
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, The University of Gothenburg, Göteborg, Sweden.
| | - Minna Turkkila
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, The University of Gothenburg, Göteborg, Sweden.
| | - Apostolos Bossios
- The Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The University of Gothenburg, Göteborg, Sweden.
| | - Malin Erlandsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, The University of Gothenburg, Göteborg, Sweden.
| | - Karin M Andersson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, The University of Gothenburg, Göteborg, Sweden.
| | - Linda Ekerljung
- The Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The University of Gothenburg, Göteborg, Sweden.
| | - Carina Malmhäll
- The Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The University of Gothenburg, Göteborg, Sweden.
| | - Mikael Brisslert
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, The University of Gothenburg, Göteborg, Sweden.
| | - Sofia Töyrä Silfverswärd
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, The University of Gothenburg, Göteborg, Sweden.
| | - Bo Lundbäck
- The Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The University of Gothenburg, Göteborg, Sweden.
| | - Maria I Bokarewa
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, The University of Gothenburg, Göteborg, Sweden.
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Mechanisms leading from systemic autoimmunity to joint-specific disease in rheumatoid arthritis. Nat Rev Rheumatol 2016; 13:79-86. [PMID: 27974851 DOI: 10.1038/nrrheum.2016.200] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A key unanswered question in the pathophysiology of rheumatoid arthritis (RA) is how systemic autoimmunity progresses to joint-specific inflammation. In patients with seropositive RA (that is, characterized by the presence of autoantibodies) evidence is accumulating that immunity against post-translationally modified (such as citrullinated) autoantigens might be triggered in mucosal organs, such as the lung, long before the first signs of inflammation are seen in the joints. However, the mechanism by which systemic autoimmunity specifically homes to the joint and bone compartment, thereby triggering inflammation, remains elusive. This Review summarizes potential pathways involved in this joint-homing mechanism, focusing particularly on osteoclasts as the primary targets of anti-citrullinated protein antibodies (ACPAs) in the bone and joint compartment. Osteoclasts are dependent on citrullinating enzymes for their normal differentiation and are unique in displaying citrullinated antigens on their cell surface in a non-inflamed state. The binding of ACPAs to osteoclasts releases the chemokine IL-8, leading to bone erosion and pain. This process initiates a chain of events that could lead to attraction and activation of neutrophils, resulting in a complex series of proinflammatory processes in the synovium, eventually leading to RA.
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Scher JU, Joshua V, Artacho A, Abdollahi-Roodsaz S, Öckinger J, Kullberg S, Sköld M, Eklund A, Grunewald J, Clemente JC, Ubeda C, Segal LN, Catrina AI. The lung microbiota in early rheumatoid arthritis and autoimmunity. MICROBIOME 2016; 4:60. [PMID: 27855721 PMCID: PMC5114783 DOI: 10.1186/s40168-016-0206-x] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/02/2016] [Indexed: 05/09/2023]
Abstract
BACKGROUND Airway abnormalities and lung tissue citrullination are found in both rheumatoid arthritis (RA) patients and individuals at-risk for disease development. This suggests the possibility that the lung could be a site of autoimmunity generation in RA, perhaps in response to microbiota changes. We therefore sought to test whether the RA lung microbiome contains distinct taxonomic features associated with local and/or systemic autoimmunity. METHODS 16S rRNA gene high-throughput sequencing was utilized to compare the bacterial community composition of bronchoalveolar lavage fluid (BAL) in patients with early, disease-modifying anti-rheumatic drugs (DMARD)-naïve RA, patients with lung sarcoidosis, and healthy control subjects. Samples were further assessed for the presence and levels of anti-citrullinated peptide antibodies (including fine specificities) in both BAL and serum. RESULTS The BAL microbiota of RA patients was significantly less diverse and abundant when compared to healthy controls, but similar to sarcoidosis patients. This distal airway dysbiosis was attributed to the reduced presence of several genus (i.e., Actynomyces and Burkhordelia) as well as reported periodontopathic taxa, including Treponema, Prevotella, and Porphyromonas. While multiple clades correlated with local and systemic levels of autoantibodies, the genus Pseudonocardia and various related OTUs were the only taxa overrepresented in RA BAL and correlated with higher disease activity and erosions. CONCLUSIONS Distal airway dysbiosis is present in untreated early RA and similar to that detected in sarcoidosis lung inflammation. This community perturbation, which correlates with local and systemic autoimmune/inflammatory changes, may potentially drive initiation of RA in a proportion of cases.
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Affiliation(s)
- Jose U. Scher
- Division of Rheumatology, NYU School of Medicine, New York, NY USA
| | - Vijay Joshua
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Johan Öckinger
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Kullberg
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Eklund
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Grunewald
- Respiratory Medicine Unit, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jose C. Clemente
- Department of Genetics and Genomic Sciences, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Carles Ubeda
- Institute for Research in Public Health, Valencia, Spain
| | - Leopoldo N. Segal
- Division of Pulmonary and Critical Care Medicine, NYU School of Medicine, New York, NY USA
| | - Anca I. Catrina
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Kelmenson LB, Demoruelle MK, Deane KD. The Complex Role of the Lung in the Pathogenesis and Clinical Outcomes of Rheumatoid Arthritis. Curr Rheumatol Rep 2016; 18:69. [DOI: 10.1007/s11926-016-0618-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Turunen S, Huhtakangas J, Nousiainen T, Valkealahti M, Melkko J, Risteli J, Lehenkari P. Rheumatoid arthritis antigens homocitrulline and citrulline are generated by local myeloperoxidase and peptidyl arginine deiminases 2, 3 and 4 in rheumatoid nodule and synovial tissue. Arthritis Res Ther 2016; 18:239. [PMID: 27765067 PMCID: PMC5072303 DOI: 10.1186/s13075-016-1140-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/27/2016] [Indexed: 02/04/2023] Open
Abstract
Background Seropositive rheumatoid arthritis (RA) is characterized by autoantibodies binding to citrullinated and homocitrullinated proteins. We wanted to study the expression patterns of these disease-associated protein forms and if the rheumatoid nodule and synovial tissue itself contain biologically active levels of citrullinating peptidyl arginine deiminases 2, 3 and 4 and homocitrullination-facilitating neutrophil enzyme myeloperoxidase. Method Total of 195 synovial samples from metatarsal joints from five ACPA/RF-positive RA patients (n = 77), synovial samples from knees of eight seropositive RA (n = 60), seven seronegative RA (n = 33) and five osteoarthritis (n = 25) patients were analyzed for citrulline and homocitrulline contents using HPLC. The location of citrulline- and homocitrulline-containing proteins, PAD 2, 3, 4 and myeloperoxidase were shown by immunostaining. Myeloperoxidase and citrulline- or homocitrulline-containing proteins were stained on Western blot. Results Overall, necrosis was frequent in metatarsals of seropositive RA and absent in seronegative RA and osteoarthritis patients. In histological analysis, there was a significant local patterning and variation in the citrulline and homocitrulline content and it was highest in metatarsal synovial tissues of seropositive RA patients. We found peptidyl arginine deiminase 2, 3 and 4 in the lining and sublining layers of intact synovial tissue. Myeloperoxidase was found locally around necrotic areas. The tissues with necrosis contained the highest levels of citrulline and homocitrulline. Conclusions Rheumatoid nodules and synovia contain significant amount of PAD2, 3 and 4 and myeloperoxidase enzymes. These enzymes could explain the levels of citrulline and homocitrulline in seropositive RA synovial and rheumatoid nodule tissues especially around necrotic tissue.
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Affiliation(s)
- Sanna Turunen
- Department of Anatomy and Cell Biology, Cancer and Translational Medicine Research Unit, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.
| | - Johanna Huhtakangas
- Department of Anatomy and Cell Biology, Cancer and Translational Medicine Research Unit, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Division of Rheumatology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Tomi Nousiainen
- Division of Orthopedic Surgery, Oulu University Hospital, Oulu, Finland
| | | | - Jukka Melkko
- Department of Pathology, Cancer and Translational Medicine Research Unit, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha Risteli
- Department of Clinical Chemistry, Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland.,Northern Finland Laboratory Centre NordLab, Oulu University Hospital, Oulu, Finland
| | - Petri Lehenkari
- Department of Anatomy and Cell Biology, Cancer and Translational Medicine Research Unit, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.,Division of Orthopedic Surgery, Oulu University Hospital, Oulu, Finland
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Lataoui S, Belghali S, Zeglaoui H, Bouajina E, Ben Saad H. [Sub-maximal aerobic capacity and quality of life of patients with rheumatoid arthritis]. Rev Mal Respir 2016; 34:74-85. [PMID: 27639946 DOI: 10.1016/j.rmr.2016.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies about sub-maximal aerobic capacity of patients with rheumatoid arthritis are scarce. AIMS To assess the sub-maximal aerobic capacity of these patients through the 6-min walk test, estimated age of the "muscular and cardiorespiratory" chain. METHODS Thirty-seven consecutive patients (aged 20 to 60 years) with newly diagnosed rheumatoid arthritis will be included. Non-inclusion criteria will be: use of drugs (e.g.; methotrexate, beta-blockers), orthopaedic or rheumatologic conditions (other than rheumatoid arthritis) that may alter walking ability and recent infections. Exclusion criteria will be: 6-min walking test contra-indications and imperfect performance of the required lung function and walking maneuvers. Signs of walking intolerance will be: test interruption, distance ≤lower limit of normal, dyspnea score ≥5/10 (visual analogue scale) at the end of the test, haemoglobin oxygen saturation (SpO2) drop ≥5%, cardiac frequency at the end of the test ≤60% of maximum predicted. An estimated "muscular and cardiorespiratory chain" age higher than the chronological one will be considered as a sign of accelerated ageing. EXPECTED RESULTS A high percentage of patients suffering from rheumatoid arthritis would show evidences of walking limitation and accelerated "muscular and cardiorespiratory chain" ageing. There would be a significant correlation between the walking test and clinical, biological, radiological and pulmonary function data and the patients' quality-of-life status.
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Affiliation(s)
- S Lataoui
- Service de rhumatologie, hôpital universitaire Farhat Hached, 4031 Sousse, Tunisie
| | - S Belghali
- Service de rhumatologie, hôpital universitaire Farhat Hached, 4031 Sousse, Tunisie
| | - H Zeglaoui
- Service de rhumatologie, hôpital universitaire Farhat Hached, 4031 Sousse, Tunisie
| | - E Bouajina
- Service de rhumatologie, hôpital universitaire Farhat Hached, 4031 Sousse, Tunisie
| | - H Ben Saad
- Service de physiologie et explorations fonctionnelles, hôpital universitaire Farhat Hached, 4031 Sousse, Tunisie; Laboratoire de physiologie, faculté de médecine de Sousse, université de Sousse, 4000 Sousse, Tunisie.
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Elshafie AI, Elkhalifa AD, Elbagir S, Aledrissy MIE, Elagib EM, Nur MAM, Weitoft T, Rönnelid J. Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between Sudan and Sweden. J Rheumatol 2016; 43:1777-1786. [PMID: 27481904 DOI: 10.3899/jrheum.160303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare clinical characteristics and treatment between simultaneously investigated Sudanese and Swedish outpatients with rheumatoid arthritis (RA). METHODS Outpatients with RA from Sudan (n = 281) and Sweden (n = 542) diagnosed according to the 1987 American College of Rheumatology criteria were recruited between December 2008 and September 2010 and compared concerning clinical presentation, treatment, and laboratory findings, including immunoglobulin M with rheumatoid factor (IgM-RF). RESULTS Sudanese patients had lower inclusion age (median 49 vs 68 yrs), disease duration (48 vs 107 mos), and disease onset age (43 vs 56 yrs) as compared with Swedish patients (p < 0.0001 for all). When stratified concerning the age of inclusion, Swedish patients between 41-50 years had, however, a significantly lower age of onset, with a similar trend for all age groups above 30 years. The female preponderance was higher among Sudanese patients (89.3% vs 72.5%, p < 0.0001), and smoking was nonexistent among Sudanese female patients (p < 0.0001). Erythrocyte sedimentation rate levels and number of tender joints were significantly higher among Sudanese patients. The proportion of IgM-RF positivity was lower among Sudanese patients with RA (52.4% vs 75.5%, p < 0.0001). Higher proportions of Sudanese patients with RA were treated with methotrexate (MTX) and disease-modifying antirheumatic drug combinations, but none of them used biologics. Sudanese patients used lower doses of MTX and sulfasalazine (p < 0.0001) and higher doses of prednisolone (p < 0.0001) than Swedish patients. CONCLUSION Sudanese patients with RA have significantly higher disease activity and are often IgM-RF-seronegative. Together with reports from Uganda and Cameroon, our data indicate a cluster of highly active and often seronegative RA in central Africa.
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Affiliation(s)
- Amir I Elshafie
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University.
| | - Abdalla D Elkhalifa
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Sahwa Elbagir
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Mawahib I E Aledrissy
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Elnour M Elagib
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Musa A M Nur
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Tomas Weitoft
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Johan Rönnelid
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
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Sparks JA, Karlson EW. The Roles of Cigarette Smoking and the Lung in the Transitions Between Phases of Preclinical Rheumatoid Arthritis. Curr Rheumatol Rep 2016; 18:15. [PMID: 26951253 PMCID: PMC4941234 DOI: 10.1007/s11926-016-0563-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
While the etiology of rheumatoid arthritis (RA) remains to be fully elucidated, recent research has advanced the understanding of RA pathogenesis to the point where clinical trials for RA prevention are underway. The current paradigm for RA pathogenesis is that individuals progress through distinct preclinical phases prior to the onset of clinically apparent RA. These preclinical RA phases consist of genetic risk, local inflammation, presence of RA-related autoantibodies, asymptomatic systemic inflammation, and early non-specific symptoms prior to clinical seropositive RA. Epidemiologic studies have been important in forming hypotheses related to the biology occurring in preclinical RA. Specifically, studies associating cigarette smoking with overall RA risk as well as transitions between phases of preclinical RA were vital in helping to establish the lung as a potential important initiating site in the pathogenesis of seropositive RA. Herein, we review the epidemiology associating smoking with transitions in preclinical phases of RA as well as the recent literature supporting the lung as a critical site in RA pathogenesis.
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Affiliation(s)
- Jeffrey A. Sparks
- Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 20115, USA
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