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Parrey A, Koka M, Ismail M. Correlation between Quality of Life and Erythrocyte Sedimentation Rate with Disease Activity in Rheumatoid Arthritis. Curr Rheumatol Rev 2024; 20:563-568. [PMID: 38375840 DOI: 10.2174/0115733971276855231208103527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Inflammatory markers are crucial in diagnosing and monitoring rheumatoid arthritis. Patients with rheumatoid arthritis (RA) live with constant pain that limits their daily activities. Our study highlights the effects of disease activity on the quality of life in patients with rheumatoid arthritis. METHODS Swollen joint count (SJC), tender joint count (TJC), and visual activity scale (VAS) were utilized to acquire patients' subjective feelings of wellness and their performance of routine daily activities to determine the disease activity. The patient's erythrocyte sedimentation rate (ESR) was measured at the clinical hematology laboratory using the Westergren method. The Quality of Life was rated on a scale of 1 to 10. RESULTS Our study found that disease activity is inversely proportional to the quality of life. Out of 111 patients, 3 (2.7%) were in remission, 1 (0.9%) had mild disease, 51 (45.9%) had moderate disease, and 56 (50.5%) had high disease activity. The ESR was normal (<20) in 11 patients (9.9%), moderately elevated (20-50) in 56 (50.5%) patients, and very high (>50) in 44 (39.6%) patients. The study revealed that 66% of patients in remission had normal, while 33% had moderately elevated ESR. 12.5% of patients with moderate disease activity had normal ESR, and none with high disease activity had normal ESR. Of 44 patients with high ESR, 7 had moderate disease activity, and 37 had high disease activity. In our study, 60% of patients had a less than 50% quality of life compared to patients with pre-arthritis. CONCLUSION High disease activity affects the productivity and quality of life in patients with rheumatoid arthritis. Assessing the impact of different interventions on the QOL should be an essential task that can help define a holistic and integrative treatment and rehabilitation model for RA patients.
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Affiliation(s)
- Ashaq Parrey
- Department of Medicine, Government Medical College, Akbar Colony Nowgam, India
| | - Manzoor Koka
- Department of Medicine, Government Medical College, Akbar Colony Nowgam, India
| | - Mohd Ismail
- Department of Medicine, Government Medical College, Akbar Colony Nowgam, India
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2
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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3
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Tarakci F, Ozkan IA, Yilmaz S, Tezcan D. Diagnosing rheumatoid arthritis disease using fuzzy expert system and machine learning techniques. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2022. [DOI: 10.3233/jifs-221582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rheumatoid Arthritis (RA) is a very common autoimmune disease that causes significant morbidity and mortality, and therefore early diagnosis and treatment are important. Early diagnosis of RA and knowing the severity of the disease are very important for the treatment to be applied. The diagnosis of RA usually requires a physical examination, laboratory tests, and a review of the patient’s medical history. In this study, the diagnosis of RA was made with two different methods using a fuzzy expert system (FES) and machine learning (ML) techniques, which were designed and implemented with the help of a specialist in the field, and the results were compared. For this purpose, blood counts were taken from 286 people, including 91 men and 195 women from various age groups. In the first method, an FES structure that determines the severity of RA disease has been established from blood count using the laboratory test results of CRP, ESR, RF, and ANA. The FES result that determines RA disease severity, the Anti-CCP level that is used to distinguish RA disease, and the patient’s medical history were used to design the Decision Support System (DSS) that diagnoses RA disease. The DSS is web-based and publicly accessible. In the second method, RA disease was diagnosed using kNN, SVM, LR, DT, NB, and MLP algorithms, which are widely used in machine learning. To examine the effect of the patient’s history on RA disease diagnosis, two different models were used in machine learning techniques, one with and one without the patient’s history. The results of the fuzzy-based DSS were also compared with the diagnoses made by the specialist and the diagnoses made according to the 2010 ACR / EULAR RA classification criteria. The performed DSS has achieved a diagnostic success rate of 94.05% on 286 patients. In the study of machine learning techniques, the highest success rate was achieved with the LR model. While the success rate of the model was 91.25 % with only blood count data, the success rate was 97.90% with the addition of the patient’s history. In addition to the high success rate, the results show that the patient’s history is important in diagnosing RA disease.
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Affiliation(s)
- Fatih Tarakci
- Department of Computer Engineering, Faculty of Technology, Selcuk University, Konya, Turkey
| | - Ilker Ali Ozkan
- Department of Computer Engineering, Faculty of Technology, Selcuk University, Konya, Turkey
| | - Sema Yilmaz
- Division of Rheumatology, Selcuk University School of Medicine, Konya, Turkey
| | - Dilek Tezcan
- Division of Rheumatology, Selcuk University School of Medicine, Konya, Turkey
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4
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Zhang HG, Hejblum BP, Weber GM, Palmer NP, Churchill SE, Szolovits P, Murphy SN, Liao KP, Kohane IS, Cai T. ATLAS: an automated association test using probabilistically linked health records with application to genetic studies. J Am Med Inform Assoc 2021; 28:2582-2592. [PMID: 34608931 DOI: 10.1093/jamia/ocab187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/14/2021] [Accepted: 08/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Large amounts of health data are becoming available for biomedical research. Synthesizing information across databases may capture more comprehensive pictures of patient health and enable novel research studies. When no gold standard mappings between patient records are available, researchers may probabilistically link records from separate databases and analyze the linked data. However, previous linked data inference methods are constrained to certain linkage settings and exhibit low power. Here, we present ATLAS, an automated, flexible, and robust association testing algorithm for probabilistically linked data. MATERIALS AND METHODS Missing variables are imputed at various thresholds using a weighted average method that propagates uncertainty from probabilistic linkage. Next, estimated effect sizes are obtained using a generalized linear model. ATLAS then conducts the threshold combination test by optimally combining P values obtained from data imputed at varying thresholds using Fisher's method and perturbation resampling. RESULTS In simulations, ATLAS controls for type I error and exhibits high power compared to previous methods. In a real-world genetic association study, meta-analysis of ATLAS-enabled analyses on a linked cohort with analyses using an existing cohort yielded additional significant associations between rheumatoid arthritis genetic risk score and laboratory biomarkers. DISCUSSION Weighted average imputation weathers false matches and increases contribution of true matches to mitigate linkage error-induced bias. The threshold combination test avoids arbitrarily choosing a threshold to rule a match, thus automating linked data-enabled analyses and preserving power. CONCLUSION ATLAS promises to enable novel and powerful research studies using linked data to capitalize on all available data sources.
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Affiliation(s)
- Harrison G Zhang
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Biological Sciences, Columbia University, New York City, New York, USA
| | - Boris P Hejblum
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Bordeaux Population Health, Université de Bordeaux, Inserm U1219, Inria SISTM, Bordeaux, France
| | - Griffin M Weber
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathan P Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanne E Churchill
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Szolovits
- Computer Science and Artificial Intelligence Laboratory (CSAIL), Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Shawn N Murphy
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Research IS and Computing, Mass General Brigham HealthCare, Charlestown, Massachusetts, USA
| | - Katherine P Liao
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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5
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Abstract
The utilization and identification of biomarkers in rheumatoid arthritis (RA) to facilitate timely diagnosis and the optimal management of the disease is an area of active investigation. This review focuses on biomarkers available for routine clinical use, details potential investigational biomarkers, and raises outstanding clinical questions.
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Affiliation(s)
- Samantha C Shapiro
- Rheumatology, University of Texas at Austin, Dell Medical School, Austin, USA
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6
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Barrett A, Gnehm D, Jones J, Trask BC. α1‐antitrypsin and C‐reactive protein levels in tear fluid after continuous contact lens wear. Clin Exp Optom 2021; 97:66-71. [DOI: 10.1111/cxo.12093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 01/28/2013] [Accepted: 02/05/2013] [Indexed: 01/04/2023] Open
Affiliation(s)
- Aaron Barrett
- Medical Laboratory Sciences Department, Weber State University, Ogden, Utah, USA,
| | - Derek Gnehm
- Medical Laboratory Sciences Department, Weber State University, Ogden, Utah, USA,
| | - Jordan Jones
- Medical Laboratory Sciences Department, Weber State University, Ogden, Utah, USA,
| | - Barbara C Trask
- Zoology Department, Weber State University, Ogden, Utah, USA,
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7
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Tang S, Dong X, Liu W, Qi W, Ye L, Yang X, Cao Q, Ge X, Zhou W. Compare risk factors associated with postoperative infectious complication in Crohn's disease with and without preoperative infliximab therapy: a cohort study. Int J Colorectal Dis 2020; 35:727-737. [PMID: 32060607 DOI: 10.1007/s00384-019-03481-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 02/04/2023]
Abstract
PURPOSES The incidence of postoperative complication is higher in Crohn's disease (CD) compared with other intestinal disease. There is less published data yet on the comparison of risk factors to predict postoperative complications in CD exposed and unexposed to previous infliximab therapy. Also the relationship between infliximab and postoperative infectious complications is still controversial. Our aim is to compare the risk factors to predict infectious complications in CD with and without preoperative infliximab and to clarify relationship between infliximab and infectious complications. METHODS This retrospective study included 390 patients from June 2014 to June 2018. Postoperative complications were compared in patients with and without preoperative infliximab. Univariate and multivariable analyses were performed to identify risk factors. RESULTS Eighty-five patients received infliximab within 8 weeks of surgery. A total of 129 patients had postoperative complications, with 35 receiving infliximab. No significant differences of whole postoperative complications were found in CD with and without infliximab (p = 0.073). However, patients receiving infliximab suffered more infectious complications (p = 0.010). Preoperative infliximab was confirmed to be an independent risk factor in infectious complications (p = 0.042). Multivariate analysis suggested that increased erythrocyte sedimentation rate (ESR) was an independent risk factor for infectious complications in patients receiving preoperative infliximab (p = 0.022), and increased C-reactive protein was an independent risk factor in patients not receiving preoperative infliximab (p = 0.019). CONCLUSIONS Preoperative use of infliximab ≤ 8 weeks was independently associated with infectious complications in CD. Risk factors were different in predicting postoperative complications in CD with and without infliximab, and preoperative ESR and C-reactive protein were risk factors, respectively.
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Affiliation(s)
- Shasha Tang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Xue Dong
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Wei Liu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Weilin Qi
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Lingna Ye
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Xiaoyan Yang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China
| | - Xiaolong Ge
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China.
| | - Wei Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang, China.
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8
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Vyas SP, Hansda AK, Goswami R. Rheumatoid arthritis: ‘melting pot’ of T helper subsets. Int Rev Immunol 2019; 38:212-231. [PMID: 31155981 DOI: 10.1080/08830185.2019.1621865] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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9
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Razi B, Reykandeh SE, Alizadeh S, Amirzargar A, Saghazadeh A, Rezaei N. TIM family gene polymorphism and susceptibility to rheumatoid arthritis: Systematic review and meta-analysis. PLoS One 2019; 14:e0211146. [PMID: 30730912 PMCID: PMC6366744 DOI: 10.1371/journal.pone.0211146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND TIM-family proteins are expressed on different immune cells such as dendritic cells, macrophages, type 1 and 2 T helper (Th) cells. Therefore, they have the ability to contribute to the various intracellular signals and immune responses, importantly the regulation of Th1 and Th17 cell differentiation, which plays a remarked role in fight against inflammatory and autoimmune diseases. Association of TIM family gene polymorphisms with rheumatoid arthritis (RA) has been frequently investigated. The findings however are not entirely consistent. Therefore, we carried out the present meta-analysis to examine the association between RA and the following TIM family gene polymorphisms: rs41297579, rs1036199, rs10515746, and rs7700944. METHODS A systematic search of Scopus, PubMed, and Web of Science databases was conducted through December 2018. Combined odds ratios (OR) with their corresponding 95% confidence intervals (CI) were calculated under different possible genetic models. RESULTS A total of eight case-control studies were included in the present meta-analysis. The results demonstrated significant association of RA with TIM-3 rs1036199 polymorphism under dominant (OR, 1.93, 95% CI, 1.43-2.61) and allelic models (OR, 1.74, 95% CI, 1.31-2.30). None of the other examined polymorphisms indicated significant association with RA. CONCLUSIONS The present meta-analysis revealed that the TIM-3 rs1036199 polymorphism might confer susceptibility to RA. Further studies are required to reassert our findings.
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Affiliation(s)
- Bahman Razi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Shahab Alizadeh
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - AliAkbar Amirzargar
- Molecular Immunology Research Center, Tehran University of Medical Sciences(TUMS), Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amene Saghazadeh
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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10
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Chung MK, Park B, Kim IJ, Cho SK, Kim D, Sung YK, Choi CB, Choe JY, Chung WT, Hong SJ, Kim TH, Koh E, Lee SS, Yoon BY, Park H, Bae SC, Lee J. Clinical outcomes of patients with active rheumatoid arthritis with normal acute phase reactant values. Int J Rheum Dis 2019; 22:852-859. [PMID: 30677239 DOI: 10.1111/1756-185x.13469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/06/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
AIM Despite high clinical disease activity, some patients with active rheumatoid arthritis (RA) have normal acute phase reactant (APR) values. This study aimed to determine the clinical outcomes of active RA patients with normal APR values. METHOD Of 5376 patients with RA enrolled in the Korean observational study network for arthritis (KORONA) registry, 400 patients with disease duration of <2 years who had Clinical Disease Activity Index (CDAI) score of >2.8 at baseline, biologic-naïve, and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) drawn at both baseline and 2-year follow-up visits were identified. Patients were grouped according to baseline APR levels: normal APRs, one APR elevated, and both APRs elevated. RESULTS Baseline tender and swollen joint counts, mean CDAI and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores were significantly lower in the normal APRs group compared with APR-elevated groups (P < 0.0001). At 2-year follow-up, mean CDAI scores, HAQ-DI, and percentage of the patient achieving remission were not significantly different between the normal APRs group compared with the APR-elevated groups regardless of the baseline disease activity. However, in patients with baseline CDAI moderate to high disease activity, the normal APRs group less frequently required initiation of the biologic disease-modifying anti-rheumatic drugs compared with the APR-elevated groups (P = 0.044). CONCLUSION Active RA patients with normal APR values have milder disease presentation, but similar clinical outcomes to those with elevated APRs.
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Affiliation(s)
- Min Kyung Chung
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Bohyun Park
- Department of Preventive Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - In Je Kim
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Soo-Kyung Cho
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.,Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Dam Kim
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.,Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yoon-Kyoung Sung
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.,Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Chan-Bum Choi
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.,Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jung-Yoon Choe
- Department of Rheumatology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Won Tae Chung
- Department of Rheumatology, Dong-A University Hospital, Busan, Korea
| | - Seung-Jae Hong
- Department of Rheumatology, Kyung Hee University Hospital, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Eunmi Koh
- Department of Rheumatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Bo Young Yoon
- Department of Rheumatology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sang-Cheol Bae
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.,Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jisoo Lee
- Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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Shaona F, Hassan R, Chakraborty S, Sultana S, Akther J, Nabi AHMN. Genotypic Analysis Revealed Association of HLA Alleles with Clinical Parameters in Bangladeshi Patients with Rheumatoid Arthritis. AMERICAN JOURNAL OF MOLECULAR BIOLOGY 2019; 09:173-190. [DOI: 10.4236/ajmb.2019.94013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
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12
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Iranshahi N, Assar S, Amiri SM, Zafari P, Fekri A, Taghadosi M. Decreased Gene Expression of Epstein–Barr Virus-Induced Gene 3 (EBI-3) may Contribute to the Pathogenesis of Rheumatoid Arthritis. Immunol Invest 2018; 48:367-377. [DOI: 10.1080/08820139.2018.1549066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nasrin Iranshahi
- Department of Immunology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shirin Assar
- Rheumatology in Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Mojtaba Amiri
- Department of Biostatistics and Epidemiology, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Zafari
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Adel Fekri
- Department of Immunology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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13
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Fuertes-Martín R, Taverner D, Vallvé JC, Paredes S, Masana L, Correig Blanchar X, Amigó Grau N. Characterization of 1H NMR Plasma Glycoproteins as a New Strategy To Identify Inflammatory Patterns in Rheumatoid Arthritis. J Proteome Res 2018; 17:3730-3739. [PMID: 30353728 DOI: 10.1021/acs.jproteome.8b00411] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease associated with a high index of morbidity and mortality from cardiovascular diseases. We used 1H NMR to characterize the plasma glycoprotein and lipoprotein profiles of a cohort of patients with RA ( n = 210) versus healthy individuals ( n = 203) to associate them with the RA disease and its severity. Using 1H NMR, we developed a line-shape method to characterize the two peaks associated with glycoproteins (GlycA and GlycB) and its derived variables: areas of GlycB (Area GlycB) and GlycA (Area GlycA), shape factors of these two peaks (H/W = height/width), and the distance between them (Distance GlycB-GlycA). We also used the advanced lipoprotein test Liposcale (CE) to characterize the lipoprotein subclasses. The standard lipid panel and traditional inflammatory markers such as C-reactive protein, the erythrocyte sedimentation rate, fibrinogen, the rheumatoid factor, anticitrullinated peptide antibodies, and the DAS28 index have also been determined. RA patients presented a significant 10.65% increase in the GlycA associated area compared with the control group ( p = 2.21 × 10-10). They also presented significantly higher H/W GlycA and GlycB ratios than the control population (H/W GlycB p = 7.88 × 10-8; H/W GlycA p = 5.61 × 10-8). The prediction model that uses the traditional inflammatory variables and the 1H NMR-derived parameters presented an AUC that was almost 10% higher than the model that only uses the traditional inflammatory variables (from 0.7 to 0.79 AUC). We have demonstrated that GlycA and GlycB variables derived from 1H NMR, along with classic inflammatory parameters, help to improve the classification of individuals with high RA disease activity.
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Affiliation(s)
- Rocío Fuertes-Martín
- Biosfer Teslab SL; DEEEA, Metabolomics Platform , Universitat Rovira i Virgili, IISPV; CIBERDEM , 43007 Tarragona , Spain
| | - Dèlia Taverner
- Unitat de Recerca en Lipids i Arteriosclerosi , Hospital Universitari Sant Joan de Reus; IISPV; CIBERDEM , 43204 Reus , Spain
| | - Joan-Carles Vallvé
- Unitat de Recerca en Lipids i Arteriosclerosi , Hospital Universitari Sant Joan de Reus; IISPV; CIBERDEM , 43204 Reus , Spain
| | - Silvia Paredes
- Unitat de Recerca en Lipids i Arteriosclerosi , Hospital Universitari Sant Joan de Reus; IISPV; CIBERDEM , 43204 Reus , Spain
| | - Lluis Masana
- Unitat de Recerca en Lipids i Arteriosclerosi , Hospital Universitari Sant Joan de Reus; IISPV; CIBERDEM , 43204 Reus , Spain
| | | | - Núria Amigó Grau
- Biosfer Teslab SL; DEEEA, Metabolomics Platform , Universitat Rovira i Virgili, IISPV; CIBERDEM , 43007 Tarragona , Spain
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14
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Smolen JS, van Vollenhoven RF, Florentinus S, Chen S, Suboticki JL, Kavanaugh A. Predictors of disease activity and structural progression after treatment with adalimumab plus methotrexate or continued methotrexate monotherapy in patients with early rheumatoid arthritis and suboptimal response to methotrexate. Ann Rheum Dis 2018; 77:1566-1572. [PMID: 30076156 PMCID: PMC6225797 DOI: 10.1136/annrheumdis-2018-213502] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 01/21/2023]
Abstract
Objectives Methotrexate is considered to be first-line therapy for rheumatoid arthritis (RA). However, a substantial proportion of treated patients do not achieve the desired goals of therapy. This analysis aimed to identify predictors of insufficient response to methotrexate in patients with early RA. Methods The Optimal Protocol for Treatment Initiation with Methotrexate and Adalimumab (OPTIMA) and PREMIER studies in patients with RA for <1 and <3 years, respectively, examined the efficacy of methotrexate and adalimumab in methotrexate-naive patients. This post hoc analysis included patients for whom initial methotrexate monotherapy was not successful after 6 months. Candidate predictors of insufficient response and clinically relevant radiographic progression (CRRP) included demographics, baseline disease characteristics and time-averaged disease variables over a 12-week interval. In OPTIMA, adalimumab was added to therapy after insufficient treatment response; in PREMIER, initial methotrexate therapy was continued; clinical, functional and radiologic outcomes were assessed after 1 year. Results Baseline 28-joint Disease Activity Score based on C-reactive protein (DAS28(CRP)) and time-averaged DAS28(CRP) over 4, 8 and 12 weeks were the strongest predictors of insufficient response to methotrexate and CRRP. Addition of adalimumab to methotrexate therapy was associated with better clinical, functional and radiographic outcomes after 1 year compared with continuing on methotrexate monotherapy. Conclusions In patients with early RA, baseline disease characteristics and early disease activity can predict response to methotrexate treatment and radiographic progression at 6 months. The addition of adalimumab at 6 months after methotrexate failure is associated with improved outcomes. These results support treatment-to-target strategies and timely adaptation of therapy in patients with early RA. Trial registration number NCT00420927, NCT00195663; Post-results.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Ronald F van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam, The Netherlands
| | | | - Su Chen
- Data and Statistical Sciences, AbbVie Inc., North Chicago, Illinois, USA
| | | | - Arthur Kavanaugh
- Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, California, USA
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Almousa AA, Morris M, Fowler S, Jones J, Alcorn J. Elevation of serum pyruvate kinase M2 (PKM2) in IBD and its relationship to IBD indices. Clin Biochem 2017; 53:19-24. [PMID: 29273328 DOI: 10.1016/j.clinbiochem.2017.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/04/2017] [Accepted: 12/17/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Endoscopy remains the gold standard to diagnose and evaluate inflammatory bowel disease (IBD) activity. Current biomarkers or their combinations cannot adequately predict IBD risk, diagnosis, progression or relapse, and response to therapy. Pyruvate kinase M2 (PKM2) is emerging as a significant mediator of the inflammatory process. We aimed to assess levels of serum PKM2 in healthy and newly diagnosed IBD patients and its relationship with IBD indices and microbiota changes. DESIGN AND METHODS IBD serum samples from newly diagnosed patients were collected and analyzed using a PKM2-ELISA and correlated with disease activity scores, IBD disease type, and intestinal microbiota. Furthermore, we tested the genetic and protein expression of PKM2 in an in vitro intestinal cell model of inflammation. RESULTS Serum PKM2 levels were 6-fold higher in IBD patients compared to healthy controls, with no sensitivity to disease phenotype (Crohn's Disease or Ulcerative Colitis) or localization of inflammation. Serum PKM2 had considerably less interindividual variability than established IBD fecal biomarkers. A positive Pearson correlation (r=0.6121) existed between serum PKM2 and Bacteroidetes fecal levels in Crohn's disease (CD), while a negative (r=-0.6128) correlation was observed with Actinobacteria fecal levels. Furthermore, LPS (500ng/mL) significantly increased PKM2 expression in vitro, which was significantly suppressed by an anti-inflammatory flaxseed bioactive agent. CONCLUSION Our data suggests PKM2 as a putative biomarker for IBD and the dysbiosis of microflora in CD. Investigations involving larger number of clinical patients are necessary to validate its use as a serum biomarker of IBD.
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Affiliation(s)
- Ahmed A Almousa
- Drug Discovery and Development Research Group, College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, Canada
| | - Marc Morris
- Drug Discovery and Development Research Group, College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, Canada
| | - Sharyle Fowler
- Department of Gastroenterology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Jennifer Jones
- Division of Digestive Care & Endoscopy, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Jane Alcorn
- Drug Discovery and Development Research Group, College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, Canada.
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Godinez F, Gong K, Zhou J, Judenhofer MS, Chaudhari AJ, Badawi RD. Development of an Ultra High Resolution PET Scanner for Imaging Rodent Paws: PawPET. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2017; 2:7-16. [PMID: 31930184 DOI: 10.1109/trpms.2017.2765486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A positron emission tomography (PET) scanner with submillimeter spatial resolution, capable of in vivo imaging of murine extremities was built based on two dual ended readout, hybrid depth of interaction (DOI) PET detectors. Each was composed of a 36 × 36 array of 0.43 mm × 0.43 mm × 8 mm unpolished lutetium oxyorthosilicate crystals separated by a 50 μm white diffuse reflector. The array was coupled to a position-sensing photomultiplier tube at one end and to an avalanche photodiode at the other end. The detector characterization included crystal identification accuracy, DOI, energy, and timing resolution measurements. The scanner was characterized in terms of its spatial resolution and its sensitivity and mouse images were acquired of a mouse paw injected with 18-F-NaF. Out of the 36 × 36 crystals only 33 × 33 crystals were identified. The coincidence timing, DOI, and energy resolution of the scanner was measured to be 2.8 ns, 1.4 mm, and 27%, respectively. The scanner's spatial resolution was measured with a line source and determined from an ordered subsets expectation maximization reconstruction to be 0.56 mm. The sensitivity of the scanner was measured to be 0.6% at the center of the field of view.
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Affiliation(s)
- Felipe Godinez
- Department of Perinatal Imaging, King's College London, London SE1 7EH, U.K
| | - Kuang Gong
- Department of Biomedical Engineering, University of California at Davis, Davis, CA 95616 USA
| | - Jian Zhou
- Toshiba Medical Research Institute, USA, Inc., Vernon Hills, IL 60061 USA
| | - Martin S Judenhofer
- Department of Biomedical Engineering, University of California at Davis, Davis, CA 95616 USA
| | - Abhijit J Chaudhari
- Department of Biomedical Engineering, University of California at Davis, Davis, CA 95616 USA
| | - Ramsey D Badawi
- Department of Biomedical Engineering, University of California at Davis, Davis, CA 95616 USA
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Poorvashree J, Suneela D. Novel drug delivery of dual acting prodrugs of hydroxychloroquine with aryl acetic acid NSAIDs: Design, kinetics and pharmacological study. Drug Deliv Transl Res 2017; 7:709-730. [DOI: 10.1007/s13346-017-0420-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Park GS, Wong WK, Oh M, Khanna D, Gold RH, Sharp JT, Paulus HE. Classifying radiographic progression status in early rheumatoid arthritis patients using propensity scores to adjust for baseline differences. Stat Methods Med Res 2016; 16:13-29. [PMID: 17338292 DOI: 10.1177/0962280207070623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Various methods are used to measure radiographic joint damage in patients with rheumatoid arthritis (RA), but determining proportions of responsive patients is difficult. A key problem in observational studies when assessing damage outcomes is incorporating time to treatment initialization and adjusting for observed baseline differences. We examined five different definitions to select an appropriate index to classify radiographic damage in RA patients as progressive or nonprogressive. In addition, we compared different times from symptom onset to treatment and their effects on patient radiographic categorization. Propensity scores to adjust for baseline differences, including time since symptom onset, were used to match those treated early with those treated later using the stratification, radius, nearest neighbor and kernel methods. The mean effect of treatment on the treated was computed for each matching method. Observational data were analyzed for 185 early RA patients from the Western Consortium study followed six to sixty months (mean thirty-one months). For the selected index, 75 patients were categorized as nonprogressors; they had significantly lower disease activity, more clinical improvement and were treated earlier than the progressors. Of those treated within three months of symptom onset, 57% were classified as radiographically progressive versus 35% of those treated later ( P = 0.0058). However, after propensity score adjustment for baseline differences, we noticed nonsignificant ( P > 0.05) nonprogression in patients given earlier treatment. We conclude that propensity score analysis reduced but did not remove all bias.
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Affiliation(s)
- Grace S Park
- Department of Biostatistics, School of Public Health, University of California, Los Angeles, CA 90095-1772, USA.
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Increased Kappa/Lambda Hybrid Antibody in Serum Is a Novel Biomarker Related to Disease Activity and Inflammation in Rheumatoid Arthritis. Mediators Inflamm 2016; 2016:2953072. [PMID: 27143816 PMCID: PMC4837281 DOI: 10.1155/2016/2953072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/01/2016] [Accepted: 03/16/2016] [Indexed: 12/03/2022] Open
Abstract
The κ/λ hybrid antibodies in normal human serum were reported recently, but their clinical relevance has not yet been explored. Rheumatoid arthritis (RA) is one of the major joint diseases, and the early diagnosis and treatment of RA remain a challenge. Here, we developed a double-sandwich enzyme-linked immunosorbent assay system to quantify relative serum κ/λ hybrid antibody levels in RA patients, osteoarthritis (OA) patients, and healthy controls (HC) in order to assess their potential use as a serological biomarker of early disease and clinical activity and to preliminarily investigate their immunomodulatory roles in RA. Surprisingly, we found that κ/λ hybrid antibody was markedly increased in both early and established RA. Serum κ/λ hybrid antibody levels were significantly correlated with clinical indexes and inflammatory markers in RA. Further analysis showed a positive correlation between κ/λ hybrid antibody levels and the 28-joint disease activity score (DAS28). In conclusion, serum κ/λ hybrid antibodies in RA were identified for the first time. High levels of κ/λ hybrid antibody may be a useful tool in distinguishing early RA from OA and HC. We suggest κ/λ hybrid antibody as a marker for disease activity. The increased κ/λ hybrid antibodies were associated with inflammatory conditions in RA.
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Kim SJ, Lee JH, Kim SM, Park MG, Park SH, Kim DK, Hwang JY, Choi JS, Park SK. Relationship between Neutrophil-lymphocyte, Platelet-lymphocyte Ratio and Rheumatoid Arthritis Activity. JOURNAL OF RHEUMATIC DISEASES 2016. [DOI: 10.4078/jrd.2016.23.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sung Jun Kim
- Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Ji Hyun Lee
- Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Seong Man Kim
- Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Min Gi Park
- Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Su Ho Park
- Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Dong Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Ji Yeon Hwang
- Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Joon Sul Choi
- Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
| | - Suk Ki Park
- Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
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Law RJ, Saynor ZL, Gabbitas J, Jones J, Kraus A, Breslin A, Maddison PJ, Thom JM. The Effects of Aerobic and Resistance Exercise on Markers of Large Joint Health in Stable Rheumatoid Arthritis Patients: A Pilot Study. Musculoskeletal Care 2015; 13:222-35. [PMID: 25962747 DOI: 10.1002/msc.1103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Exercise is beneficial for people with rheumatoid arthritis (RA). However, patients and health professionals have expressed concern about the possible detrimental effects of exercise on joint health. The present study investigated the acute and chronic effects of high-intensity, low-impact aerobic and resistance exercise on markers of large joint health in RA. METHODS Eight RA patients and eight healthy, matched control (CTL) participants performed 30 minutes' high-intensity, low-impact aerobic and lower-body resistance exercise, one week apart. Primary outcome measures assessing joint health were serum cartilage oligomeric matrix protein (sCOMP) and knee joint synovial inflammation (Doppler ultrasound colour fraction; CF). These measures were taken at baseline, immediately after and 0.5, one, two, six and 24 hours post-exercise. In a separate study, nine RA patients completed eight weeks of progressive exercise training. The same outcome measures were reassessed at baseline, and at one hour post-exercise of training weeks 0, 1, 4 and 8. RESULTS RA patients showed higher overall sCOMP [RA: 1,347 ± 421, CTL: 1,189 ± 562 ng/mL; p < 0.05; effect size (ES) = 0.32] and CF when scanned longitudinally (RA: 0.489 ± 0.30 × 10(-3) , CTL: 0.101 ± 0.13 × 10(-3) ; p < 0.01; ES = 1.73) and transversely (RA: 0.938 ± 0.69 × 10(-3) , CTL: 0.199 ± 0.36 × 10(-3) ; p < 0.01; ES = 1.33) than CTL. However, no acute effects on joint health were observed post-exercise. Similarly, no chronic effects were observed over eight weeks of combined aerobic and resistance training in RA, with positive effects on physical fitness and function. CONCLUSIONS RA patients on stable treatment with low disease activity were able to perform an individually prescribed high-intensity, low-impact aerobic and resistance exercise without changes in markers of large joint health. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK.,School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Zoe L Saynor
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Julia Gabbitas
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Jeremy Jones
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK.,Peter Maddison Rheumatology Centre, Betsi Cadwaladr University Health Board, Llandudno, UK
| | - Alexandra Kraus
- Radiology Department, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Anne Breslin
- Peter Maddison Rheumatology Centre, Betsi Cadwaladr University Health Board, Llandudno, UK
| | - Peter J Maddison
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Jeanette M Thom
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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Windgassen EB, Funtowicz L, Lunsford TN, Harris LA, Mulvagh SL. C-Reactive Protein and High-Sensitivity C-Reactive Protein: An Update for Clinicians. Postgrad Med 2015; 123:114-9. [DOI: 10.3810/pgm.2011.01.2252] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Flormann D, Kuder E, Lipp P, Wagner C, Kaestner L. Is there a role of C-reactive protein in red blood cell aggregation? Int J Lab Hematol 2014; 37:474-82. [PMID: 25382124 DOI: 10.1111/ijlh.12313] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/13/2014] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Numerous clinical studies related the plasma level of C-reactive protein (CRP) to the erythrocyte sedimentation rate (ESR) independent of the kind of disease. The molecular regulation of the process is unknown. METHODS We performed a meta-analysis of 10 previous studies and experimentally probed for a direct action of CRP on red blood cells (RBCs) by different methods including determination of a microscopic aggregation index, Ca(2+) imaging and analysis of sedimentation experiments. RESULTS The meta-analysis revealed a statistically significant correlation (Pearson coefficient of 0.37; P < 0.0001), but we could not find any experimental evidence for a direct CRP-RBC interaction. Instead, we could confirm a correlation between fibrinogen level and ESR. CONCLUSION Therefore, we concluded that CRP and ESR cannot account for nor replace each other as a diagnostic measure. The correlation between CRP level and ESR is most probably caused by fibrinogen, because its increase coincides with elevated CRP levels.
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Affiliation(s)
- D Flormann
- Experimental Physics, Saarland University, Saarbrücken, Germany
| | - E Kuder
- Institute for Molecular Cell Biology and Research Centre for Molecular Imaging and Screening, School of Medicine, Saarland University, Homburg/Saar, Germany
| | - P Lipp
- Institute for Molecular Cell Biology and Research Centre for Molecular Imaging and Screening, School of Medicine, Saarland University, Homburg/Saar, Germany
| | - C Wagner
- Experimental Physics, Saarland University, Saarbrücken, Germany
| | - L Kaestner
- Institute for Molecular Cell Biology and Research Centre for Molecular Imaging and Screening, School of Medicine, Saarland University, Homburg/Saar, Germany
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Crockett SD, Mott LA, Barry EL, Figueiredo JC, Burke CA, Baxter GJ, Sandler RS, Baron JA. C-reactive protein and risk of colorectal adenomas or serrated polyps: a prospective study. Cancer Prev Res (Phila) 2014; 7:1122-7. [PMID: 25145487 DOI: 10.1158/1940-6207.capr-14-0167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Serum C-reactive protein (CRP) is a sensitive marker of systemic inflammation. Because there is a well-recognized relationship between local inflammation and colorectal cancer, we aimed to evaluate whether serum CRP levels were associated with the occurrence of colorectal adenomas and serrated polyps using data from a large adenoma prevention trial. A total of 930 participants with a history of colorectal adenomas were enrolled in a randomized trial of calcium supplementation (1,200 mg/day) for the prevention of colorectal adenomas. Outcomes in this analysis are metachronous adenomas (and advanced neoplasms specifically), and serrated polyps at follow-up colonoscopy. High-sensitivity CRP levels were measured 1 year following baseline colonoscopy. Multivariate analysis was performed to estimate risk ratios (RR) using Poisson regression, controlling for potential confounders. We measured serum CRP levels in 689 participants (mean CRP, 3.62 ± 5.72 mg/L). There was no difference in CRP levels with respect to calcium versus placebo treatment assignment (P = 0.99). After adjustment for potential confounders, we found no association between CRP level and risk of recurrent adenoma or advanced lesion [quartile 4 vs. quartile 1: RR, 95% confidence interval (CI) = 0.99 (0.73-1.34) and 0.92 (0.49-1.75), respectively]. Similarly, no association was seen between CRP levels and risk of serrated polyps or proximal serrated polyps [quartile 4 vs. quartile 1: RR (95% CI) = 1.32 (0.85-2.03) and 1.19 (0.54-2.58), respectively]. In conclusion, this large prospective colorectal adenoma chemoprevention study found no significant relationship between CRP levels and occurrence of adenomas, advanced neoplasms, or serrated polyps.
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Affiliation(s)
- Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Leila A Mott
- Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire
| | - Elizabeth L Barry
- Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire
| | - Jane C Figueiredo
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Carol A Burke
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Gwen J Baxter
- Dumfries and Galloway Royal Infirmary, Dumfries, Scotland, United Kingdom
| | - Robert S Sandler
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - John A Baron
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Kay J, Morgacheva O, Messing SP, Kremer JM, Greenberg JD, Reed GW, Gravallese EM, Furst DE. Clinical disease activity and acute phase reactant levels are discordant among patients with active rheumatoid arthritis: acute phase reactant levels contribute separately to predicting outcome at one year. Arthritis Res Ther 2014; 16:R40. [PMID: 24485007 PMCID: PMC3978994 DOI: 10.1186/ar4469] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 01/24/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Clinical trials of new treatments for rheumatoid arthritis (RA) typically require subjects to have an elevated acute phase reactant (APR), in addition to tender and swollen joints. However, despite the elevation of individual components of the Clinical Disease Activity Index (CDAI) (tender and swollen joint counts and patient and physician global assessment), some patients with active RA may have normal erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels and thus fail to meet entry criteria for clinical trials. We assessed the relationship between CDAI and APRs in the Consortium of Rheumatology Researchers of North America (CORRONA) registry by comparing baseline characteristics and one-year clinical outcomes of patients with active RA, grouped by baseline APR levels. Methods This was an observational study of 9,135 RA patients who had both ESR and CRP drawn and a visit at which CDAI was >2.8 (not in remission). Results Of 9,135 patients with active RA, 58% had neither elevated ESR nor CRP; only 16% had both elevated ESR and CRP and 26% had either ESR or CRP elevated. Among the 4,228 patients who had a one-year follow-up visit, both baseline and one-year follow-up modified Health Assessment Questionnaire (mHAQ) and CDAI scores were lowest for patients with active RA but with neither APR elevated; both mHAQ and CDAI scores increased sequentially with the increase in number of elevated APR levels at baseline. Each individual component of the CDAI followed the same trend, both at baseline and at one-year follow-up. The magnitude of improvement in both CDAI and mHAQ scores at one year was associated positively with the number of APRs elevated at baseline. Conclusions In a large United States registry of RA patients, APR levels often do not correlate with disease activity as measured by joint counts and global assessments. These data strongly suggest that it is appropriate to obtain both ESR and CRP from RA patients at the initial visit. Requiring an elevation in APR levels as a criterion for inclusion of RA patients in studies of experimental agents may exclude some patients with active disease.
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Prakash Babu N, Saravanan S, Pandikumar P, Bala Krishna K, Karunai Raj M, Ignacimuthu S. Anti-inflammatory and anti-arthritic effects of 3-hydroxy, 2-methoxy sodium butanoate from the leaves of Clerodendrum phlomidis L.f. Inflamm Res 2013; 63:127-38. [DOI: 10.1007/s00011-013-0681-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 10/17/2013] [Accepted: 10/22/2013] [Indexed: 11/30/2022] Open
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Smolen JS, van der Heijde D, Machold KP, Aletaha D, Landewé R. Proposal for a new nomenclature of disease-modifying antirheumatic drugs. Ann Rheum Dis 2013; 73:3-5. [PMID: 24072562 DOI: 10.1136/annrheumdis-2013-204317] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In light of the recent emergence of new therapeutics for rheumatoid arthritis, such as kinase inhibitors and biosimilars, a new nomenclature for disease-modifying antirheumatic drugs (DMARDs), which are currently often classified as synthetic (or chemical) DMARDs (sDMARDS) and biological DMARDs (bDMARDs), may be needed. We propose to divide the latter into biological original and biosimilar DMARDs (boDMARDs and bsDMARDs, respectively, such as abatacept, adalimumab, anakinra, certolizumab pegol, etanercept, golimumab, infliximab, rituximab or tocilizumab, but also emerging ones like clazakizumab, ixekizumab, sarilumab, secukinumab or sirukumab) and the former into conventional synthetic and targeted synthetic DMARDs (csDMARDs and tsDMARDs, respectively). tsDMARDs would then constitute only those that were specifically developed to target a particular molecular structure (such as tofacitinib, fostamatinib, baricitinib or apremilast, or agents not focused primarily on rheumatic diseases, such as imatinib or ibrutinib), while csDMARDs would comprise the traditional drugs (such as methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, gold salts and others). The proposed nomenclature may provide means to group and distinguish the different types of DMARDs in clinical studies and review articles.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, , Vienna , Austria
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Doyle MK, Rahman MU, Frederick B, Birbara CA, de Vries D, Toedter G, Wu X, Chen D, Ranganath VK, Westerman ME, Furst DE. Effects of subcutaneous and intravenous golimumab on inflammatory biomarkers in patients with rheumatoid arthritis: results of a phase 1, randomized, open-label trial. Rheumatology (Oxford) 2013; 52:1214-9. [PMID: 23418046 DOI: 10.1093/rheumatology/kes381] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the effects of the anti-TNF-α monoclonal antibody golimumab, administered by s.c. injection or i.v. infusion, on markers of inflammation in patients with RA. METHODS In this phase 1, open-label study, patients with active RA were randomized to receive s.c. golimumab 100 mg at baseline and every 4 weeks through week 20 (n = 33; group 1) or i.v. golimumab 2 mg/kg at baseline and week 12 (n = 16; group 2). Serum levels of CRP, IL-6, serum amyloid A (SAA), TNF receptor II (TNFRII), MMP-3, hyaluronic acid, haptoglobin, ferritin and haemoglobin and serum/urine hepcidin were measured at various time points. Associations between the biomarkers were assessed with Spearman's correlations. RESULTS In both groups 1 and 2, decreases in mean serum levels of CRP, IL-6, SAA, TNFRII, MMP-3, haptoglobin, ferritin and hepcidin, and mean urine levels of hepcidin occurred within 1 week and were sustained through week 8. Decreases in concentrations of serum CRP, IL-6, SAA, MMP-3, hepcidin, ferritin and haptoglobin and urine hepcidin were maintained through week 24 in group 1, but began to reverse after week 8 in group 2. Among all patients, decreases in serum hepcidin correlated significantly with decreases in serum CRP and ferritin. CONCLUSION Decreases in serum and urine concentrations of markers of inflammation occurred as early as 24 h after treatment with golimumab, and most of these improvements were sustained through week 24 in group 1.
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Affiliation(s)
- Mittie K Doyle
- Janssen Research & Development, LLC, Spring House, PA, USA.
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Sipe JD. The Acute Phase Response in the Pathogenesis of Inflammatory Disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/bf03259281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Krisp C, Randall SA, McKay MJ, Molloy MP. Towards clinical applications of selected reaction monitoring for plasma protein biomarker studies. Proteomics Clin Appl 2011; 6:42-59. [PMID: 22213646 DOI: 10.1002/prca.201100062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 01/13/2023]
Abstract
The widespread clinical adoption of protein biomarkers with diagnostic, prognostic and/or predictive value remains a formidable challenge for the biomedical community. From discovery to validation, the path to biomarkers of clinical relevance abounds with many protein candidates, yet so few concrete examples have been substantiated. In this review, we focus on the recent adoption of selected reaction monitoring (SRM) of plasma proteins in the path to clinical use for a broad range of diseases including cancer, cardiovascular disease, genetic disorders and various metabolic disorders. Recent progress reveals a promising outlook for clinical applications using SRM, which now provides the routine analysis of clinically relevant protein markers at low nanogram per millilitre in plasma.
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Affiliation(s)
- Christoph Krisp
- Department of Chemistry and Biomolecular Sciences, Macquarie University, Sydney, Australia
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Patterns of radiographic outcomes in early, seropositive rheumatoid arthritis: A baseline analysis. Contemp Clin Trials 2011; 32:160-8. [DOI: 10.1016/j.cct.2010.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/02/2010] [Accepted: 11/09/2010] [Indexed: 11/22/2022]
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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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FOSTER WILL, CARRUTHERS DAVID, LIP GREGORYY, BLANN ANDREWD. Inflammation and Microvascular and Macrovascular Endothelial Dysfunction in Rheumatoid Arthritis: Effect of Treatment. J Rheumatol 2010; 37:711-6. [DOI: 10.3899/jrheum.090699] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine whether abnormalities in microvascular and macrovascular function in rheumatoid arthritis (RA) are associated with plasma markers [von Willebrand factor (VWF)] of endothelial dysfunction and inflammation [C-reactive protein (CRP)] and whether the abnormalities would be altered by treatment. Endothelial dysfunction and inflammation in RA may contribute to adverse cardiovascular events. Although endothelial dysfunction in RA has been demonstrated by altered plasma markers, the relationships with macrovascular and microvascular function are relatively unexplored.Methods.We recruited 66 patients with chronic RA, 48 community controls (CC), and 25 patients with diabetes and hypertension as a disease control group (DC). Subjects had venous blood sampled for plasma markers, and underwent laser Doppler perfusion imaging of forearm skin (to assess microvascular circulation) following acetylcholine and sodium nitroprusside iontophoresis, to assess endothelium-dependent and endothelium-independent responses, respectively. Brachial artery flow-mediated dilatation assessed endothelial dysfunction in a macrovascular bed. A subgroup of 29 patients with RA were assessed pretherapy and after 2–4 weeks of antirheumatic therapy.Results.As expected, patients with RA had higher CRP, erythrocyte sedimentation rate (ESR), and VWF. Endothelium-independent vasoreactivity was abnormal in RA, and this correlated negatively with CRP. All aspects of microvascular function were abnormal in the DC compared to the CC. Macrovascular function was preserved in RA but was abnormal in the DC group. Four weeks of antiinflammatory therapy reduced CRP and ESR but had no effect on any vascular function index in the patients with RA.Conclusion.Patients with RA have abnormal endothelium-independent microvascular function that correlates with inflammation but is not altered by short-term antiinflammatory therapy.
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Abstract
Biomarkers are increasingly employed in empirical studies of human populations to understand physiological processes that change with age, diseases whose onset appears linked to age, and the aging process itself. In this chapter, we describe some of the most commonly used biomarkers in population aging research, including their collection, associations with other markers, and relationships to health outcomes. We discuss biomarkers of the cardiovascular system, metabolic processes, inflammation, activity in the hypothalamic-pituitary axis (HPA) and sympathetic nervous system (SNS), and organ functioning (including kidney, lung, and heart). In addition, we note that markers of functioning of the central nervous system and genetic markers are now becoming part of population measurement. Where possible, we detail interrelationships between these markers by providing correlations between high risk levels of each marker from three population-based surveys: the National Health and Nutrition Examination Survey (NHANES) III, NHANES 1999-2002, and the MacArthur Study of Successful Aging. NHANES III is used instead of NHANES 1999-2002 when specific markers of interest are available only in NHANES III and when we examine the relationship of biomarkers to mortality which is only known for NHANES III. We also describe summary measures combining biomarkers across systems. Finally, we examine associations between individual markers and mortality and provide information about biomarkers of growing interest for future research in population aging and health.
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Affiliation(s)
- Eileen Crimmins
- Andrus Gerontology Center, Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, USA
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Schiff MH, Hobbs KF, Gensler T, Keenan GF. A retrospective analysis of low-field strength magnetic resonance imaging and the management of patients with rheumatoid arthritis. Curr Med Res Opin 2007; 23:961-8. [PMID: 17519063 DOI: 10.1185/030079907x178892] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess how in-office magnetic resonance imaging (MRI) scans of the hand/wrist or feet are utilized in a rheumatology practice to make clinical evaluations regarding therapeutic options for rheumatoid arthritis (RA) patients. METHODS In a large clinical practice, a retrospective review was conducted on the first 300 RA patients who had office-based MRI scans at baseline. Information was collected on demographics, baseline therapy, and whether any change in therapy occurred at the time of the MRI scans. MR images of the affected wrist were obtained with a low-field strength dedicated extremity unit. RESULTS Of the 300 patients, 99 patients (33%) had MRIs that exhibited signs of erosions, joint space narrowing, or bone edema. These patients were classified as MRI-positive. The remaining 201 patients (67%) were classified as MRI-negative. A substantial majority (85%) of MRI-positive patients received a change in their therapeutic regimen, compared with only 9.5% of the MRI-negative patients (p < 0.001). In the 84 MRI-positive patients who had their therapy changed, 65% received a new prescription for a biologic or an increase in the dose of their existing biologic and 34% of the MRI-positive patients received a DMARD. In the 19 MRI-negative patients with a therapeutic change, 11% received a biologic agent and 88% received a DMARD. The major limitation of this study is that it was a retrospective analysis and the assessments of MRI findings were qualitative. CONCLUSION In this large population of RA patients, there was an association between MRI detection of joint space narrowing, erosions, and/or bone edema and change in therapeutic management.
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Abstract
The potential for disproportionately altering outcome in the early stages of rheumatoid arthritis (RA) was first hypothesized in the early 1990s. This window of opportunity hypothesis for therapeutic intervention in RA is based on the existence of a time frame within which there is a potential for a greater response to therapy, resulting in sustained benefits or, perhaps most important, a chance of cure. Given the persistent, progressive, damaging, inflammatory nature of RA, this approach to altering outcome in the early stages seems attractive.
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Affiliation(s)
- Mark A Quinn
- Academic Unit of Musculoskeletal Disease, Department of Rheumatology, Chapel Allerton Hospital, 2nd Floor, Chapel Town Road, Leeds LS7 4SA, UK
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Matsuzaki T, Nakajima A, Ishigami S, Tanno M, Yoshino S. Mirthful laughter differentially affects serum pro- and anti-inflammatory cytokine levels depending on the level of disease activity in patients with rheumatoid arthritis. Rheumatology (Oxford) 2005; 45:182-6. [PMID: 16319105 DOI: 10.1093/rheumatology/kei081] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine the effect of mirthful laughter in rheumatoid arthritis (RA), we evaluated the levels of serum cytokines before and after patients experienced mirthful laughter. METHODS Forty-one patients with RA and 23 healthy subjects were enrolled. They listened to 'Rakugo', a traditional Japanese comic story, to induce mirthful laughter. We measured serum IL-6, IL-1beta, TNF-alpha, IL-4 and IL-1 receptor antagonist (IL-1Ra) concentrations before and after patients listened to the story. The RA subjects were divided into two groups. One was designated the 'difficult-to-control RA' group (CRP > or =1.0 mg/dl); The other group was regarded as the 'easily controlled RA' group (CRP <1.0 mg/dl). RESULTS The basal levels of serum IL-6 and TNF-alpha in the RA patients were significantly higher than those in the healthy group. After experiencing mirthful laughter, the levels of serum IL-6 decreased significantly in the RA group but not in the healthy subjects. Interestingly, the level of serum TNF-alpha decreased only in the easily controlled RA group. Serum IL-4 concentration in the RA group was significantly higher than that in healthy subjects before the story. After the story, the level of serum IL-4 significantly decreased in the RA group, especially in the difficult-to-control RA group. In contrast, serum IL-1Ra concentration was statistically higher in the RA group than that in healthy subjects before the story, and a further increase was observed after the story, especially in the easily controlled RA group. CONCLUSIONS Our findings suggest that mirthful laughter affects the levels of serum pro- and anti-inflammatory cytokines differentially, depending on the RA disease activity.
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Affiliation(s)
- T Matsuzaki
- Department of Joint Disease and Rheumatism, Nippon Medical School, Tokyo, Japan.
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Abstract
It is believed that rheumatoid arthritis (RA) is the most common, potentially treatable cause of disability in the Western world. A commonsense approach to the management of a persistent, progressive, damaging condition such as RA would seem to be intervention before the onset of damage, at a stage when disease still may be reversible. Such a phase of disease has been described as a "window of opportunity" for intervention. This article discusses the evidence for early intervention in RA.
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Affiliation(s)
- Mark A Quinn
- Academic Unit of Musculoskeletal Disease, Department of Rheumatology, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
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Shin YS, Choi JH, Nahm DH, Park HS, Cho JH, Suh CH. Rheumatoid factor is a marker of disease severity in Korean rheumatoid arthritis. Yonsei Med J 2005; 46:464-70. [PMID: 16127769 PMCID: PMC2815829 DOI: 10.3349/ymj.2005.46.4.464] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2004] [Accepted: 03/28/2005] [Indexed: 12/01/2022] Open
Abstract
Serum rheumatoid factor (RF) is important in the diagnosis and prognosis of rheumatoid arthritis (RA). The purpose of this study is to compare the clinical characteristics and treatment patterns of RA according to the presence of RF in Korean patients. A retrospective analysis was performed on the records of 109 patients who were followed for at least 2 years, among 230 RA patients who visited at the rheumatology clinic in Ajou University Hospital and who fulfilled the 1987 revised American College of Rheumatology criteria for RA. Sixty-four patients were RF positive (58.7%) and 91 patients were female (83.5%). There was no significant difference in demographic characteristics, joint involvements, or percentage of morning stiffness between seropositive and seronegative groups. Antinuclear antibody was detected more frequently in the seropositive group (p < 0.05). At initial diagnosis, the seropositive group had higher white blood cell and platelet counts than the seronegative group (p < 0.01). However, the difference was disappeared at the last follow-up. Inflammatory markers such as ESR and CRP were also higher at diagnosis in the seropositive group (p < 0.01). These inflammatory markers were still greater than the seronegative group at the last follow-up (p < 0.01). There was no significant difference in the use of disease modifying antirheumatic drug (DMARD) and steroid dosage between groups. However, DMARD combination therapy was more commonly used in the seropositive group (p < 0.05), especially triple DMARD combination. These results suggest that disease activity is more severe in the seropositive than the seronegative group, and more aggressive treatments are needed in the seropositive group.
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Affiliation(s)
- Yoo-Seob Shin
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Jeong-Hee Choi
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Ho Nahm
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyun Cho
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Chang-Hee Suh
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
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Barnes BH, Borowitz SM, Saulsbury FT, Hellems M, Sutphen JL. Discordant erythrocyte sedimentation rate and C-reactive protein in children with inflammatory bowel disease taking azathioprine or 6-mercaptopurine. J Pediatr Gastroenterol Nutr 2004; 38:509-12. [PMID: 15097439 DOI: 10.1097/00005176-200405000-00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is characterized by periods of relapse and remission. Treatment is aimed at reducing symptoms during relapse and prolonging the duration of remissions. 6-Mercaptopurine (6-MP) and its prodrug azathioprine (AZA) are commonly used to prolong clinical remissions. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are two widely used laboratory markers of inflammation. The authors observed an unexplained discordance between ESR and CRP in children with asymptomatic IBD who were being treated with AZA or 6-MP. OBJECTIVE To characterize children with IBD in remission treated with 6-MP or AZA who have persistently elevated ESR but normal CRP. METHODS All patients seen in Pediatric Gastroenterology Clinic between January 1, 1995, and December 31, 2002, with Crohn disease or ulcerative colitis who received AZA or 6-MP continuously for at least 6 months were identified and their medical records reviewed. RESULTS One hundred twenty patients met the eligibility criteria. Twelve had an ESR >18 mm/hour on at least three occasions during at least 12 consecutive months with a simultaneous CRP <0.8 mg/dL. Eleven of these 12 had no signs or symptoms of active disease and had Pediatric Crohn Disease Activity Index scores <10 for at least 12 consecutive months while the ESR was elevated. Disease duration was similar in the 11 children with asymptomatic disease and with discordant ESR and CRP and in 108 children with concordant ESR and CRP (69.2 + 22.5 months v 54.3 +/- 40.1 months, P = 0.0709). Duration of AZA or 6-MP therapy was greater in the 11 children with asymptomatic disease and discordant ESR and CRP than in those with or without symptoms and with concordant ESR and CRP (58.1 +/- 16.4 months v 36.6 +/- 24.1 months, P = 0.0043). There were no differences between the groups with respect to diagnosis, location of disease, or age at onset of symptoms. The mean corpuscular volume (MCV) was somewhat larger in the children with discordant ESR and CRP than in the children with concordant ESR and CRP (91.4 +/- 6.97 fL v 87.0 +/-7.07 fL, respectively, P = 0.0373); however, in both groups, the MCV was in the normal range. There were no significant differences in hematocrit, white blood cell count, serum albumin, total serum protein, or estimated serum globulin between the groups. CONCLUSIONS The results suggest that among children treated with AZA or 6-MP, CRP may be a more reliable indirect indicator of inflammation than ESR. This report alerts clinicians that some children taking AZA or 6-MP may have persistent elevation of the ESR with a normal CRP and have no clinical evidence of active disease.
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Affiliation(s)
- Barrett H Barnes
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22908, USA
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Mercado FB, Marshall RI, Bartold PM. Inter-relationships between rheumatoid arthritis and periodontal disease. A review. J Clin Periodontol 2003; 30:761-72. [PMID: 12956651 DOI: 10.1034/j.1600-051x.2003.00371.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This review considers the considerable similarities between periodontal disease and rheumatoid arthritis (RA). While the etiology of these two diseases may differ, the underlying pathogenic mechanisms are remarkably similar and it is possible that individuals manifesting both periodontitis and RA may suffer from a unifying underlying systemic dysregulation of the inflammatory response. In light of these findings, the implications for the use of disease-modifying medications in the management of these two chronic inflammatory conditions is apparent. Further longitudinal studies and medication-based intervention studies are required to determine just how closely these two conditions are allied.
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Affiliation(s)
- F B Mercado
- University of Queensland, Brisbane, Australia
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Abstract
Five decades of experimental and clinical experience have changed corticoid therapy thoroughly. Corticoides have two modes of action. The first is a genomic effect through which anti-inflammatory proteins are formed which inhibit pro-inflammatory cytokines. This effect is initiated even by small doses, but is of late onset. The use of high doses initiates non-genomic effects through alterations of the cell membrane; these effects are found early after initiation of treatment. The risk of adverse corticoid effects are extremely rare when modern application forms and therapy regimens are used: Very high doses for a short time in case of acute states of illness, very low doses in long-term therapy of chronic illnesses, and the use of topical substances wherever this is possible. As for the dose regimen, one should start with an initial dose which suffices to treat the acute state, and subsequently reduce the dosage after the first positive results are obtained. In long-term therapy a daily dose of 5 mg prednisolone should not be exceeded; usually even lower doses are sufficient. These very low doses can only be reached by reducing in steps of one half to one milligram over very long periods of time. During long-term therapy osteoporosis prophylaxis is mandatory. Due to these new therapeutic concepts treatment of rheumatoid arthritis with corticoids is experiencing a revival. Low-dose corticoid therapy is of lower risk than nonsteroidal antirheumatic treatment and slows down disease progression, i.e. joint destruction is significantly inhibited. Corticoids have also undergone a new development in the treatment of asthma. Previously used only in acute systemic therapy, they have now been established in basic therapy, i.e. long term therapy using special topic applications.
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Podolin PL, Bolognese BJ, Foley JJ, Schmidt DB, Buckley PT, Widdowson KL, Jin Q, White JR, Lee JM, Goodman RB, Hagen TR, Kajikawa O, Marshall LA, Hay DWP, Sarau HM. A potent and selective nonpeptide antagonist of CXCR2 inhibits acute and chronic models of arthritis in the rabbit. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2002; 169:6435-44. [PMID: 12444152 DOI: 10.4049/jimmunol.169.11.6435] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Much evidence implicates IL-8 as a major mediator of inflammation and joint destruction in rheumatoid arthritis. The effects of IL-8 and its related ligands are mediated via two receptors, CXCR1 and CXCR2. In the present study, we demonstrate that a potent and selective nonpeptide antagonist of human CXCR2 potently inhibits (125)I-labeled human IL-8 binding to, and human IL-8-induced calcium mobilization mediated by, rabbit CXCR2 (IC(50) = 40.5 and 7.7 nM, respectively), but not rabbit CXCR1 (IC(50) = >1000 and 2200 nM, respectively). These data suggest that the rabbit is an appropriate species in which to examine the anti-inflammatory effects of a human CXCR2-selective antagonist. In two acute models of arthritis in the rabbit induced by knee joint injection of human IL-8 or LPS, and a chronic Ag (OVA)-induced arthritis model, administration of the antagonist at 25 mg/kg by mouth twice a day significantly reduced synovial fluid neutrophils, monocytes, and lymphocytes. In addition, in the more robust LPS- and OVA-induced arthritis models, which were characterized by increased levels of proinflammatory mediators in the synovial fluid, TNF-alpha, IL-8, PGE(2), leukotriene B(4), and leukotriene C(4) levels were significantly reduced, as was erythrocyte sedimentation rate, possibly as a result of the observed decreases in serum TNF-alpha and IL-8 levels. In vitro, the antagonist potently inhibited human IL-8-induced chemotaxis of rabbit neutrophils (IC(50) = 0.75 nM), suggesting that inhibition of leukocyte migration into the knee joint is a likely mechanism by which the CXCR2 antagonist modulates disease.
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MESH Headings
- Acute Disease
- Animals
- Anti-Inflammatory Agents, Non-Steroidal/pharmacology
- Arthritis, Experimental/etiology
- Arthritis, Experimental/immunology
- Arthritis, Experimental/prevention & control
- Arthritis, Rheumatoid/etiology
- Arthritis, Rheumatoid/immunology
- Chemotaxis, Leukocyte/drug effects
- Chronic Disease
- Female
- Humans
- In Vitro Techniques
- Interleukin-8/administration & dosage
- Interleukin-8/immunology
- Interleukin-8/metabolism
- Lipopolysaccharides/toxicity
- Neutrophils/drug effects
- Neutrophils/immunology
- Ovalbumin/administration & dosage
- Ovalbumin/immunology
- Rabbits
- Receptors, Interleukin-8B/antagonists & inhibitors
- Receptors, Interleukin-8B/genetics
- Receptors, Interleukin-8B/metabolism
- Recombinant Proteins/antagonists & inhibitors
- Recombinant Proteins/genetics
- Recombinant Proteins/metabolism
- Urea/analogs & derivatives
- Urea/pharmacology
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Affiliation(s)
- Patricia L Podolin
- Respiratory and Inflammation Center of Excellence for Drug Discovery, Seattle, WA 98108, USA.
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Ishikawa H, Murasawa A, Hanyu T. The effect of activity and type of rheumatoid arthritis on the flexible implant arthroplasty of the metacarpophalangeal joint. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2002; 27:180-3. [PMID: 12027497 DOI: 10.1054/jhsb.2001.0704] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A retrospective study was performed on 184 Swanson flexible implant arthroplasties of the metacarpophalangeal joint in 75 hands of 64 patients with rheumatoid arthritis, to investigate the influence of systemic factors on the clinical and radiological results. The mean follow-up period was 6 years. The postoperative serum C-reactive protein level was found to affect postoperative pain, and there was a larger extension lag and more subsidence of the implant in those with the mutilating type of the disease.
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Affiliation(s)
- H Ishikawa
- Department of Orthopaedic Surgery, Rheumatic Center, Niigata Prefectural Senami Hospital, Murakami, Japan.
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45
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Rau R, Herborn G, Menninger H, Sangha O. Radiographic outcome after three years of patients with early erosive rheumatoid arthritis treated with intramuscular methotrexate or parenteral gold. Extension of a one-year double-blind study in 174 patients. Rheumatology (Oxford) 2002; 41:196-204. [PMID: 11886970 DOI: 10.1093/rheumatology/41.2.196] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the radiographic outcomes after 36 months in patients with early erosive rheumatoid arthritis (RA) who were treated with methotrexate (MTX) or gold sodium thiomalate (GSTM). METHODS In a randomized, double-blind fashion, 174 patients from two centres were assigned to receive weekly intramuscular injections of either 15 mg MTX or 50 mg GSTM. After 12 months, the study was continued as an open prospective study for an additional 2 yr, administering the same amount of MTX and half of the GSTM dose. Radiographic outcomes were assessed by standardized methods in all patients at baseline and after 6, 12, 24 and 36 months. RESULTS Intention-to-treat analysis showed that patients treated with MTX had higher radiographic scores and more erosive joints at all follow-up points. However, there was no statistically significant difference between the two treatment groups. The progression rate was significantly slower during the second and third years of follow-up in both groups. Baseline and time-integrated (area under the curve over 6 months) disease activity parameters were good predictors of radiographic outcome after 3 yr. Seropositivity was not an independent predictor of progression. However, patients who were positive for rheumatoid factor had higher time-integrated disease activity (with less response to treatment) and thus their disease was significantly more progressive. CONCLUSION Both of the disease-modifying compounds used in this study, MTX and GSTM, were able to reduce the slope of radiographic progression during 3 yr of follow-up. There was some advantage for parenteral gold but no significant intergroup difference.
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Affiliation(s)
- R Rau
- Department of Rheumatology, Evangelisches Fachkrankenhaus, Ratingen, Germany
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46
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Johnson AH, Hassell AB, Jones PW, Mattey DL, Saklatvala J, Dawes PT. The mechanical joint score: a new clinical index of joint damage in rheumatoid arthritis. Rheumatology (Oxford) 2002; 41:189-95. [PMID: 11886969 DOI: 10.1093/rheumatology/41.2.189] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate the mechanical joint score (MJS) in terms of its reliability between observers and over time, its ease of use and its relationship with conventional measures of rheumatoid arthritis (RA) disease activity, severity and functional outcome. METHODS The MJS was evaluated in 103 patients with reference to the following joints: total proximal interphalangeal (PIP) joints, total metacarpophalangeal (MCP) joints, wrists, elbows, shoulders, hips, knees, ankles and total metatarsophalangeal (MTP) joints. The score was based on the appearance of the joints on a scale of 0-3, 0 representing no abnormality and 3 severe abnormality or previous surgery. The MJS was evaluated in terms of its intra- and inter-observer variability and its content, construct and criterion validities. A subset of 29 patients were re-evaluated after 5 yr to examine change in MJS over time. RESULTS The MJS performed well in terms of inter-observer and intra-observer reliability. The MJS showed strong correlation with the Larsen X-ray score of hands and feet (Spearman correlation coefficient 0.74) and with the modified Health Assessment Questionnaire (Spearman correlation coefficient 0.56) and only weak correlation with indices of disease activity, such as the Ritchie index and erythrocyte sedimentation rate. The MJS showed highly significant positive change over time. CONCLUSION The MJS is a reliable clinical index of joint damage and may be a useful new outcome measure in RA.
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Affiliation(s)
- A H Johnson
- Staffordshire Rheumatology Centre, Stoke-on-Trent ST6 7AG, Leeds General Infirmary, Leeds LS1 3EX, UK
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Nordahl S, Alstergren P, Eliasson S, Kopp S. Radiographic signs of bone destruction in the arthritic temporomandibular joint with special reference to markers of disease activity. A longitudinal study. Rheumatology (Oxford) 2001; 40:691-4. [PMID: 11426029 DOI: 10.1093/rheumatology/40.6.691] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate the progression of radiographic changes of the temporomandibular joint (TMJ) with reference to plasma levels of interleukin-1beta (IL-1beta), C-reactive protein (CRP) and disease duration. METHODS Twenty-one patients with chronic inflammatory joint disease and TMJ involvement were included. Individualized tomography of the TMJ was performed twice with an interval of at least 12 months. Blood samples were analysed for IL-1beta and CRP. RESULTS Significant progression of the overall grade of radiographic changes occurred during the observation period, whereas erosions showed great interindividual variability. Progression of TMJ bone loss was correlated to raised levels of CRP and, in patients with a diagnosis of rheumatoid arthritis, or with shorter duration, also to plasma IL-1beta. CONCLUSION Progression of overall grade of radiographic changes in the TMJ occurs in patients with chronic inflammatory joint disease. Raised levels of serum CRP are associated with progression of TMJ bone loss.
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Affiliation(s)
- S Nordahl
- Departments of Clinical Oral Physiology and Oral Radiology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden
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Mercado FB, Marshall RI, Klestov AC, Bartold PM. Relationship between rheumatoid arthritis and periodontitis. J Periodontol 2001; 72:779-87. [PMID: 11453241 DOI: 10.1902/jop.2001.72.6.779] [Citation(s) in RCA: 273] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Because of several similar features in the pathobiology of periodontitis and rheumatoid arthritis, in a previous study we proposed a possible relationship between the two diseases. Therefore, the aims of this study were to study a population of rheumatoid arthritis patients and determine the extent of their periodontal disease and correlate this with various indicators of rheumatoid arthritis. METHODS Sixty-five consecutive patients attending a rheumatology clinic were examined for their levels of periodontitis and rheumatoid arthritis. A control group consisted of age- and gender-matched individuals without rheumatoid arthritis. Specific measures for periodontitis included probing depths, attachment loss, bleeding scores, plaque scores, and radiographic bone loss scores. Measures of rheumatoid arthritis included tender joint analysis, swollen joint analysis, pain index, physician's global assessment on a visual analogue scale, health assessment questionnaire, levels of C-reactive protein, and erythrocyte sedimentation rate. The relationship between periodontal bone loss and rheumatological findings as well as the relationship between bone loss in the rheumatoid arthritis and control groups were analyzed. RESULTS No differences were noted for the plaque and bleeding indices between the control and rheumatoid arthritis groups. The rheumatoid arthritis group did, however, have more missing teeth than the control group and a higher percentage of these subjects had deeper pocketing. When the percentage of bone loss was compared with various indicators of rheumatoid arthritis disease activity, it was found that swollen joints, health assessment questionnaire scores, levels of C-reactive protein, and erythrocyte sedimentation rate were the principal parameters which could be associated with periodontal bone loss. CONCLUSIONS The results of this study provide further evidence of a significant association between periodontitis and rheumatoid arthritis. This association may be a reflection of a common underlying disregulation of the inflammatory response in these individuals.
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Affiliation(s)
- F B Mercado
- Department of Dentistry, University of Queensland, Brisbane, Australia
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Abstract
Currently the diagnosis of rheumatoid arthritis (RA) may be difficult; the ACR criteria appear most sensitive and specific in long-standing disease. Without clear definition or diagnostic criteria for early disease it is difficult to define late or established RA. The distinction between early and established RA has been further blurred by recent imaging studies that suggest even in what is currently termed early disease, there is evidence of joint damage. The natural history of RA suggests that most patients with clinic-diagnosed RA have a progressively disabling course, but evidence is growing that modern therapeutic strategies result in better long-term outcomes, especially when applied early in the disease course. In established disease, quantitative markers such as C-reactive protein (CRP) give prognostic information, but in the pre-erosive, early phase of the disease the qualitative markers such as rheumatoid factor (RF) and shared epitope are crucial. As rheumatologists, our major aims must remain: (1) to diagnose the disease as early as possible; (2) to identify those patients with poor prognosis who will benefit most from targeted therapy; and (3) to aim for more intensive disease control irrespective of disease duration.
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Affiliation(s)
- P G Conaghan
- Rheumatology and Rehabilitation Research Unit, University of Leeds, England
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