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Ghozzi M, Mankai A, Zneidi I, Manoubi W, Melayah S, Mechi F, Trabelsi A, Ghedira I. Serological markers of rheumatoid arthritis in patients with primary biliary cholangitis and the vice versa: A Tunisian study. Immunobiology 2023; 228:152398. [PMID: 37269587 DOI: 10.1016/j.imbio.2023.152398] [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: 02/09/2023] [Revised: 04/14/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Primary biliary cholangitis (PBC) is an autoimmune disease of the liver characterized by destructive lymphocytic cholangitis and anti-mitochondrial antibodies (AMA). Anti-gp210 and anti-Sp100, are used for the diagnosis of PBC in AMA-negative PBC patients. Patients with PBC have a propensity to have an extrahepatic manifestation which is especially autoimmune. OBJECTIVE We aimed to determine the frequency of serological markers of rheumatoid arthritis (RA) (CCP-Ab or RF) in PBC patients and to do the vice versa. METHODS Our PBC study included 70 patients with PBC and 80 healthy blood donors (HBD) and our RA study included 75 patients with RA and 75 HBD. Anti-cyclic citrullinated peptide antibodies (CCP-Ab) and rheumatoid factor (RF) were performed by indirect ELISA. AMA, anti-Sp100 and anti-gp210 were determined by indirect immunofluorescence. RESULTS RA autoantibodies (CCP-Ab or RF) were more frequent in PBC patients than in HBD (65.7% vs. 8.7% p 〈10-6). CCP-Ab were significantly more frequent in patients than in controls (15.7% vs. 2.5%; p = 0.004). Nine patients had both CCP-Ab and RF vs. none of controls (12.8% vs. 0%; p = 0.001). RF were detected in 45 patients with PBC and in 5 HBD (64.3% vs. 6.2%; p 〈10-6). In PBC patients, RF were more frequent than CCP-Ab (64.3% vs. 15.7%; p 〈10-6). RF-IgG were present in 18.5% of patients; RF-immunoglobulin (Ig) A in 34.3% and RF-IgM in 54.3%. These frequencies were significantly higher than those found in control group (1.2% for RF-IgG (p 〈10-3); 0% for RF-IgA (p 〈10-6); and 6.2% for RF-IgM (p 〈10-6)). In our PBC patients, RF-IgA were more frequent than RF-IgG (34.3% vs. 18.5%; p = 0.03) and than CCP-Ab (34.3% vs. 15.7%; p = 0.01). Six patients had only RF-IgA versus none of the control group (8.6% vs. 0%; p = 0.01). AMA, anti-Sp100 and anti-gp 210 were absent in all RA patients. CONCLUSIONS Serological markers of RA were more frequent in PBC patients than in HBD and the vice versa was not true.
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Affiliation(s)
- Mariam Ghozzi
- Laboratory of Immunology, Farhat Hached University Hospital, Sousse, Tunisia; Faculty of Pharmacy, Department of Immunology, University of Monastir, Monastir, Tunisia; Research Laboratory for "Epidemiology and Immunogenetics of Viral Infections" (LR14SP02), Sahloul University Hospital, University of Sousse, Sousse, Tunisia.
| | - Amani Mankai
- High School of Sciences and Techniques of Health, Tunis El Manar University, Tunis, Tunisia; Research Unit "Obesity: Etiopathology and Treatment, UR18ES01", National Institute of Nutrition and Food Technology, Tunis, Tunisia
| | - Inssaf Zneidi
- Faculty of Pharmacy, Department of Immunology, University of Monastir, Monastir, Tunisia
| | - Wiem Manoubi
- Erasmus University Medical Centre, Department of Neuroscience, Rotterdam, Netherlands
| | - Sarra Melayah
- Laboratory of Immunology, Farhat Hached University Hospital, Sousse, Tunisia; Faculty of Pharmacy, Department of Immunology, University of Monastir, Monastir, Tunisia; LR12SP11, Biochemistry Department, Sahloul University Hospital, Sousse, Tunisia
| | - Fatma Mechi
- Laboratory of Immunology, Farhat Hached University Hospital, Sousse, Tunisia; Faculty of Pharmacy, Department of Immunology, University of Monastir, Monastir, Tunisia
| | - Abdelhalim Trabelsi
- Research Laboratory for "Epidemiology and Immunogenetics of Viral Infections" (LR14SP02), Sahloul University Hospital, University of Sousse, Sousse, Tunisia; Laboratory of Microbiology and Virology, Sahloul University Hospital, Sousse, Tunisia
| | - Ibtissem Ghedira
- Laboratory of Immunology, Farhat Hached University Hospital, Sousse, Tunisia; Faculty of Pharmacy, Department of Immunology, University of Monastir, Monastir, Tunisia
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Melayah S, Ghozzi M, Mankaï A, Mechi F, Ghedira I. Frequency of serological markers of rheumatoid arthritis in patients with IgA anti-β2 glycoprotein I antibodies. J Clin Lab Anal 2022; 36:e24537. [PMID: 35666694 PMCID: PMC9279944 DOI: 10.1002/jcla.24537] [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: 03/16/2022] [Revised: 04/28/2022] [Accepted: 05/22/2022] [Indexed: 11/11/2022] Open
Abstract
Aim To determine the frequency of serological markers of RA in patients with anti‐β2 glycoprotein I antibodies (aβ2GPI) of IgA isotype. Material and Methods A retrospective study was conducted on 67 patients with aβ2GPI‐IgA. Ninety healthy blood donors (HBD) were used as a control group. IgG anti‐cyclic citrullinated peptides antibodies (CCP‐Ab) and rheumatoid factors (RF) IgG, IgA, and IgM were detected by enzyme‐linked immunosorbent assay (ELISA). Results Seventeen patients and eight HBD had CCP‐Ab and/or RF (25.4% vs. 8.9%, p = 0.005, CI 95% [14.95; 35.79], odds ratio = 3.5). The frequency of CCP‐Ab was significantly higher in patients than in healthy subjects (14.9% vs. 3.3%, p = 0.009). IgA isotype of RF was significantly higher in patients than in controls (7.5% vs. 0%, p = 0.02). In male patients, CCP‐Ab and/or RF were more frequent than in healthy male subjects (37.5% vs. 11.8%, p = 0.02). In patients, no correlation was found between the levels of aβ2GPI‐IgA and CCP‐Ab (r = 0.082, p = 0.51). There was no correlation between the level aβ2GPI‐IgA and the level of the isotypes of RF (IgG, IgA, and IgM) in patients (r = 0.1, p = 0.37; r = 0.17, p = 0.17 and r = 0.07, p = 0.59 respectively). Conclusion Frequencies of CCP‐Ab and RF are high in patients with aβ2GPI‐IgA suggesting that these patients are susceptible to developing RA.
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Affiliation(s)
- Sarra Melayah
- Laboratory of Immunology, Farhat Hached Hospital, Sousse, Tunisia.,Department of Immunology, Faculty of Pharmacy, Monastir University, Monastir, Tunisia.,LR12SP11, Biochemistry Department, Sahloul University Hospital, Sousse, Tunisia
| | - Mariem Ghozzi
- Laboratory of Immunology, Farhat Hached Hospital, Sousse, Tunisia.,Department of Immunology, Faculty of Pharmacy, Monastir University, Monastir, Tunisia.,Research Unit "Epidemiology and Immunogenetics of Viral Infections, LR14SP02", Sahloul University Hospital, Sousse, Tunisia
| | - Amani Mankaï
- Laboratory of Immunology, Farhat Hached Hospital, Sousse, Tunisia.,High School of Sciences and Techniques of Health, Tunis El Manar University, Tunis, Tunisia.,Research Unit "Obesity: Etiopathology and Treatment, UR18ES01", National Institute of Nutrition and Food Technology, Tunis, Tunisia
| | - Fatma Mechi
- Laboratory of Immunology, Farhat Hached Hospital, Sousse, Tunisia.,Department of Immunology, Faculty of Pharmacy, Monastir University, Monastir, Tunisia
| | - Ibtissem Ghedira
- Laboratory of Immunology, Farhat Hached Hospital, Sousse, Tunisia.,Department of Immunology, Faculty of Pharmacy, Monastir University, Monastir, Tunisia
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Ebel AV, Lutt G, Poole JA, Thiele GM, Baker JF, Cannon GW, Gaffo A, Kerr GS, Reimold A, Schwab P, Singh N, Richards JS, Ascherman DP, Mikuls TR, England BR. Association of Agricultural, Occupational, and Military Inhalants With Autoantibodies and Disease Features in US Veterans With Rheumatoid Arthritis. Arthritis Rheumatol 2021; 73:392-400. [PMID: 33058561 PMCID: PMC8236239 DOI: 10.1002/art.41559] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/02/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the association of inhalant exposures with rheumatoid arthritis (RA)-related autoantibodies and severity in US veterans. METHODS Participants in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were mailed surveys assessing occupational, agricultural, and military inhalant exposures. Demographic characteristics, disease activity, functional status, and extraarticular features were obtained from the VARA registry, while HLA-DRB1 shared epitope (SE) status, anti-cyclic citrullinated peptide (anti-CCP) antibodies, and rheumatoid factor (RF) were measured using banked DNA/serum from enrollment. Associations between inhalant exposures and RA-related factors (autoantibodies, severity, and extraarticular features) were assessed using multivariable linear and logistic regression models adjusted for age, sex, race, and tobacco use and stratified by SE status. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS Questionnaires were returned by 797 of 1,566 participants (50.9%). Survey respondents were older, more often White or male, and less frequently smokers, and had lower disease activity compared to nonrespondents. Anti-CCP positivity was more common among veterans exposed to burn pits (OR 1.66 [95% CI 1.02, 2.69]) and military waste disposal (OR 1.74 [95% CI 1.04, 2.93]) independent of other factors. Among participants who were positive for SE alleles, burn pit exposure (OR 5.69 [95% CI 2.73, 11.87]) and military waste disposal exposure (OR 5.05 [95% CI 2.42, 10.54]) were numerically more strongly associated with anti-CCP positivity. Several inhalant exposures were associated with the presence of chronic lung disease, but not with the presence of RF or the level of disease activity. CONCLUSION Military burn pit exposure and military waste disposal exposure were independently associated with the presence of anti-CCP antibodies in RA patients. These findings are consistent with emerging evidence that various inhalant exposures influence autoantibody expression and RA risk.
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Affiliation(s)
- Ariadne V. Ebel
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Gabrielle Lutt
- Gabrielle Lutt: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, and University of Nebraska Lincoln
| | - Jill A. Poole
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Geoffrey M. Thiele
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Joshua F. Baker
- Joshua F. Baker, MD, MSCE: Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia
| | - Grant W. Cannon
- Grant W. Cannon, MD: VA Salt Lake City Health Care System and University of Utah, Salt Lake City
| | - Angelo Gaffo
- Angelo Gaffo, MD, MSPH: Birmingham VA Medical Center and University of Alabama at Birmingham
| | - Gail S. Kerr
- Gail S. Kerr, MD: Washington, DC VA Medical Center, Georgetown University, and Howard University, Washington, DC
| | - Andreas Reimold
- Andreas Reimold, MD: Dallas VA Medical Center and University of Texas Southwestern, Dallas
| | - Pascale Schwab
- Pascale Schwab, MD: VA Portland Healthcare System and Oregon Health & Science University, Portland
| | - Namrata Singh
- Namrata Singh, MD, MSCI: University of Washington, Seattle
| | - J. Steuart Richards
- J. Steuart Richards, MBBS, Dana P. Ascherman, MD: VA Pittsburgh Health Care and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dana P. Ascherman
- J. Steuart Richards, MBBS, Dana P. Ascherman, MD: VA Pittsburgh Health Care and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ted R. Mikuls
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Bryant R. England
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
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Reed E, Hedström AK, Hansson M, Mathsson-Alm L, Brynedal B, Saevarsdottir S, Cornillet M, Jakobsson PJ, Holmdahl R, Skriner K, Serre G, Alfredsson L, Rönnelid J, Lundberg K. Presence of autoantibodies in "seronegative" rheumatoid arthritis associates with classical risk factors and high disease activity. Arthritis Res Ther 2020; 22:170. [PMID: 32678001 PMCID: PMC7364538 DOI: 10.1186/s13075-020-02191-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/22/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is classified as seropositive or seronegative, depending on the presence/absence of rheumatoid factor (RF), primarily IgM RF, and/or anti-citrullinated protein antibodies (ACPA), commonly detected using anti-cyclic citrullinated peptide (CCP) assays. Known risk factors associate with the more severe seropositive form of RA; less is known about seronegative RA. Here, we examine risk factors and clinical phenotypes in relation to presence of autoantibodies in the RA subset that is traditionally defined as seronegative. METHODS Anti-CCP2 IgG, 19 ACPA fine-specificities, IgM/IgG/IgA RF, anti-carbamylated-protein (CarP) antibodies, and 17 other autoantibodies, were analysed in 2755 RA patients and 370 controls. Antibody prevalence, levels, and co-occurrence were examined, and associations with risk factors and disease activity during 5 years were investigated for different antibody-defined RA subsets. RESULTS Autoantibodies were detected in a substantial proportion of the traditionally defined seronegative RA subset, with ACPA fine-specificities found in 30%, IgA/IgG RF in 9.4%, and anti-CarP antibodies in 16%, with a 9.6% co-occurrence of at least two types of RA-associated autoantibodies. HLA-DRB1 shared epitope (SE) associated with the presence of ACPA in anti-CCP2-negative RA; in anti-CCP2-positive RA, the SE association was defined by six ACPA fine-specificities with high co-occurrence. Smoking associated with RF, but not with ACPA, in anti-CCP2-negative RA. Presence of ACPA and RF, but not anti-CarP antibodies, in conventionally defined "seronegative" RA, associated with worse clinical outcome. CONCLUSIONS "Seronegative" RA is not truly a seronegative disease subset. Additional screening for ACPA fine-specificities and IgA/IgG RF defines a group of patients that resembles seropositive patients with respect to risk factors and clinical picture and may contribute to earlier diagnosis for a subset of anti-CCP2-/IgM RF- patients with a high need for active treatment.
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Affiliation(s)
- Evan Reed
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, CMM L8:04, 171 76, Stockholm, Sweden
| | - Anna Karin Hedström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Monika Hansson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, CMM L8:04, 171 76, Stockholm, Sweden
| | - Linda Mathsson-Alm
- Thermo Fisher Scientific, Uppsala, Sweden
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Boel Brynedal
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Saedis Saevarsdottir
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, CMM L8:04, 171 76, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Martin Cornillet
- Unité Différenciation Epithéliale et Autoimmunité Rhumatoïde, Université de Toulouse-INSERM UMR 1056, Toulouse, France
| | - Per-Johan Jakobsson
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, CMM L8:04, 171 76, Stockholm, Sweden
| | - Rikard Holmdahl
- Section for Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Karl Skriner
- Department of Rheumatology and Clinical Immunology, Charité University, Berlin, Germany
| | - Guy Serre
- Unité Différenciation Epithéliale et Autoimmunité Rhumatoïde, Université de Toulouse-INSERM UMR 1056, Toulouse, France
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Johan Rönnelid
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Karin Lundberg
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, CMM L8:04, 171 76, Stockholm, Sweden.
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Gianfrancesco MA, Trupin L, Shiboski S, van der Laan M, Graf J, Imboden J, Yazdany J, Schmajuk G. Smoking Is Associated with Higher Disease Activity in Rheumatoid Arthritis: A Longitudinal Study Controlling for Time-varying Covariates. J Rheumatol 2018; 46:370-375. [PMID: 30504507 DOI: 10.3899/jrheum.180262] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Prior studies around the relationship between smoking and rheumatoid arthritis (RA) disease activity have reported inconsistent findings, which may be ascribed to heterogeneous study designs or biases in statistical analyses. We examined the association between smoking and RA outcomes using statistical methods that account for time-varying confounding and loss to followup. METHODS We included 282 individuals with an RA diagnosis using electronic health record data collected at a public hospital between 2013 and 2017. Current smoking status and disease activity were assessed at each visit; covariates included sex, race/ethnicity, age, obesity, and medication use. We used longitudinal targeted maximum likelihood estimation to estimate the causal effect of smoking on disease activity measures at 27 months, and compared results to conventional longitudinal methods. RESULTS Smoking was associated with an increase of 0.64 units in the patient global score compared to nonsmoking (p = 0.01), and with 2.58 more swollen joints (p < 0.001). While smoking was associated with a higher clinical disease activity score (2.11), the difference was not statistically significant (p = 0.22). We found no association between smoking and physician global score, or C-reactive protein levels, and an inverse association between smoking and tender joint count (p = 0.05). Analyses using conventional methods showed a null relationship for all outcomes. CONCLUSION Smoking is associated with higher levels of disease activity in RA. Causal methods may be useful for investigations of additional exposures on longitudinal outcome measures in rheumatologic disease.
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Affiliation(s)
- Milena A Gianfrancesco
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA. .,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA.
| | - Laura Trupin
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Stephen Shiboski
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Mark van der Laan
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jonathan Graf
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - John Imboden
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jinoos Yazdany
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
| | - Gabriela Schmajuk
- From the Division of Rheumatology, Department of Medicine, University of California, San Francisco, California, USA.,M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; S. Shiboski, PhD, Department of Epidemiology and Biostatistics, University of California, San Francisco; M. van der Laan, PhD, Division of Biostatistics, School of Public Health, University of California, Berkeley; J. Graf, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Imboden, MD, Division of Rheumatology, Department of Medicine, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, Department of Medicine, University of California, San Francisco; G. Schmajuk, MD, MS, Division of Rheumatology, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California, USA
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Koslow M, Young JR, Yi ES, Baqir M, Decker PA, Johnson GB, Ryu JH. Rheumatoid pulmonary nodules: clinical and imaging features compared with malignancy. Eur Radiol 2018; 29:1684-1692. [PMID: 30288558 DOI: 10.1007/s00330-018-5755-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/28/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objective of this study was to identify clinical and imaging features that distinguish rheumatoid lung nodules from malignancy. METHODS We conducted a retrospective review of 73 rheumatoid patients with histologically-proven rheumatoid and malignant lung nodules encountered at Mayo Clinic, Rochester, MN (2001-2016). Medical records and imaging were reviewed including a retrospective blinded review of CT and PET/CT studies. RESULTS The study cohort had a mean age of 67 ± 11 years (range 45-86) including 44 (60%) women, 82% with a smoking history, 38% with subcutaneous rheumatoid nodules, and 78% with rheumatoid factor seropositivity. Subjects with rheumatoid lung nodules compared to malignancy were younger (59 ± 12 vs 71 ± 9 years, p < 0.001), more likely to manifest subcutaneous rheumatoid nodules (73% vs 20%, p < 0.001) and rheumatoid factor seropositivity (93% vs 68%, p = 0.034) but a history of smoking was common in both groups (p = 0.36). CT features more commonly associated with rheumatoid lung nodules compared to malignancy included multiplicity, smooth border, cavitation, satellite nodules, pleural contact, and a subpleural rind of soft tissue. Optimal sensitivity (77%) and specificity (92%) (AUC 0.85, CI 0.75-0.94) for rheumatoid lung nodule were obtained with ≥ 3 CT findings (≥ 4 nodules, peripheral location, cavitation, satellite nodules, smooth border, and subpleural rind). Key 18FDG-PET/CT features included low-level metabolism (SUVmax 2.7 ± 2 vs 7.2 ± 4.8, p = 0.007) and lack of 18F-fluorodeoxyglucose (FDG)-avid draining lymph nodes. CONCLUSION Rheumatoid lung nodules have distinct CT and PET/CT features compared to malignancy. Patients with rheumatoid lung nodules are younger and more likely to manifest subcutaneous rheumatoid nodules and seropositivity. KEY POINTS • Rheumatoid lung nodules have distinct clinical and imaging features compared to lung malignancy. • CT features of rheumatoid lung nodules include multiplicity, cavitation, satellite nodules, smooth border, peripheral location, and subpleural rind. • Key PET/CT features include low-level metabolism and lack of FDG-avid draining lymph nodes.
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Affiliation(s)
- Matthew Koslow
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Gonda 18 South, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Jason R Young
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eunhee S Yi
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Gonda 18 South, 200 First St. SW, Rochester, MN, 55905, USA
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Gonda 18 South, 200 First St. SW, Rochester, MN, 55905, USA
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7
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Meyer P, Ally M, Hodkinson B, Anderson R, Tikly M. Diagnostic utility of, and influence of tobacco usage and genetic predisposition on, immunoglobulin A, rheumatoid factor and anti-citrullinated peptide auto-antibodies in South African rheumatoid arthritis patients. Afr Health Sci 2018; 18:295-303. [PMID: 30602956 PMCID: PMC6306983 DOI: 10.4314/ahs.v18i2.14] [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] [Indexed: 11/17/2022] Open
Abstract
Background The immunoglobulin A isotypes of anti-cyclic citrullinated peptide antibodies (ACPA) and rheumatoid factor (RF) are associated with disease severity and progression in Caucasian rheumatoid arthritis (RA) patients, as well as with genetic predisposition and tobacco use. Objectives To compare levels of ACPA-IgA and RF-IgA with those of ACPA-IgG and cRF in a cohort of black South African RA patients and healthy controls.To investigate the relationship between IGA autoantibodies and disease severity, genetic predisposition and tobacco use Methods RF-IgA and ACPA-IgA were determined in a cohort of predominantly black South African RA patients (n=75) in relation to serodiagnostic and prognostic potential, as well as tobacco use and genetic predisposition. Healthy control subjects were included to determine sensitivity, specificity and predictive values. ACPA-IgG/IgA and RF-IgA were determined by enzyme immunoassay and hs-CRP and cRF by nephelometry. Cotinine levels were determined by ELISA. Results The frequencies of ACPA-IgA and RF-IgA were 31% and 88% respectively compared to 88% for both types of traditional autoantibody procedures. ACPA-IgA was significantly higher (p=0.007) in patients with short disease duration, while linear regression analysis revealed a positive relationship with baseline disease activity scores. Levels of ACPA-IgG and ACPA-IgA were significantly higher in tobacco users who carried the HLA shared epitope. Conclusion Although lacking in serodiagnostic superiority over cRF and ACPA-IgG, inclusion of RF-IgA and ACPA-IgA in autoantibody panels may provide insights into disease pathogenesis, interactions between tobacco usage and HLA genotype in the production of potentially disease-triggering ACPA-IgA antibodies.
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Affiliation(s)
- Pieter Meyer
- University of Pretoria, Immunology; NHLS, Immunology
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8
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Othman MA, Ghazali WSW, Hamid WZWA, Wong KK, Yahya NK. Anti-carbamylated protein antibodies in rheumatoid arthritis patients and their association with rheumatoid factor. Saudi Med J 2018; 38:934-941. [PMID: 28889152 PMCID: PMC5654028 DOI: 10.15537/smj.2017.9.20841] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To evaluate levels of anti-carbamylated protein (anti-CarP) antibodies in rheumatoid arthritis (RA) patients and to determine their association with serological parameters and disease activity. Methods: A cross-sectional study involving 105 multiethnic RA patients (48 rheumatoid factor [RF]-positive and 57 RF-negative patients) was conducted at Hospital Universiti Sains Malaysia, Kelantan, Malaysia, from January 2015 to February 2016. Fifty healthy controls (HCs) were included. C-reactive protein (CRP), RF, anti-cyclic citrullinated peptide (anti-CCP) and anti-CarP antibodies were measured. A health assessment questionnaire (HAQ) was administered to the study participants and 28-joint Disease Activity Score (DAS28) were obtained. Results: The level of anti-CarP antibodies was significantly increased in the RA patients compared with HCs (p=0.042). The presence of anti-CarP antibodies was significantly associated with RF (p=0.019) and the HAQ (p=0.010). A significant association between the presence of anti-CarP antibodies and the DAS28 was not found (p=0.632). Conclusion: Our study provides further evidence that the level of anti-CarP antibodies is significantly elevated in RA patients.
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Affiliation(s)
- Maizatul A Othman
- Department of Immunology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia. E-mail.
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9
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Abstract
Antiphospholipid syndrome is characterized by the presence of antiphospholipid antibodies, specifically lupus anticoagulant, anticardiolipin antibodies, and anti-β2 glycoprotein-I antibodies. Antiphospholipid syndrome can occur on its own or in association with other autoimmune diseases, most commonly systemic lupus erythematosus (SLE). A connection between cigarette smoking and anti-phospholipid antibodies (aPL) was first reported in the late1980s. Systemic lupus erythematosus patients with aPL are more likely to be smokers than those without aPL. These patients have a particularly high frequency of vascular events. Recently, a potential link between periodontitis, tobacco, and aPL has been proposed. Research has also suggested that periodontitis and Porphyromonas gingivalis infection are associated with citrullination through the action of peptidylarginine deiminase. A strong correlation between smoking and the presence of citrillunated autoantibodies, which are characteristic of rheumatoid arthritis, has also been observed. While many studies have investigated possible links between infection and aPL in patients with autoimmune diseases, the association of smoking with aPL has not been systematically examined. The fact that both aPL and tobacco are risk factors for thrombosis has complicated efforts to evaluate these factors separately. Also, there has been great variability in measurement techniques, and laboratories lack routine methods for differentiating transient and persistent aPL; both of these factors can make interpretation of autoantibody results quite challenging. This review summarizes the clinical evidence supporting a posited link between aPL and smoking, both in patients with a systemic autoimmune disease and in patients with other medical conditions.
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Affiliation(s)
- Steven R Binder
- Clinical Diagnostics Group, Bio-Rad Laboratories, 4000 Alfred Nobel Drive 4-2115, Hercules, CA, 94547, USA.
| | - Christine M Litwin
- Medical University of South Carolina, 165 Ashley Ave, Suite 324G, MSC 908, Charleston, SC, 29425, USA
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10
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The impact of smoking on disease activity, disability, and radiographic damage in rheumatoid arthritis: is cigarette protective? Rheumatol Int 2017; 37:2065-2070. [PMID: 29022134 DOI: 10.1007/s00296-017-3845-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
The ojective of this study is to assess the effect of tobacco smoking on disease activity, functional ability, and joint damage in a cohort of patients with early onset rheumatoid arthritis (EORA). 129 EORA patients attending the Rheumatology Unit of the School of Medicine of the "Universidad Nacional de Colombia" and the "Clínica de Artritis y Rehabilitación" in Bogota, Colombia, were enrolled in a prospective observational cohort study with 3-year follow-up. Clinical, biological, immunogenetics, and radiographic data were analyzed. Active disease was defined as DAS28 > 2.6. Smoking status was assessed by self-report as "never smokers" and "ever smokers". Patient groups with different smoking status were compared for RA measures. Status as "never smokers" and "ever smokers" was reported by 81.3 and 18.7%. Ever smokers had less risk of disability (HAQ-DI ≥ 0.5) at 36 month (Ever smokers vs. Never smokers OR for HAQ ≥ 0.5 0.25, 95% CI 0.06-0.97, p = 0.04). When former smokers were excluded in analysis, we found that current smoking was also associated with less disability and less risk of active disease. The percentage of erosive disease, radiographic progression, and SvdH score were similar in all smoking categories. In Colombian patients with EORA, smoking was associated with less disease activity and disability. Radiographic joint damage progressed at an equivalent rate in smokers and non-smokers. These data suggest a more benign, or at least not deleterious clinical course in smokers with RA.
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11
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Eriksson K, Nise L, Alfredsson L, Catrina AI, Askling J, Lundberg K, Klareskog L, Yucel-Lindberg T. Seropositivity combined with smoking is associated with increased prevalence of periodontitis in patients with rheumatoid arthritis. Ann Rheum Dis 2017; 77:1236-1238. [PMID: 28986364 PMCID: PMC6059048 DOI: 10.1136/annrheumdis-2017-212091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Kaja Eriksson
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Nise
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Alfredsson
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre of Environmental and Occupational Medicine, Stockholm County Council, Stockholm, Sweden
| | - Anca Irinel Catrina
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Askling
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Klareskog
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Tülay Yucel-Lindberg
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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12
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Brunier L, Bleterry M, Merle S, Derancourt C, Polomat K, Dehlinger V, Deligny C, Jean-Baptiste G, Arfi S, Banydeen R, De Bandt M. Prevalence of rheumatoid arthritis in the French West Indies: Results of the EPPPRA study in Martinique. Joint Bone Spine 2017; 84:455-461. [PMID: 27825567 DOI: 10.1016/j.jbspin.2016.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
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13
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Danila MI, Laufer VA, Reynolds RJ, Yan Q, Liu N, Gregersen PK, Lee A, Kern M, Langefeld CD, Arnett DK, Bridges SL. Dense Genotyping of Immune-Related Regions Identifies Loci for Rheumatoid Arthritis Risk and Damage in African Americans. Mol Med 2017; 23:177-187. [PMID: 28681901 DOI: 10.2119/molmed.2017.00081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/19/2017] [Indexed: 12/29/2022] Open
Abstract
Over 100 risk loci for rheumatoid arthritis (RA) have been identified in individuals of European and Asian descent, but the genetic basis for RA in African Americans is less well understood. We genotyped 610 African Americans with autoantibody positive RA and 933 African American controls on the ImmunoChip (iChip) array. Using multivariable regression we evaluated the association between iChip markers and the risk of RA and radiographic severity. The single nucleotide polymorphism (SNP) rs1964995 (OR = 1.97, p = 1.28 × 10-15) near HLA-DRB1 was the most strongly associated risk SNP for RA susceptibility; SNPs in AFF3, TNFSF11, and TNFSF18 loci were suggestively associated (10-4 < p < 3.1 × 10-6). Trans-ethnic fine mapping of AFF3 identified a 90% credible set containing previously studied variants including rs9653442, rs7608424, and rs6712515 as well as the novel candidate variant rs11681966; several of these likely influence AFF3 gene expression level. Variants in TNFRSF9, CTLA4, IL2RA, C5/TRAF1, and ETS1 - but no variants within the major histocompatibility complex - were associated with RA radiographic severity. Conditional regression and pairwise linkage disequilibrium (LD) analyses suggest that additional pathogenic variants may be found in ETS1 and IL2RA beyond those found in other ethnicities. In summary, we use the dense genotyping of the iChip array and unique LD structure of African Americans to validate known risk loci for RA susceptibility and radiographic severity, and to better characterize the associations of AFF3, ETS1, and IL2RA.
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Affiliation(s)
- Maria I Danila
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology
| | - Vincent Albert Laufer
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology
| | - Richard J Reynolds
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology
| | - Qi Yan
- University of Pittsburgh, Division of Pulmonary Medicine, Allergy and Immunology; Department of Pediatrics
| | - Nianjun Liu
- Indiana University School of Public Health - Bloomington, Department of Epidemiology and Biostatistics
| | | | | | | | | | | | - S Louis Bridges
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology
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14
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Short article: Absence of serological rheumatoid arthritis biomarkers in inflammatory bowel disease patients with arthropathies. Eur J Gastroenterol Hepatol 2017; 29:345-348. [PMID: 27926664 DOI: 10.1097/meg.0000000000000805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Biomarkers that are associated with future progression to rheumatoid arthritis (RA) and joint destruction have been discovered previously in patients with arthralgia. The present study examined these RA biomarkers in inflammatory bowel disease (IBD) patients with arthropathies. PATIENTS AND METHODS Sera from 155 IBD patients with and 99 IBD patients without arthropathies were analyzed for immunoglobulin (Ig) M rheumatoid factor (RF), IgA-RF, anti-cyclic citrullinated peptide 2, anti-cyclic citrullinated peptide 3.1, and anti-carbamylated protein antibody positivity using enzyme-linked immunosorbent assays. The prevalence of the autoantibodies in the IBD patients was compared with the prevalence in RA patients. RESULTS No differences were found in biomarker positivity between IBD patients with and without arthropathies. Significantly more biomarker positivity (P<0.001) was observed in RA patients compared with IBD patients with arthropathies. Also, smoking turned out to be significantly associated with positivity for IgM-RF or IgA-RF. CONCLUSION Our findings suggest that there is no apparent clinical value in the detection of RA biomarkers in serum of IBD patients to help identify arthropathies.
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15
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Risk of incident chronic obstructive pulmonary disease in patients with rheumatoid arthritis: A systematic review and meta-analysis. Joint Bone Spine 2016; 83:290-4. [DOI: 10.1016/j.jbspin.2015.05.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/28/2015] [Indexed: 01/11/2023]
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16
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Ungprasert P, Srivali N, Kittanamongkolchai W. Risk of incident atrial fibrillation in patients with rheumatoid arthritis: a systematic review and meta-analysis. Int J Rheum Dis 2015; 20:434-441. [PMID: 26692475 DOI: 10.1111/1756-185x.12820] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS Patients with rheumatoid arthritis (RA) might be at an increased risk of developing atrial fibrillation (AF) as a result of deleterious effects of inflammatory cytokines on cardiomyocytes. This study aimed to comprehensively review all available evidence to further characterize this possible association. METHODS We conducted a systematic review and meta-analysis of cohort studies that reported relative risk, hazard ratio, incidence ratio or standardized incidence ratio with 95% confidence intervals comparing the risk of incidence of AF in patients with RA versus non-RA participants. Pooled risk ratio and 95% confidence interval were calculated using random-effect, generic inverse-variance methods of DerSimonian and Laird. RESULTS Three retrospective cohort studies with 39 912 cases of RA and 4 269 161 non-RA controls were included in the data analysis. The pooled risk ratio of subsequent development of AF in patients with RA versus controls was 1.29 (95% CI, 1.05-1.59). The statistical heterogeneity was moderate with an I2 of 71%. CONCLUSION Our meta-analysis demonstrated a statistically significant increased risk of subsequent development of AF among patients with RA.
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Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narat Srivali
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wonngarm Kittanamongkolchai
- Division ofNephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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17
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Baker JF, Cannon GW, Ibrahim S, Haroldsen C, Caplan L, Mikuls TR. Predictors of longterm changes in body mass index in rheumatoid arthritis. J Rheumatol 2015; 42:920-7. [PMID: 25834210 DOI: 10.3899/jrheum.141363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Low body mass index (BMI) is a risk factor for poor longterm outcomes in rheumatoid arthritis (RA). The purpose of this study was to identify factors associated with longterm changes in BMI. METHODS Subjects with RA from the Veterans Affairs (VA) Rheumatoid Arthritis (VARA) Registry (n = 1474) were studied. Information on inflammatory markers, presence of erosions, and smoking status were extracted from the VARA database. BMI was extracted from VA electronic medical records within 14 days of each visit date. VA pharmacy records were queried to identify prescriptions for specific RA therapies within 1 month of the visit date. We used robust generalized estimating equations marginal regression models to calculate independent associations between clinical variables and BMI over time. Similar models determined predictors of change in weight and risk of weight loss over the subsequent study observation period. RESULTS Increasing age, active smoking, and the presence of erosions at baseline were associated with lower BMI. Weight decreased over time among older adults. Factors associated with greater reductions in BMI over time and a greater risk of weight loss were higher inflammatory markers, smoking, older age, higher BMI, and less subsequent improvement in inflammation. Methotrexate use was associated with a lower risk of weight loss. The use of prednisone or anti-tumor necrosis factor therapies was not associated with change in BMI or the risk of weight loss independent of other factors. CONCLUSION Greater age, greater inflammatory activity, and active smoking are associated with greater weight loss in RA over time.
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Affiliation(s)
- Joshua F Baker
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center.
| | - Grant W Cannon
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center
| | - Said Ibrahim
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center
| | - Candace Haroldsen
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center
| | - Liron Caplan
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center
| | - Ted R Mikuls
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs (VA) Medical Center; Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Salt Lake City VA Medical Center and University of Utah, Salt Lake City, Utah; Department of Medicine, Denver VA Medical Center, Denver, Colorado; Department of Medicine, Nebraska-Western Iowa VA Medical Center, Omaha, Nebraska, USA.J.F. Baker, MD, MSCE, Division of Rheumatology, Philadelphia VA Medical Center, and Division of Rheumatology, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania; G.W. Cannon, MD, Salt Lake City VA Medical Center and University of Utah; S. Ibrahim, MD, MPH, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, and Perelman School of Medicine, University of Pennsylvania; C. Haroldsen, MSPH, Salt Lake City VA Medical Center and University of Utah; L. Caplan, MD, PhD, Department of Medicine, Denver VA Medical Center; T.R. Mikuls, MD, MSPH, Department of Medicine, Nebraska-Western Iowa VA Medical Center
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18
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Effects of cigarette smoking on early arthritis: a cross-sectional study—data from the Argentine Consortium for Early Arthritis (CONAART). Rheumatol Int 2014; 35:855-9. [DOI: 10.1007/s00296-014-3188-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/27/2014] [Indexed: 11/27/2022]
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Karabulut G, Kitapcioglu G, Inal V, Kalfa M, Yargucu F, Keser G, Emmungil H, Gokmen NM, Kocanaogullari H, Aksu K. Cigarette smoking in primary Sjögren’s syndrome: positive association only with ANA positivity. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0446-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Vesperini V, Lukas C, Fautrel B, Le Loet X, Rincheval N, Combe B. Association of Tobacco Exposure and Reduction of Radiographic Progression in Early Rheumatoid Arthritis: Results From a French Multicenter Cohort. Arthritis Care Res (Hoboken) 2013; 65:1899-906. [DOI: 10.1002/acr.22057] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 06/03/2013] [Indexed: 01/23/2023]
Affiliation(s)
| | - Cedric Lukas
- Lapeyronie Hospital, Montpellier I University; UMR5535, Montpellier France
| | | | | | | | - Bernard Combe
- Lapeyronie Hospital, Montpellier I University; UMR5535, Montpellier France
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21
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Ellingsen T, Hansen I, Thorsen J, Møller BK, Tarp U, Lottenburger T, Andersen LS, Skjødt H, Pedersen JK, Lauridsen UB, Svendsen A, Lindegaard H, Jacobsen S, Østergaard M, Vestergaard A, Jurik AG, Junker P, Christensen AF, Hetland ML, Hørslev-Petersen K, Stengaard-Pedersen K. Upregulated baseline plasma CCL19 and CCR7 cell-surface expression on monocytes in early rheumatoid arthritis normalized during treatment and CCL19 correlated with radiographic progression. Scand J Rheumatol 2013; 43:91-100. [DOI: 10.3109/03009742.2013.803149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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22
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Maska LB, Sayles HR, O'Dell JR, Curtis JR, Bridges SL, Moreland LW, Cofield SS, Mikuls TR. Serum cotinine as a biomarker of tobacco exposure and the association with treatment response in early rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012; 64:1804-10. [PMID: 22730343 PMCID: PMC3467327 DOI: 10.1002/acr.21758] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/07/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cigarette smoking has emerged as a risk factor for the development of rheumatoid arthritis (RA). Recent studies have suggested that cigarette smoking may lead to lower treatment response rates with methotrexate (MTX) and some biologic agents in RA. Knowledge of whether tobacco exposure reduces treatment efficacy is important, since smoking could represent a modifiable factor in optimizing RA treatment. METHODS The study participants included patients with early RA (<3 years in duration) enrolled in the Treatment of Early Aggressive Rheumatoid Arthritis study, a randomized, blinded, placebo-controlled clinical trial comparing early intensive therapy (MTX + etanercept or MTX + hydroxychloroquine + sulfasalazine triple therapy) versus initial treatment with MTX with step-up to MTX + etanercept or to triple therapy if the disease was still active at 24 weeks. Serum cotinine was measured using a commercially available enzyme-linked immunosorbent assay at baseline and at 48 weeks, with detectable concentrations at both visits serving as an indicator of smoking status. The mean Disease Activity Score in 28 joints (DAS28) was compared by smoking status, adjusting for baseline disease activity. RESULTS Of the 412 subjects included in the analysis, 293 (71%) were categorized as nonsmokers and 119 (29%) as current smokers. There were no differences in the mean DAS28 score between 48 and 102 weeks based on smoking status for the overall group (P = 0.881) or by specific treatment assignment. CONCLUSION Among patients enrolled in a large randomized controlled trial of early RA with poor prognostic factors, smoking status did not impact treatment responses for those receiving early combination or initial MTX with step-up therapy at 24 weeks if the disease was still active.
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Affiliation(s)
- Leann B Maska
- University of Nebraska Medical Center, Omaha, NE 68198-3025, USA
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23
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Pal G. Association of cardiovascular risks with sympathovagal imbalance in rheumatoid arthritis. Indian J Med Res 2012; 136:547-8. [PMID: 23168694 PMCID: PMC3516021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- G.K. Pal
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605 006, India
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Health-related quality of life in Moroccan patients with rheumatoid arthritis. Clin Rheumatol 2012; 31:1471-7. [PMID: 22903698 DOI: 10.1007/s10067-012-2037-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 04/11/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
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Abstract
Although treat-to-target goals for rheumatoid arthritis (RA) have been well-established through several guidelines in recent years, concerns regarding treat-to-prevent goals for RA remain unclear. RA patients are typically subjected to over- or under-treatment because it is difficult for clinicians to determine the prognosis of RA patients. This typically results in failure to select and identify patient subsets that should receive monotherapy or combination therapy to treat early RA. Understanding treat-to-prevent goals, as well as unfavorable prognoses, risk factors, and prediction methods for RA, is therefore critical for making treatment decisions. Rapid radiographic progression plays a central role in contributing to other composite RA indices, so this may be the best method for defining treat-to-prevent goals for RA. Accordingly, risk factors of rapid radiographic progression have been defined and two prediction models were retrospectively derived based on clinical trial data. Additional studies are required to develop risk models that can be used for accurate predictions.
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Affiliation(s)
- Min Yang
- Rheumatology Center, PLA General Hospital of Chengdu Military Area Command, Chengdu, Sichuan Province, PR China
| | - Mingyang Guo
- Rheumatology Center, PLA General Hospital of Chengdu Military Area Command, Chengdu, Sichuan Province, PR China
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26
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Newkirk MM, Mitchell S, Procino M, Li Z, Cosio M, Mazur W, Kinnula VL, Hudson M, Baron M, Fritzler MJ, El-Gabalawy HS. Chronic smoke exposure induces rheumatoid factor and anti-heat shock protein 70 autoantibodies in susceptible mice and humans with lung disease. Eur J Immunol 2012; 42:1051-61. [PMID: 22531929 DOI: 10.1002/eji.201141856] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The impact of cigarette smoke (CS), a risk factor for rheumatoid arthritis (RA), on sauto-antibody production was studied in humans and mice with and without chronic lung disease (LD). Rheumatoid factor (RF), anti-cyclic citrullinated peptides (CCPs), and anti-HSP70 autoantibodies were measured in several mouse strains and in cohorts of smokers and nonsmokers with and without autoimmune disease. Chronic smoking-induced RFs in AKR/J mice, which are most susceptible to LD. RFs were identified in human smokers, preferentially in those with LD. Anti-HSP70 auto-antibodies were identified in CS-exposed AKR/J mice but not in ambient air exposed AKR/J controls. Whereas inflammation could induce anti-HSP70 IgM, smoke exposure promoted the switch to anti-HSP70 IgG autoantibodies. Elevated anti-CCP autoantibodies were not detected in CS-exposed mice or smokers. AKR/J splenocytes stimulated in vitro by immune complexes (ICs) of HSP70/anti-HSP70 antibodies produced RFs. The CD91 scavenger pathway was required as anti-CD91 blocked the HSP70-IC-induced RF response. Blocking Toll-like receptors did not influence the HSP70-IC-induced RFs. These studies identify both anti-HSP70 and RFs as serological markers of smoke-related LD in humans and mice. Identification of these autoantibodies could suggest a common environmental insult, namely CS, in a number of different disease settings.
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Affiliation(s)
- Marianna M Newkirk
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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Ruiz-Esquide V, Sanmartí R. Tobacco and other environmental risk factors in rheumatoid arthritis. ACTA ACUST UNITED AC 2012; 8:342-50. [PMID: 22609003 DOI: 10.1016/j.reuma.2012.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/29/2012] [Accepted: 02/29/2012] [Indexed: 12/21/2022]
Abstract
Many environmental factors have been associated with an increased risk of developing Rheumatoid Arthritis (RA), but so far smoking is the only environmental risk factor that has been extensively studied and widely accepted. Smoking is associated with an increased risk of developing seropositive RA (RF and/or ACPA). Recent studies show that tobacco smoking can influence disease phenotype, with the development of more aggressive disease and greater joint damage; but other studies show contradictory results. Recent data suggests that response to antirheumatic therapy in RA is worse in smokers. In this article we review different environmental factors that have been associated with an increased risk of developing RA, with a special interest in tobacco smoking.
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Affiliation(s)
- Virginia Ruiz-Esquide
- Unidad de Artritis, Servicio de Reumatologia, Hospital Clínic de Barcelona, Barcelona, España.
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Too CL, Yahya A, Murad S, Dhaliwal JS, Larsson PT, Muhamad NA, Abdullah NA, Mustafa AN, Klareskog L, Alfredsson L, Padyukov L, Bengtsson C. Smoking interacts with HLA-DRB1 shared epitope in the development of anti-citrullinated protein antibody-positive rheumatoid arthritis: results from the Malaysian Epidemiological Investigation of Rheumatoid Arthritis (MyEIRA). Arthritis Res Ther 2012; 14:R89. [PMID: 22537824 PMCID: PMC3446463 DOI: 10.1186/ar3813] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/10/2012] [Accepted: 04/26/2012] [Indexed: 12/26/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a multifactorial autoimmune disease in which genetic and environmental factors interact in the etiology. In this study, we investigated whether smoking and HLA-DRB1 shared-epitope (SE) alleles interact differently in the development of the two major subgroups of rheumatoid arthritis (RA), anti-citrullinated proteins antibody (ACPA)-positive and ACPA-negative disease, in a multiethnic population of Asian descent. Methods A case-control study comprising early diagnosed RA cases was carried out in Malaysia between 2005 and 2009. In total, 1,076 cases and 1,612 matched controls participated in the study. High-resolution HLA-DRB1 genotyping was performed for shared-epitope (SE) alleles. All participants answered a questionnaire on a broad range of issues, including smoking habits. The odds ratio (OR) of developing ACPA-positive and ACPA-negative disease was calculated for smoking and the presence of any SE alleles separately. Potential interaction between smoking history (defined as "ever" and "never" smoking) and HLA-DRB1 SE alleles also was calculated. Results In our multiethnic study, both the SE alleles and smoking were associated with an increased risk of developing ACPA-positive RA (OR SE alleles, 4.7; 95% confidence interval (CI), 3.6 to 6.2; OR smoking, 4.1; 95% CI, 1.9 to 9.2). SE-positive smokers had an odds ratio of ACPA-positive RA of 25.6 (95% CI, 10.4 to 63.4), compared with SE-negative never-smokers. The interaction between smoking and SE alleles was significant (attributable proportion due to interaction (AP) was 0.7 (95% CI, 0.5 to 1.0)). The HLA-DRB1*04:05 SE allele, which is common in Asian populations, but not among Caucasians, was associated with an increased risk of ACPA-positive RA, and this allele also showed signs of interaction with smoking (AP, 0.4; 95% CI, -0.1 to 0.9). Neither smoking nor SE alleles nor their combination was associated with an increased risk of ACPA-negative RA. Conclusions The risk of developing ACPA-positive RA is associated with a strong gene-environment interaction between smoking and HLA-DRB1 SE alleles in a Malaysian multiethnic population of Asian descent. This interaction seems to apply also between smoking and the specific HLA-DRB1*04:05 SE allele, which is common in Asian populations but not in Caucasians.
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Affiliation(s)
- Chun Lai Too
- Rheumatology Unit, Department of Medicine, Center of Molecular Medicine L8:04, Karolinska University Hospital, 17176 Stockholm, Sweden.
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Fisher MC, Hochberg MC, El-Taha M, Kremer JM, Peng C, Greenberg JD. Smoking, smoking cessation, and disease activity in a large cohort of patients with rheumatoid arthritis. J Rheumatol 2012; 39:904-9. [PMID: 22422494 DOI: 10.3899/jrheum.110852] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE While cigarette smoking is the best-studied environmental factor contributing to rheumatoid arthritis (RA), no study to date has examined the influence of smoking cessation on disease activity. We examined this relationship in an observational cohort of patients with RA in the United States. METHODS Patients enrolled in the Consortium of Rheumatology Researchers of North America registry (CORRONA) were stratified into never, former, and current smokers at enrollment. Current smokers were further stratified into continued and ceased smoking groups during their followup in the registry. The primary outcome was change in Clinical Disease Activity Index (CDAI) at last visit in a multivariate, random-effects regression model accounting for multiple timepoints. RESULTS At last visit, there was no significant change in CDAI between ceased smokers and continued smokers (coefficient -0.00091, SE 0.0033, p = 0.7834). The study did confirm prior cross-sectional studies that current smokers have worse disease activity than former or never smokers. CONCLUSION In the short term, smoking cessation did not appear to influence change in disease activity over time.
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Affiliation(s)
- Mark C Fisher
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA 02114, USA.
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30
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Ditre JW, Brandon TH, Zale EL, Meagher MM. Pain, nicotine, and smoking: research findings and mechanistic considerations. Psychol Bull 2012; 137:1065-93. [PMID: 21967450 DOI: 10.1037/a0025544] [Citation(s) in RCA: 237] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either effects of smoking on pain or effects of pain on smoking. We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
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Affiliation(s)
- Joseph W Ditre
- Department of Psychology, Texas A&M University, College Station, USA.
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31
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RUIZ-ESQUIDE VIRGINIA, GÓMEZ-PUERTA JOSÉA, CAÑETE JUAND, GRAELL EDUARD, VAZQUEZ IVONNE, ERCILLA MGUADALUPE, VIÑAS ODETTE, GÓMEZ-CENTENO ANTONIO, HARO ISABEL, SANMARTÍ RAIMON. Effects of Smoking on Disease Activity and Radiographic Progression in Early Rheumatoid Arthritis. J Rheumatol 2011; 38:2536-9. [DOI: 10.3899/jrheum.110410] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To analyze the effects of cigarette smoking on disease activity and radiographic damage in patients with early rheumatoid arthritis (RA).Methods.Study subjects were 156 patients with early RA (< 2 yrs). Disease activity, therapeutic response, and radiographic progression were compared in smokers and nonsmokers at 24 months.Results.At baseline, ever-smokers had earlier disease onset and a closer association with the shared epitope (SE), but not more seropositive disease. No significant differences were observed in disease activity and European League Against Rheumatism therapeutic responses between smokers and nonsmokers. Multivariate analysis showed that baseline Larsen score, the HLA-DRB*04 genotype, being female, and current smoking were associated with radiographic progression.Conclusion.In patients with early RA, smoking was associated with earlier disease onset and the SE. Smoking was an independent factor of radiographic progression.
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Karabulut G, Kitapcioglu G, Inal V, Kalfa M, Yargucu F, Keser G, Emmungil H, Gokmen NM, Kocanaogullari H, Aksu K. Cigarette smoking in primary Sjögren's syndrome: positive association only with ANA positivity. Mod Rheumatol 2011; 21:602-7. [PMID: 21445716 DOI: 10.1007/s10165-011-0446-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 03/07/2011] [Indexed: 10/18/2022]
Abstract
Smoking is well known to contribute to the pathogenesis and severity of some systemic autoimmune rheumatic diseases and especially to the production of certain autoantibodies. Primary Sjögren's syndrome (pSS) is an autoimmune disease, affecting primarily the exocrine glands. It may also cause extraglandular involvement in some cases. In this study, we aimed to determine the frequency of smoking habits in our cohort of pSS patients and to investigate whether the frequencies of autoantibody positivity and extraglandular involvement were significantly different between patients with and without smoking. In this cross-sectional study, 207 patients with pSS (F/M 203/4), fulfilling the United States-European Consensus Criteria, and 602 healthy controls (F/M 534/68) were included. Patients and controls were classified into five groups: never smokers, current smokers, former smokers; ever smokers, and passive smokers. The χ(2) and Kruskal-Wallis tests were used for statistical analysis; a p value of less than 0.05 was accepted as statistically significant. While the frequency of current smokers was significantly lower in the pSS group compared with the healthy controls (11.6 vs 22.3%), the frequencies of former smokers (30.4 vs 11.8%), ever smokers (42.0 vs 34.1%), and passive smokers (47.3 vs 37.5%) were significantly higher in the pSS group compared with the healthy controls. In pSS patients, only antinuclear antibody (ANA) positivity was significantly associated with smoking habits, while there was no significant association with other autoantibodies or with the presence of extraglandular involvement. We found that in pSS patients smoking was significantly associated only with ANA positivity. Unlike the deleterious effects of smoking upon disease severity and anti-cyclic citrullinated protein (CCP) antibody production in rheumatoid arthritis, we could not find any association of smoking with extraglandular involvement and/or anti-Ro/anti-La antibody positivity in pSS. These results are indeed in line with the limited number of previous studies reported in the literature. Further studies with higher numbers of pSS patients are required to confirm the seemingly negative association of smoking with pSS.
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Affiliation(s)
- Gonca Karabulut
- Division of Rheumatology, Department of Internal Medicine, Ege University School of Medicine, Bornova, Izmir, Turkey
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Fatigue and severity of rheumatoid arthritis in Moroccan patients. Rheumatol Int 2011; 32:1901-7. [PMID: 21448644 DOI: 10.1007/s00296-011-1876-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 02/18/2011] [Indexed: 01/18/2023]
Abstract
The aim of this study was to assess fatigue aspects in Moroccan patients with rheumatoid arthritis (RA) and its relationships with disease-specific variables especially parameters of functional and structural severity. A total of 248 patients with RA were included. Patients' and disease characteristics were identified. Disease activity was measured clinically using physical examination, biologically and by the disease activity scores (DAS28). Radiographs were evaluated by using Sharp's method as modified by van der Heijde. Functional disability was measured by using the Moroccan version of Health Assessment Questionnaire (HAQ). Immunological abnormalities and treatment (doses and duration) were identified. Fatigue was evaluated by using a 0-100 visual analogue scale (VAS fatigue) and the multidimensional assessment of fatigue (MAF). Quality of life (QoL) was assessed using the Arabic version of the generic instrument SF-36. The mean age of patients was 47.5 ± 11.7 years [25-72]; 37.5% of patients had a high activity of disease and 11.3% were in remission. The mean Sharp score was 107.13 ± 91, and the mean score of HAQ was 1.40 ± 0.63. All domains of QoL were deteriorated; 89.51% of our patients experienced fatigue. The mean total score of MAF was 30.21 ± 11.32. A low level of education, low socioeconomic status, atlantoaxial subluxation, hip involvement, the presence of a Sjögren syndrome, and cigarette smoking had a negative impact on fatigue scores. The severity of fatigue was correlated with the duration of RA, the intensity of joint pain, the activity of disease, the importance of structural damage, the degree of functional impairment, and the rate of anti-cyclic citrullinated protein (CCP) antibodies (P < 0.05). Patients receiving methotrexate had better scores of fatigue. Also, severity of fatigue was correlated with the deterioration of all domains of QoL. Fatigue is a major issue for our patients with RA and must be included in the routine assessment of patients. In our sample, fatigue appears to be related to disease activity, functional disability, structural damage, and immunological status and had a negative impact on QoL.
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Mikuls TR, Sayles H, Yu F, Levan T, Gould KA, Thiele GM, Conn DL, Jonas BL, Callahan LF, Smith E, Brasington R, Moreland LW, Reynolds RJ, Bridges SL. Associations of cigarette smoking with rheumatoid arthritis in African Americans. ACTA ACUST UNITED AC 2011; 62:3560-8. [PMID: 20722010 DOI: 10.1002/art.27716] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the associations of cigarette smoking with rheumatoid arthritis (RA) in African Americans, and to determine whether this association is impacted by the HLA-DRB1 shared epitope (SE). METHODS Smoking status, cumulative smoking exposure, and SE status were determined in African American patients with RA and African American healthy controls. Associations of smoking with RA were examined using age- and sex-adjusted logistic regression analyses. Additive and multiplicative SE-smoking interactions were examined. RESULTS After adjustment for age and sex, ever smoking (odds ratio [OR] 1.45, 95% confidence interval [95% CI] 1.07, 1.97) and current smoking (OR 1.56, 95% CI 1.07, 2.26), relative to never smoking, were more common in African American patients with RA (n = 605) than in controls (n = 255). The association of smoking with RA was limited to those with a cumulative exposure exceeding 10 pack-years, associations that were evident both in autoantibody-positive and in autoantibody-negative disease. There was evidence of a significant additive interaction between SE status and heavy smoking (≥10 pack-years) in relation to RA risk (attributable proportion [AP] due to interaction 0.58, P = 0.007), with similar results for the additive interaction between SE status and ever smoking (AP 0.47, P = 0.006). There was no evidence of multiplicative interactions. CONCLUSION Among African Americans, cigarette smoking is associated not only with the risk of autoantibody-positive RA but also with the risk of autoantibody-negative disease. The risk of RA attributable to smoking is limited to African Americans with more than 10 pack-years of exposure and is more pronounced among individuals positive for the HLA-DRB1 SE.
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Affiliation(s)
- Ted R Mikuls
- University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha, USA.
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Montes A, Dieguez-Gonzalez R, Perez-Pampin E, Calaza M, Mera-Varela A, Gomez-Reino JJ, Gonzalez A. Particular association of clinical and genetic features with autoimmunity to citrullinated α-enolase in rheumatoid arthritis. ACTA ACUST UNITED AC 2011; 63:654-61. [DOI: 10.1002/art.30186] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Association of anticyclic citrullinated peptide antibodies with extra-articular manifestations, gender, and tabagism in rheumatoid arthritis patients from southern Brazil. Clin Rheumatol 2011; 30:975-80. [DOI: 10.1007/s10067-011-1711-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/24/2011] [Accepted: 02/01/2011] [Indexed: 11/26/2022]
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The swollen joint, the thickened artery, and the smoking gun: tobacco exposure, citrullination and rheumatoid arthritis. Rheumatol Int 2010; 31:567-72. [PMID: 21136261 DOI: 10.1007/s00296-010-1644-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 11/14/2010] [Indexed: 12/23/2022]
Abstract
Autoimmune diseases result from an interplay between susceptibility genes and environmental factors. These interacting etiopathogenetic components converge in a critical step preceding disease, the loss of tolerance to self. In this review, we examine the evidences linking tobacco smoking with the initiation and perpetuation of inflammation affecting both the synovial membrane and the endothelial lining in patients with rheumatoid arthritis. This disease is a compelling argument for the decisive role of environment in the triggering of a human autoimmune disease in genetically prone individuals.
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MARKATSELI THEODORAE, VOULGARI PARASKEVIV, ALAMANOS YANNIS, DROSOS ALEXANDROSA. Prognostic Factors of Radiological Damage in Rheumatoid Arthritis: A 10-year Retrospective Study. J Rheumatol 2010; 38:44-52. [DOI: 10.3899/jrheum.100514] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To describe the longterm clinical and radiological outcomes in rheumatoid arthritis (RA) in a cohort in northwestern Greece; and to investigate predictive factors of radiological damage at the 10-year followup in patients with RA.Methods.We studied the disease course and outcome of 144 patients with RA and radiographs of the hands and wrists available at baseline and at 10 years. Baseline measurements and time-averaged measures of swollen joint count (SJC) and inflammatory markers [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] were tested in univariate analysis, and then those presenting a statistically significant association with either Larsen score at 10 years or annual progression rate were included in 2 logistic regression models in order to determine relevant independent prognostic factors.Results.A significant clinical improvement was noted, associated with a decrease of inflammatory markers along the timepoints. Larsen score and the number of erosive joints were increased. In the univariate analysis, both final Larsen score at 10 years and accelerated annual radiological progression rate were significantly associated with baseline radiographic measurements (Larsen score and number of erosive joints), the presence of autoantibodies [anticyclic citrullinated peptide antibodies (anti-CCP) and rheumatoid factor of IgA and IgM isotype], disease duration, and time-averaged measures of ESR, CRP, and SJC. In the logistic regression analysis, the baseline Larsen score, anti-CCP antibodies, and time-averaged CRP presented significant and independent associations with Larsen score at 10 years. An accelerated annual radiological progression rate was also predicted by baseline Larsen score and time-averaged measures of SJC and CRP.Conclusion.Despite clinical improvement, the radiologic progression of RA continues over time, because of the underlying inflammatory process. Baseline radiographic damage, anti-CCP antibodies, and time-averaged CRP constitute the main predictive factors of poor radiologic outcome in the long term.
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Harty LC, Veale DJ. Irish smokers with rheumatoid arthritis suffer more than their nonsmoking counterparts. J Rheumatol 2010; 37:1062; author reply 1063. [PMID: 20439523 DOI: 10.3899/jrheum.091403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bridges SL, Causey ZL, Burgos PI, Huynh BQN, Hughes LB, Danila MI, van Everdingen A, Ledbetter S, Conn DL, Tamhane A, Westfall AO, Jonas BL, Callahan LF, Smith EA, Brasington R, Moreland LW, Alarcón GS, van der Heijde DM. Radiographic severity of rheumatoid arthritis in African Americans: results from a multicenter observational study. Arthritis Care Res (Hoboken) 2010; 62:624-31. [PMID: 20461784 DOI: 10.1002/acr.20040] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe radiographic changes in African Americans with rheumatoid arthritis (RA) from the Consortium for the Longitudinal Evaluations of African Americans with Early Rheumatoid Arthritis (CLEAR) Registry, a multicenter observational study. METHODS Self-declared African American patients were enrolled in CLEAR I, a longitudinal cohort of early RA (disease duration of <2 years) from 2000 to 2005, or in CLEAR II, a cross-sectional cohort (any disease duration) from 2006 to the present. Demographic and clinical data were obtained, and sets of hand/wrist and foot radiographs were scored using the modified Sharp/van der Heijde scoring system. RESULTS A total of 357 and 418 patients were enrolled in CLEAR I and CLEAR II, respectively. We report here an interim analysis of radiographic severity in these patients. For the CLEAR I cohort, 294 patients had a mean radiographic score of 2.89 at the baseline visit; 32.0% showed either erosions (25.9%) or joint space narrowing (JSN; 19.4%). At the 36-month visit, the mean score was 5.65; 44.2% had erosions, 41.5% had JSN, and 54.4% had either. Among those patients without radiographic damage at baseline, 18.9% had progressed at the 36-month visit, compared with 57.1% of those with baseline damage (P < 0.0001). For the CLEAR II cohort, of 167 patients with RA of any duration, 65.3% exhibited joint erosions, 65.3% exhibited JSN, and 74.8% exhibited either. The mean radiographic score was 33.42. CONCLUSION To our knowledge, this is the largest radiographic study of African American RA patients. Damage occurs early in the disease and is associated with radiographic progression at 3 years of disease duration. The CLEAR Registry will provide a valuable resource for future analyses of genetic, clinical, and environmental factors associated with radiographic severity of RA in African Americans.
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Affiliation(s)
- S Louis Bridges
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294-2182, USA.
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Burgos PI, Causey ZL, Tamhane A, Kelley JM, Brown EE, Hughes LB, Danila MI, van Everdingen A, Conn DL, Jonas BL, Callahan LF, Smith EA, Brasington RD, Moreland LW, van der Heijde DM, Alarcón GS, Bridges SL. Association of IL4R single-nucleotide polymorphisms with rheumatoid nodules in African Americans with rheumatoid arthritis. Arthritis Res Ther 2010; 12:R75. [PMID: 20444266 PMCID: PMC2911851 DOI: 10.1186/ar2994] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 04/22/2010] [Accepted: 05/05/2010] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION To determine whether IL4R single-nucleotide polymorphisms (SNPs) rs1805010 (I50V) and rs1801275 (Q551R), which have been associated with disease severity in rheumatoid arthritis (RA) patients of European ancestry, relate to the presence of rheumatoid nodules and radiographic erosions in African Americans. METHODS Two IL4R SNPs, rs1805010 and rs1801275, were genotyped in 749 patients from the Consortium for Longitudinal Evaluation of African-Americans with Early Rheumatoid Arthritis (CLEAR) registries. End points were rheumatoid nodules defined as present either by physical examination or by chest radiography and radiographic erosions (radiographs of hands/wrists and feet were scored using the modified Sharp/van der Heijde system). Statistical analyses were performed by using logistic regression modeling adjusted for confounding factors. RESULTS Of the 749 patients with RA, 156 (20.8%) had rheumatoid nodules, with a mean age of 47.0 years, 84.6% female gender, and median disease duration of 1.9 years. Of the 461 patients with available radiographic data, 185 (40.1%) had erosions (score>0); their mean age was 46.7 years; 83.3% were women; and median disease duration was 1.5 years. Patients positive for HLA-DRB1 shared epitope (SE) and autoantibodies (rheumatoid factor (RF) or anti-cyclic citrullinated peptide (CCP)) had a higher risk of developing rheumatoid nodules in the presence of the AA and AG alleles of rs1801275 (odds ratio (OR)adj=8.08 (95% confidence interval (CI): 1.60-40.89), P=0.01 and ORadj=2.97 (95% CI, 1.08 to 8.17), P=0.04, respectively). Likewise, patients positive for the HLA-DRB1 SE and RF alone had a higher risk of developing rheumatoid nodules in presence of the AA and AG alleles of rs1801275 (ORadj=8.45 (95% CI, 1.57 to 45.44), P=0.01, and ORadj=3.57 (95% CI, 1.18 to 10.76), P=0.02, respectively) and in the presence of AA allele of rs1805010 (ORadj=4.52 (95% CI, 1.20 to 17.03), P=0.03). No significant association was found between IL4R and radiographic erosions or disease susceptibility, although our statistical power was limited by relatively small numbers of cases and controls. CONCLUSIONS We found that IL4R SNPs, rs1801275 and rs1805010, are associated with rheumatoid nodules in autoantibody-positive African-American RA patients with at least one HLA-DRB1 allele encoding the SE. These findings highlight the need for analysis of genetic factors associated with clinical RA phenotypes in different racial/ethnic populations.
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Affiliation(s)
- Paula I Burgos
- University of Alabama, Tuscaloosa, Alabama 35487, USA
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Santiago, Chile
| | | | | | | | | | | | | | - Amalia van Everdingen
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - Doyt L Conn
- Emory University, 571 Kilgo Circle, Atlanta, GA 30322-1120, USA
| | - Beth L Jonas
- University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, USA
| | - Leigh F Callahan
- University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, USA
| | - Edwin A Smith
- Medical University of South Carolina, Jonathan Lucas Street, Charleston, SC29425, USA
| | - Richard D Brasington
- Washington University in St. Louis, 4444 Forest Park Avenue, St Louis, MO 63108-2259, USA
| | - Larry W Moreland
- University of Alabama, Tuscaloosa, Alabama 35487, USA
- Current address: The University of Pittsburgh, Pittsburgh, PA 15260, USA
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Mikuls TR. Rheumatoid arthritis incidence: What goes down must go up? ACTA ACUST UNITED AC 2010; 62:1565-7. [DOI: 10.1002/art.27432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Alsalahy MM, Nasser HS, Hashem MM, Elsayed SM. Effect of tobacco smoking on tissue protein citrullination and disease progression in patients with rheumatoid arthritis. Saudi Pharm J 2010; 18:75-80. [PMID: 23960723 DOI: 10.1016/j.jsps.2010.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 12/26/2009] [Indexed: 12/11/2022] Open
Abstract
The aim of the present work was to study the effect of tobacco smoking on disease progression in rheumatoid arthritis patients and its relation to anti-cyclical citrullinated peptide (anti-CCP) antibodies. The study included 54 patients; 20 non-smokers, 9 ex-smokers, 14 mild to moderate smokers and 11 heavy smokers. Fifteen normal volunteers were also studied as controls. Disease stage was clinically and radiologically determined, rheumatoid factor (RF) and anti-CCP antibodies were measured in serum. Higher percentage of severe disease (stage III) was seen in heavy smoker patients than mild to moderate smokers (54.6% versus 35.7%) and in moderate smokers than ex-smokers (35.7% versus 33.6%). Lowest percentage of severe disease was seen in non-smokers (15%). RF and anti-CCP were significantly higher in smoker than non-smoker and in heavy than mild to moderate smoker patients (p < 0.01, p < 0.05 and p < 0.01, p < 0.001, respectively). In smoker patients, both RF and anti-CCP antibodies correlated significantly and positively with smoking index (r = 0.581, p < 0.001; r = 0.661, p < 0.001). Also, smoking index and anti-CCP correlated significantly and positively with disease stage (r = 0.424, p < 0.05; r = 0.523, p < 0.01). It appears from our results that, tobacco smoking mostly play a role in progression of rheumatoid arthritis through tissue protein citrullination. So all rheumatoid arthritis patients must quit completely to achieve a good control.
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Affiliation(s)
- Mahmoud M Alsalahy
- Department of Chest, Faculty of Medicine, Benha University, Benha, Egypt
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Abstract
Besides atherosclerosis and lung cancer, smoking is considered to play a major role in the pathogenesis of autoimmune diseases. It has long been known that there is a connection between rheumatoid factor-positive rheumatoid arthritis and cigarette smoking. Recently, an important gene-environment interaction has been revealed; that is, carrying specific HLA-DRB1 alleles encoding the shared epitope and smoking establish a significant risk for anti-citrullinated protein antibody-positive rheumatoid arthritis. We summarize how smoking-related alteration of the cytokine balance, the increased risk of infections (the possibility of cross-reactivity) and modifications of autoantigens by citrullination may contribute to the development of rheumatoid arthritis.
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Affiliation(s)
- Zsuzsanna Baka
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Nagyvárad tér 4., Budapest, H-1445, Hungary
| | - Edit Buzás
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Nagyvárad tér 4., Budapest, H-1445, Hungary
| | - György Nagy
- Department of Genetics, Cell and Immunobiology, Semmelweis University, Nagyvárad tér 4., Budapest, H-1445, Hungary
- Department of Rheumatology, Semmelweis University, Árpád fejedelem útja 7., Budapest, H-1023, Hungary
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Tikly M. Modern management of rheumatoid arthritis—making a case for early aggressive medical treatment. S Afr Fam Pract (2004) 2009. [DOI: 10.1080/20786204.2009.10873866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Smoking has an impact on the development and outcome of rheumatoid arthritis (RA) and lupus. In RA, smoking is associated with the development of the anti-cyclic citrullinated peptide (CCP2)-positive subset. This risk is increased in heavy smokers carrying at least one copy of the HLA DRB1 shared epitope (SE) alleles. Whereas this interaction between smoking and SE relevant in northern Europe, discrepant results have been observed in other geographic locations, suggesting the involvement of other environmental stimuli and/or gene polymorphisms. There is no interaction between tobacco exposure and PTPN22 1858T for the development of anti-CCP-positive or anti-CCP-negative RA. A strong association exists between smoking and the occurrence of extra-articular manifestations (subcutaneous nodules and cardiovascular events), but smoking has no influence on radiographic outcome. In lupus, tobacco exposure has an impact on the production of anti-double-stranded Desoxyribonuclic (dsDNA) and possibly on the development of the disease, as well as on disease activity/severity. In both diseases, smoking might interfere with drug efficacy.
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Underner M, Hadjadj S, Beauchant M, Bridoux F, Debiais F, Meurice JC. Effets du tabagisme sur la thyroïde, le tube digestif, le rein et l’os. Rev Mal Respir 2008; 25:1261-78. [DOI: 10.1016/s0761-8425(08)75091-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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