1
|
Avalos-Salgado FA, Gonzalez-Lopez L, Gonzalez-Vazquez S, Ponce-Guarneros JM, Santiago-Garcia AP, Amaya-Cabrera EL, Arellano-Cervantes R, Gutiérrez-Aceves JA, Alcaraz-Lopez MF, Nava-Valdivia CA, Gonzalez-Ponce F, Rodriguez-Jimenez NA, Macias-Islas MA, Valdivia-Tangarife ER, Saldaña-Cruz AM, Cardona-Muñoz EG, Gamez-Nava JI. Risk Factors Associated with Adverse Events Leading to Methotrexate Withdrawal in Elderly Rheumatoid Arthritis Patients: A Retrospective Cohort Study. J Clin Med 2024; 13:1863. [PMID: 38610627 PMCID: PMC11012848 DOI: 10.3390/jcm13071863] [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: 02/15/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Rheumatoid arthritis (RA) in elderly population represents a challenge for physicians in terms of therapeutic management. Methotrexate (MTX) is the first-line treatment among conventional synthetic-disease-modifying anti-rheumatic drugs (cs-DMARDs); however, it is often associated with adverse events (AEs). Therefore, the objective of this study was to identify the incidence and risk factors of MTX discontinuation due to AEs in elderly patients with RA in a long-term retrospective cohort study. Methods: Clinical sheets from elderly RA patients taking MTX from an outpatient rheumatology consult in a university centre were reviewed. To assess MTX persistence, we used Kaplan-Meir curves and Cox regression models to identify the risk of withdrawing MTX due to adverse events. Results: In total, 198 elderly RA patients who reported using MTX were included. Of them, the rates of definitive suspension of MTX due to AEs were 23.0% at 5 years, 35.6% at 10 years and 51.7% at 15 years. The main organs and system involved were gastrointestinal (15.7%) and mucocutaneous (3.0%). Factors associated with withdrawing MTX due to AEs were MTX dose ≥ 15 mg/wk (adjusted HR: 2.46, 95% CI: 1.22-4.96, p = 0.012); instead, the folic acid supplementation was protective for withdrawal (adjusted HR: 0.28, 95% CI: 0.16-0.49, p < 0.001). Conclusions: Higher doses of MTX increase the risk of withdrawals in elderly RA, while folic acid supplementation reduces the risk. Therefore, physicians working in therapeutic management for elderly patients using MTX must focus on using lower MTX doses together with the concomitant prescription of folic acid.
Collapse
Affiliation(s)
- Felipe Alexis Avalos-Salgado
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
| | - Laura Gonzalez-Lopez
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Programa de Maestria Salud Publica, Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Sergio Gonzalez-Vazquez
- Hospital General Regional 110, Instituto Mexicano del Seguro Social, Guadalajara 44716, Mexico
| | - Juan Manuel Ponce-Guarneros
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 97, Magdalena 46474, Mexico
| | - Aline Priscilla Santiago-Garcia
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
| | | | - Reynaldo Arellano-Cervantes
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - J. Ahuixotl Gutiérrez-Aceves
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
| | - Miriam Fabiola Alcaraz-Lopez
- Departamento de Medicina Interna-Reumatología, Hospital General Regional Núm. 46, Instituto Mexicano del Seguro Social, Guadalajara 44910, Mexico
| | - Cesar Arturo Nava-Valdivia
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Fabiola Gonzalez-Ponce
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
| | - Norma Alejandra Rodriguez-Jimenez
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Miguel Angel Macias-Islas
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (M.A.M.-I.)
| | - Edgar Ricardo Valdivia-Tangarife
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (M.A.M.-I.)
| | - Ana Miriam Saldaña-Cruz
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Ernesto German Cardona-Muñoz
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Jorge Ivan Gamez-Nava
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (F.A.A.-S.); (J.A.G.-A.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico (F.G.-P.); (N.A.R.-J.); (E.G.C.-M.)
- Programa de Maestria Salud Publica, Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| |
Collapse
|
2
|
Xv Z, Xv X, Chen N, Yuan J, Li J, Wang L, Yu S, Li G, Ding M, Zong M, Fan L. Soluble signal inhibitory receptor on leukocytes-1 reflects disease activity and assists diagnosis of patients with rheumatoid arthritis. Clin Chim Acta 2024; 556:117808. [PMID: 38309555 DOI: 10.1016/j.cca.2024.117808] [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: 10/04/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND SIRL-1, an immunosuppressive receptor encoded by the VSTM1 gene, has recently been linked to rheumatoid arthritis (RA) due to its association with activated polymorphonuclear neutrophils (PMNs). Considering that the activated PMNs play a crucial role in the pathogenesis of rheumatoid arthritis (RA), we aimed to measure the levels of soluble SIRL-1, investigating whether they add value to RA in the clinical diagnosis. METHODS Utilizing an enzyme-linked immunosorbent assay, the concentration of sSIRL-1 was measured in serum samples from cohort 1 diagnosed with RA (n = 96), gout (n = 54), osteoarthritis (n = 47), healthy controls (n = 86) and synovial fluid samples from OA (n = 8) and RA (n = 8) patients, respectively. Additionally, an external validation in cohort 2 (n = 156) comprising various inflammatory diseases was employed. RESULTS The study revealed a distinctive upregulation of sSIRL-1 in the serum of RA compared to HC and other arthralgia diseases (p < 0.0001), which also displayed a significant elevation in synovial fluid from RA compared to OA (p < 0.05). Notably, sSIRL-1 levels exhibited a significant decrease in patients who achieved disease remission (p < 0.05). Furthermore, the diagnostic accuracy of RA was enhanced when sSIRL-1 was combined with anti-CCP and RF, yielding an impressive AUC value of 0.950. CONCLUSION The expression pattern of sSIRL-1 in RA, coupled with its correlation with disease activity, underscores its potential clinical utility for both diagnosis and disease monitoring in RA patients. This study offers valuable insights into the evolving diagnostic landscape of RA.
Collapse
Affiliation(s)
- Zhen Xv
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Xuejing Xv
- Department of Clinical Laboratory, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University, Nanjing, People's Republic of China
| | - Nianzhen Chen
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Jiayi Yuan
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Jing Li
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Lan Wang
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Shanshan Yu
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Gen Li
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Menglei Ding
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China
| | - Ming Zong
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China.
| | - Lieying Fan
- Department of Clinical Laboratory, The Affiliated East Hospital of Tongji University, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, People's Republic of China.
| |
Collapse
|
3
|
Avagimyan A, Fogacci F, Pogosova N, Kakturskiy L, Jndoyan Z, Faggiano A, Bairamyan T, Agati L, Sattar Y, Mkrchyan L, Avetisyan G, Ginosyan K, Aznauryan A, Sahakyan K, Trofimenko A, Urazova O, Mikhaleva L, Vandysheva R, Kogan E, Demura T, Kc M, Shafie D, Nicola S, Brussino L, Cicero A, Biondi-Zoccai G, Sarrafzadegan N. Methotrexate & rheumatoid arthritis associated atherosclerosis: A narrative review of multidisciplinary approach for risk modification by the international board of experts. Curr Probl Cardiol 2024; 49:102230. [PMID: 38040221 DOI: 10.1016/j.cpcardiol.2023.102230] [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: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
Rheumatoid arthritis (RA) is an idiopathic, autoimmune connective tissue disorder that primarily affects the synovial joints, causing symmetric, erosive-deforming polyarthritis. It is also associated with extra-articular manifestations, particularly cardiovascular (CV) diseases (CVD). CV risk modification in RA remains unsolved despite recent advances in the management of RA. RA is an independent risk factor for atherosclerosis. RA and atherosclerosis share similar pathophysiological features (such as the pro-inflammatory cascade activation including interleukin-6) and risk factors (such as microflora dysbacteriosis and smoking). Patients with RA experience an exacerbation of atherogenesis, with atheromas destabilization, endothelial dysfunction, vasculitis, and hypercytokinemia. Consequently, the inflammatory response associated with RA is the basis for CVD development. The treat-to-target strategy not only improved RA control but also had a favorable effect on the morpho-functional state of the CV system in patients living with RA. Thus, disease-modifying antirheumatic drugs (DMARDs) - in particular methotrexate - may have a beneficial effect on the prevention of CV events in RA. It must be mentioned that RA is a serious multi-system disease, not only because of a window period during which the course of RA can be reversed, but also due to early damage to the heart and blood vessels. For this reason, a thorough cardiological assessment must be performed for all patients with RA, regardless of sex, age, disease stage, and disease activity score.
Collapse
Affiliation(s)
- Ashot Avagimyan
- MD, PhD, Assistant Professor, Department of Anatomical Pathology and Clinical Morphology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.
| | - Federica Fogacci
- MD, Research Fellow, Atherosclerosis and Metabolic Disorders Research Unit, University of Bologna, Bologna, Italy
| | - Nana Pogosova
- MD, PhD, Professor, Head of Laboratory of Preventive Cardiology, Deputy Director for Science and Preventive Cardiology, National Medical Research Center of Cardiology named after academician E. Chazov, Moscow, Russia
| | - Lev Kakturskiy
- MD, Ph.D, Scientific Director, A. P. Avtsyn Research Institute of Human Morphology of Petrovskiy NRCS, Moscow, Russia
| | - Zinaida Jndoyan
- MD, PhD, Head of Internal Diseases Propaedeutic Department, Head of Internal Medicine Unit of University Clinical Hospital, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Andrea Faggiano
- MD, PhD, Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Italy; Department of Clinical Sciences and Community Health, University of Milano, Italy
| | - Tamara Bairamyan
- MD, PhD, Associate Professor, Department of Rheumatology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Luciano Agati
- MD, PhD, Head of Cardiology Unit Aziendo Umberto II, Department of Cardiology, La Sapienza University of Rome, Rome, Italy
| | - Yasar Sattar
- MD, Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Lusine Mkrchyan
- MD, PhD, Associate Professor, Department of Cardiology, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Gayane Avetisyan
- MD, PhD, Associate Professor, Department of Topographical Anatomy and Operative Surgery, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Knarik Ginosyan
- MD, PhD, Head of Rheumatology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Anahit Aznauryan
- PhD, Associate Professor, Histology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Karmen Sahakyan
- PhD, Professor, Head of Histology Department, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Artem Trofimenko
- MD, PhD, Associate Professor, Department of Pathophysiology, Kuban State Medical University, Krasnodar, Russia
| | - Olga Urazova
- MD, PhD, Professor, Head of Pathophysiology Department, Siberian State Medical University, Tomsk, Russia
| | - Liudmila Mikhaleva
- MD, PhD, Director, A. P. Avtsyn Research Institute of Human Morphology of Petrovskiy NRCS, Moscow, Russia
| | - Rositsa Vandysheva
- MD, PhD, A. P. Avtsyn Research Institute of Human Morphology of Petrovskiy NRCS, Moscow, Russia
| | - Eugenia Kogan
- MD, PhD, Professor, Head of Anatomical Pathology Department, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Tatiana Demura
- MD, PhD, Professor, Director of Institute of Clinical Morphology and Digital Pathology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Manish Kc
- MD, North Alabama Medical Centre, Florence, Alabama, USA
| | - Davood Shafie
- MD, PhD, Director of Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Stefania Nicola
- MD, PhD, Immunology and Allergy Unit, AO Ordine Mauriziano di Torino and Department of Medical Sciences, University of Turin, Italy
| | - Luisa Brussino
- MD, PhD, Director of the Allergy and Immunology unit AO Ordine Mauriziano di Torino - Department of Medical Sciences, University of Turin, Italy
| | - Arrigo Cicero
- MD, PhD, Professor, Atherosclerosis and Metabolic Disorders Research Unit, University of Bologna, Bologna, Italy
| | - Giuseppe Biondi-Zoccai
- MD, PhD, Professor, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Nizal Sarrafzadegan
- MD, Professor, Director of Isfahan Cardiovascular Research Center (WHO Collaboration Center), Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
4
|
Rajendran K, Pahal S, Badnikar K, Nayak MM, Subramanyam DN, Vemula PK, Krishnan UM. Methotrexate delivering microneedle patches for improved therapeutic efficacy in treatment of rheumatoid arthritis. Int J Pharm 2023; 642:123184. [PMID: 37379893 DOI: 10.1016/j.ijpharm.2023.123184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/11/2023] [Accepted: 06/25/2023] [Indexed: 06/30/2023]
Abstract
Arthritis is an inflammatory disorder that leads to degeneration and swelling in the joints thereby severely affecting mobility. Till date, a complete cure for this disorder remains elusive. Administration of disease modifying anti-rheumatic drugs has not proved effective owing to poor retention of drugs at the site of inflammation in the joints. In most cases, lack of adherence to the therapeutic regimen further aggravates the condition. Localized administration of the drugs through intra-articular injections is highly invasive and painful. A possible solution to overcome these issues will be to ensure sustained release of the anti-arthritic drug at the site of inflammation through a minimally invasive method. The present work focuses on the development of a microneedle patch for localized and minimally invasive delivery of methotrexate to arthritic joints in guinea pig model. The microneedle patch was found to elicit minimal immune response and ensured sustained release of the drug that was manifested through faster restoration of mobility and a distinct reduction in inflammatory and rheumatoid markers at the joints when compared to untreated and those treated through conventional hypodermic injections. Our results demonstrate the promise of microneedle-based platform for an effective arthritic therapy.
Collapse
Affiliation(s)
- Kayalvizhi Rajendran
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), SASTRA Deemed University, Thanjavur 613401, India; School of Chemical & Biotechnology (SCBT), SASTRA Deemed University, Thanjavur 613401, India
| | - Suman Pahal
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK Post, Bengaluru 560065, India
| | - Kedar Badnikar
- Mechatronics Lab, Department of Electronic System Engineering, Indian Institute of Science, Bengaluru 560012, Karnataka, India
| | - Manjunatha M Nayak
- Centre for Nanoscience and Engineering, Indian Institute of Science, Bengaluru, 560012, Karnataka, India
| | - Dinesh N Subramanyam
- Mechatronics Lab, Department of Electronic System Engineering, Indian Institute of Science, Bengaluru 560012, Karnataka, India
| | - Praveen K Vemula
- Institute for Stem Cell Science and Regenerative Medicine (inStem), GKVK Post, Bengaluru 560065, India
| | - Uma Maheswari Krishnan
- Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), SASTRA Deemed University, Thanjavur 613401, India; School of Chemical & Biotechnology (SCBT), SASTRA Deemed University, Thanjavur 613401, India; School of Arts, Sciences, Humanities & Education (SASHE), SASTRA Deemed University, Thanjavur 613401, India.
| |
Collapse
|
5
|
Kamiya H, Panlaqui OM. Systematic review and meta-analysis of the risk of rheumatoid arthritis-associated interstitial lung disease related to anti-cyclic citrullinated peptide (CCP) antibody. BMJ Open 2021; 11:e040465. [PMID: 33789847 PMCID: PMC8016072 DOI: 10.1136/bmjopen-2020-040465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To clarify the risk of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) related to anti-cyclic citrullinated peptide (CCP) antibody. ELIGIBILITY CRITERIA Patients with RA with and without ILD were eligible. The primary outcome was the prevalence or incidence of ILD. Primary studies of any design aside from a case report were eligible. INFORMATION SOURCES Medline, EMBASE, Science Citation Index Expanded and Cochrane Central Register of Controlled Trials were searched from the inception through 12 November 2019. DATA EXTRACTION AND RISK OF BIAS Two reviewers independently selected eligible reports, extracted relevant data and assessed risk of bias using a modified Quality in Prognostic Studies tool. DATA SYNTHESIS Meta-analysis was conducted using a random-effects model. QUALITY OF EVIDENCE The Grades of Recommendation, Assessment, Development and Evaluation system was applied. RESULTS Among 29 out of 827 records retrieved through electronic databases and four additional reports identified from other sources, 29 studies were focused for the review. A total of 10158 subjects were included and the mean age at inclusion was between 45.8 and 63.9 years. The mean RA duration was between 4.3 and 14.9 years. The positivity of anti-CCP antibody ranged from 50.7% to 95.8%. All studies except for two were deemed as high risk of bias. A pooled analysis of univariate results demonstrated that the presence of anti-CCP antibody was significantly associated with RA-ILD with an OR of 2.10 (95% CI: 1.59 to 2.78). Similarly, the titre of anti-CCP antibody was significantly higher for RA-ILD with a standardised mean difference of 0.42 (95% CI: 0.20 to 0.65). These results were confirmed by multivariate analysis in the majority of studies and consistent by any subgroup and sensitivity analyses. CONCLUSION The presence and higher titres of anti-CCP antibody were suggested to be significantly associated with an increased risk of RA-ILD. However, the quality of evidence was rated as low or very low.
Collapse
Affiliation(s)
- Hiroyuki Kamiya
- Department of Respiratory Medicine, Tatebayashi Kosei Hospital, Tatebayashi, Gunma, Japan
| | - Ogee Mer Panlaqui
- Department of Intensive Care Medicine, Northern Hospital, Epping, Victoria, Australia
| |
Collapse
|
6
|
A sequencing study of CTLA4 in Pakistani rheumatoid arthritis cases. PLoS One 2020; 15:e0239426. [PMID: 32946523 PMCID: PMC7500603 DOI: 10.1371/journal.pone.0239426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 09/04/2020] [Indexed: 11/19/2022] Open
Abstract
Rheumatoid arthritis (RA) is a multifactorial autoimmune disease. The interaction of genetic and environmental factors is likely necessary for RA. Among potential genetic factors, many major histocompatibility complex (MHC) and non-MHC variants may be involved in RA susceptibility. CTLA4 is involved in the regulation of T-cell response during an immune reaction, and multiple CTLA4 single nucleotide polymorphisms (SNPs) have been associated with numerous autoimmune diseases, including RA. To our knowledge, the genetic association of CTLA4 with RA risk has not been examined previously in the Pakistani population. In this study, we sequenced the entire CTLA4 gene and flanking regions in 95 Pakistani RA cases followed the screening of identified variants in Study 1 sample consisting of 350 RA cases and controls. Four common significant variants identified in Study 1 sample were further examined in a larger Study 2 replication sample comprising 1,678 independent RA cases and controls. We report significant associations of three variants from the combined analysis: rs3087243 (OR = 1.26, p = 4.47E-03), rs5742909 (OR = 1.78, p = 4.60E-03), and rs11571319 (OR = 1.48, p = 6.64E-03); the latter is a novel association in the Pakistani sample.
Collapse
|
7
|
EBNA1 IgM-Based Discrimination Between Rheumatoid Arthritis Patients, Systemic Lupus Erythematosus Patients and Healthy Controls. Antibodies (Basel) 2019; 8:antib8020035. [PMID: 31544841 PMCID: PMC6640720 DOI: 10.3390/antib8020035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022] Open
Abstract
Epstein-Barr Virus (EBV) has been associated with development of rheumatic connective tissue diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in genetically susceptible individuals. Diagnosis of RA and SLE relies on clinical criteria in combination with the presence of characteristic autoantibodies. In addition, antibodies to several EBV antigens have been shown to be elevated in patients with these diseases compared to healthy controls (HC). Here, we elaborated improved enzyme-linked immunosorbent assays for antibodies (IgM, IgA, IgG) to the EBV proteins Epstein-Barr Virus nuclear antigen (EBNA)1 and early antigen diffuse (EAD) in order to determine their potential diagnostic role. We showed that especially EBNA1 IgM distinguished RA from SLE and HCs and also distinguished SLE from HCs. EBNA1 IgA was almost as effective in differentiating RA from SLE and HC, while EAD IgG and IgA were able to discern SLE patients from RA patients and HCs. Collectively, these findings illustrate the potential diagnostic use of antibodies to EBV proteins to diagnose RA and to differentiate SLE from RA.
Collapse
|