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Fang Q, Xie J, Zong J, Zhou Y, Zhou Q, Yin S, Cao L, Yin H, Zhou D. Expression and diagnostic value of interleukin-22 in rheumatoid arthritis-associated interstitial lung disease. Int Immunopharmacol 2024; 134:112173. [PMID: 38728884 DOI: 10.1016/j.intimp.2024.112173] [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: 02/06/2024] [Revised: 04/13/2024] [Accepted: 04/27/2024] [Indexed: 05/12/2024]
Abstract
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is characterized by a high incidence and mortality rate, highlighting the need for biomarkers to detect ILD early in RA patients. Previous studies have shown the protective effects of Interleukin-22 (IL-22) in pulmonary fibrosis using mouse models. This study aims to assess IL-22 expression in RA-ILD to validate foundational experiments and explore its diagnostic value. The study included 66 newly diagnosed RA patients (33 with ILD, 33 without ILD) and 14 healthy controls (HC). ELISA was utilized to measure IL-22 levels and perform intergroup comparisons. The correlation between IL-22 levels and the severity of RA-ILD was examined. Logistic regression analysis was employed to screen potential predictive factors for RA-ILD risk and establish a predictive nomogram. The diagnostic value of IL-22 in RA-ILD was assessed using ROC. Subsequently, the data were subjected to 30-fold cross-validation. IL-22 levels in the RA-ILD group were lower than in the RA-No-ILD group and were inversely correlated with the severity of RA-ILD. Logistic regression analysis identified IL-22, age, smoking history, anti-mutated citrullinated vimentin antibody (MCV-Ab), and mean corpuscular hemoglobin concentration (MCHC) as independent factors for distinguishing between the groups. The diagnostic value of IL-22 in RA-ILD was moderate (AUC = 0.75) and improved when combined with age, smoking history, MCV-Ab and MCHC (AUC = 0.97). After 30-fold cross-validation, the average AUC was 0.886. IL-22 expression is dysregulated in the pathogenesis of RA-ILD. This study highlights the potential of IL-22, along with other factors, as a valuable biomarker for assessing RA-ILD occurrence and progression.
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Affiliation(s)
- Quanquan Fang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221005, Jiangsu Province, China
| | - Jingzhi Xie
- Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221005, Jiangsu Province, China
| | - Juan Zong
- Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221005, Jiangsu Province, China
| | - Yu Zhou
- School of Mathematics and Statistics, Jiangsu Normal University, Xuzhou 221116, Jiangsu Province, China
| | - Qin Zhou
- School of Mathematics and Statistics, Jiangsu Normal University, Xuzhou 221116, Jiangsu Province, China
| | - Songlou Yin
- Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221005, Jiangsu Province, China
| | - Lina Cao
- Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221005, Jiangsu Province, China
| | - Hanqiu Yin
- Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221005, Jiangsu Province, China.
| | - Dongmei Zhou
- Department of Rheumatology and Immunology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221005, Jiangsu Province, China.
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Shao Y, Zhang H, Shi Q, Wang Y, Liang Q. Clinical prediction models of rheumatoid arthritis and its complications: focus on cardiovascular disease and interstitial lung disease. Arthritis Res Ther 2023; 25:159. [PMID: 37658422 PMCID: PMC10472585 DOI: 10.1186/s13075-023-03140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease of unknown etiology with erosive, symmetric polyarthritis as the main clinical manifestations. Its basic pathological changes are the formation of synovitis, and patients gradually develop destruction of articular cartilage destruction and bone erosion, which eventually leads to joint deformity, disability, and various extra-articular manifestations. Clinical prediction models (CPMs), also known as risk prediction models or risk scores, are mathematical formulas used to estimate the probability that a given individual will have a disease or an outcome in the future. The models are mainly divided into two categories: diagnostic models and prognostic models, which can be used to provide information on disease diagnosis or prognosis to help make better medical decisions. Currently, there is no cure for RA, but effective early diagnosis and treatment are crucial for limiting the severity of the disease and preventing the occurrence and development of complications. This paper reviews the CPMs associated with RA and its related complications, including cardiovascular disease (CVD) and interstitial lung disease (ILD), in order to provide reference and evidence for the early diagnosis and treatment of these diseases and personalized medicine for patients. In addition, the possible pathogenesis and risk factors of these comorbidities are summarized, and possible directions for future related research are prospected.
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Affiliation(s)
- Yubo Shao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- School of Graduate, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Hong Zhang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Qi Shi
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Yongjun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Qianqian Liang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
- Key Laboratory of Ministry of Education of Theory and Therapy of Muscles and Bones, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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Elsouri KN, Arboleda V, Basbous L, Heiser S, Collins DP, Ragusa P, Baxter C, Cabrera D, Akhand T, Stermer E, Sharma K, Seguro C, Hardigan P, Kesselman M, Beckler MD. Glucocorticoid use in rheumatoid arthritis patients and the onset of pneumonia: a systematic review and meta-analysis. J Osteopath Med 2023; 123:179-186. [PMID: 36691851 DOI: 10.1515/jom-2022-0177] [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: 08/21/2022] [Accepted: 11/29/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Rheumatoid arthritis (RA) is a systemic autoimmune disease that commonly affects joints. Although many treatment options exist, the most common, disease-modifying antirheumatic drugs (DMARDs), have been associated with pulmonary infections. These types of infections (specifically pneumonia) can be detrimental to RA patients. This leads providers to utilize other treatment modalities such as glucocorticoids (GCs). GCs are commonly utilized to treat RA; however, the role of GCs in the onset of pneumonia in RA patients is not fully understood. OBJECTIVES The goal of this study was to systematically review and statistically analyze pooled data documenting pneumonia as an adverse event in RA patients on DMARDs as a monotherapy vs RA patients on DMARDs and GCs as combination therapy utilizing the Population, Intervention, Comparison, and Outcomes (PICO) framework. METHODS On August 1, 2021, a search was conducted and completed on six databases: Embase, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, International Pharmaceutical Abstracts (IPA), and ClinicalTrials.gov. A total of 12 researchers were involved with the search and screening of articles (K.E., P.R.; V.A., D.P.C.; C.B., D.C.; T.A., E.S.; S.H., L.B.; K.S., C.S.). Search terms were identified utilizing Medical Subject Headings (MeSH) and Emtree and included "glucocorticoids," "rheumatoid arthritis," "pneumonia," and "respiratory tract infections," Inclusion criteria included human subjects over the age of 18 with seropositive RA, on a combination of GC (prednisone, methylprednisolone, or prednisolone) with DMARD (methotrexate [MTX], hydroxychloroquine [HCQ], or sulfasalazine [SSZ]) and developed pneumonia of bacterial, viral, or fungal origin. The control groups were on a DMARD monotherapy regimen. Articles were excluded if they were not in English, had less than 20 participants, were case reports or literature reviews, included animal subjects, and did not adhere to the established PICO framework. Five teams of two researchers individually sorted through abstracts of articles based on the inclusion and exclusion criteria. The same teams individually sorted through full-text articles of selected abstracts based on the same criteria. Conflicts between each team were resolved by a separate researcher. Odds ratios were utilized to quantify the effect sizes of combined studies from a random effects model. Chi-square tests and I2 statistics were utilized to analyze heterogeneity. RESULTS A total of 3360 articles were identified from all databases, and 416 duplicate articles were removed. Thus, a total of 2944 articles abstracts were screened, of which 2819 articles either did not meet the inclusion criteria or did meet the exclusion criteria. A total of 125 articles were retrieved and assessed for full-text eligibility, of which only three observational articles were included for meta-analysis. Statistical results revealed that patients treated with DMARDs monotherapy are 95% (95% CI: 0.65-0.99) less likely to develop pneumonia compared to patients treated with a DMARD and GCs (p=0.002). CONCLUSIONS Our data suggest that RA patients have a higher probability of developing pneumonia on combination therapy with GCs, compared to monotherapy with DMARDs. To our knowledge, our findings are the first to systematically review and statistically evaluate the relationship between the use of GCs and show an increased chance of developing pneumonia.
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Affiliation(s)
- Kawther N Elsouri
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Vania Arboleda
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | | | - Samantha Heiser
- William Carey University College of Osteopathic Medicine, Hattiesburg, MS, USA
| | - Dylon P Collins
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Philip Ragusa
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Courney Baxter
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Dominick Cabrera
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Tanisha Akhand
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Evan Stermer
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Kiran Sharma
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Charmaine Seguro
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Patrick Hardigan
- Nova Southeastern University Kiran Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Marc Kesselman
- Nova Southeastern University Kiran Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Michelle Demory Beckler
- Nova Southeastern University Kiran Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
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Stainer A, Tonutti A, De Santis M, Amati F, Ceribelli A, Bongiovanni G, Torrisi C, Iacopino A, Mangiameli G, Aliberti S, Selmi C. Unmet needs and perspectives in rheumatoid arthritis-associated interstitial lung disease: A critical review. Front Med (Lausanne) 2023; 10:1129939. [PMID: 37007765 PMCID: PMC10062456 DOI: 10.3389/fmed.2023.1129939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by synovitis as the most common clinical manifestation, and interstitial lung disease (RA-ILD) represents one of the most common and potentially severe extra-articular features. Our current understanding of the mechanisms and predictors of RA-ILD is limited despite the demonstration that an early identification of progressive fibrosing forms is crucial to provide timely treatment with antifibrotic therapies. While high resolution computed tomography is the gold standard technique for the diagnosis and follow-up of RA-ILD, it has been hypothesized that serum biomarkers (including novel and rare autoantibodies), new imaging techniques such as ultrasound of the lung, or the application of innovative radiologic algorithms may help towards predicting and detecting early forms of diseases. Further, while new treatments are becoming available for idiopathic and connective tissue disease-associated forms of lung fibrosis, the treatment of RA-ILD remains anecdotal and largely unexplored. We are convinced that a better understanding of the mechanisms connecting RA with ILD in a subgroup of patients as well as the creation of adequate diagnostic pathways will be mandatory steps for a more effective management of this clinically challenging entity.
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Affiliation(s)
- Anna Stainer
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Respiratory Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Antonio Tonutti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
- *Correspondence: Maria De Santis,
| | - Francesco Amati
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Respiratory Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Angela Ceribelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gabriele Bongiovanni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Chiara Torrisi
- Department of Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Antonio Iacopino
- Department of Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Mangiameli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Respiratory Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
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5
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Guiot J, Henket M, Ernst M, Seidel L, Winandy M, Denis A, Frix AN, Gester F, Thys M, Giltay L, Garah O, Njock MS, Canivet P, Meunier P, Corhay JL, Regnier C, Malaise O, Malaise M, Louis R. Airflow obstruction as a marker of adverse prognosis in rheumatoid arthritis. Front Med (Lausanne) 2023; 10:1063012. [PMID: 36968825 PMCID: PMC10033600 DOI: 10.3389/fmed.2023.1063012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/16/2023] [Indexed: 03/12/2023] Open
Abstract
ObjectivesIn our study, we explored the specific subgroup of patients with rheumatoid arthritis (RA) suffering from obstructive lung disease (OLD) and its impact on morbi-mortality.MethodsOur retrospective study included 309 patients suffering from RA with either obstructive (O-RA) or non-obstructive patterns (non-O-RA). OLD was defined based on the Tiffeneau index at the first available pulmonary functional test (PFT). Survival was then calculated and represented by a Kaplan–Meier curve. The comparison between the populations considered was performed by the Log-Rank test.ResultsOut of the 309 RA patients, 102 (33%) had airway obstruction. The overall survival time was significantly lower in the O-RA group than in the non-O-RA group (n = 207) (p < 0.001). The median survival time was 11.75 years in the O-RA group and higher than 16 years in the non-O-RA group. Multivariate analysis identified OLD as an independent risk factor for mortality (HR 2.20; 95% CI 1.21–4.00, p < 0.01).ConclusionAirway obstruction can be an independent risk factor of mortality in RA and should be considered as an early marker of poor prognosis. Further prospective longitudinal studies are required in order to determine the best clinical management for O-RA patients.
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Affiliation(s)
- Julien Guiot
- Department of Respiratory Medicine, CHU Liège, Liège, Belgium
- *Correspondence: Julien Guiot,
| | - Monique Henket
- Department of Respiratory Medicine, CHU Liège, Liège, Belgium
| | - Marie Ernst
- Biostatistics and Research Method Center (B-STAT), CHU Liège, Liège, Belgium
| | - Laurence Seidel
- Biostatistics and Research Method Center (B-STAT), CHU Liège, Liège, Belgium
| | - Marie Winandy
- Department of Respiratory Medicine, CHU Liège, Liège, Belgium
| | - Anna Denis
- Department of Respiratory Medicine, CHU Liège, Liège, Belgium
| | | | - Fanny Gester
- Department of Respiratory Medicine, CHU Liège, Liège, Belgium
| | - Marie Thys
- Department of Medico-Economic and Data, CHU Liège, Liège, Belgium
| | - Laurie Giltay
- Department of Respiratory Medicine, CHU Liège, Liège, Belgium
| | - Omaima Garah
- Department of Respiratory Medicine, CHU Liège, Liège, Belgium
| | | | | | - Paul Meunier
- Department of Radiology, CHU Liège, Liège, Belgium
| | | | | | | | | | - Renaud Louis
- Department of Respiratory Medicine, CHU Liège, Liège, Belgium
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Wan X, Xie J, Yang M, Yu H, Hou W, Xu K, Wang J, Xu P. Does Having Rheumatoid Arthritis Increase the Dose of Depression Medications? A Mendelian Randomization Study. J Clin Med 2023; 12:jcm12041405. [PMID: 36835939 PMCID: PMC9961843 DOI: 10.3390/jcm12041405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) increases the risk of depression. However, studies on the effects of RA on the dose of depression medications are limited. Therefore, in this study, we used two-sample Mendelian randomization (MR) to explore whether RA increases the dose of depression medications and gain a more comprehensive understanding of the relationship between RA and depression. METHODS Two-sample MR was used to evaluate the causal effect of RA on the dose of depression medications. The aggregated data on RA originated from extensive genome-wide association studies (GWASs) of European descent (14,361 cases and 42,923 controls). The summary GWAS data for the dose of depression medications were derived from the FinnGen consortium (58,842 cases and 59,827 controls). Random effects inverse-variance weighted (IVW), MR-Egger regression, weighted median, and fixed effects IVW methods were used for the MR analysis. Random effects IVW was the primary method. The heterogeneity of the MR results was detected using the IVW Cochran's Q test. The pleiotropy of the MR results was detected using MR-Egger regression and the MR pleiotropy residual sum and outlier (MR-PRESSO) test. Finally, a leave-one-out analysis was performed to determine whether the MR results were affected by a specific single-nucleotide polymorphism (SNP). RESULTS The primary method, random effects IVW, revealed that genetically predicted RA had a positive causal association with the dose of depression medications (Beta, 0.035; 95% confidence interval (CI), 0.007-0.064; p = 0.015). The IVW Cochran's Q test results revealed no heterogeneity in the MR analysis (p > 0.05). The MR-Egger regression and MR-PRESSO tests revealed that there was no pleiotropy in our MR analysis. The leave-one-out analysis confirmed that a single SNP did not affect the MR results, indicating the study's robustness. CONCLUSION Using MR techniques, we discovered that having RA increases the dose of depression medications; however, the exact mechanisms and pathways still need to be further explored.
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Affiliation(s)
| | | | | | | | | | | | | | - Peng Xu
- Correspondence: ; Tel.: +86-1377-209-0019
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Huang H, Chen R, Shao C, Xu Z, Wolters PJ. Diffuse lung involvement in rheumatoid arthritis: a respiratory physician's perspective. Chin Med J (Engl) 2023; 136:280-286. [PMID: 36689640 PMCID: PMC10106218 DOI: 10.1097/cm9.0000000000002577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Indexed: 01/25/2023] Open
Abstract
ABSTRACT The lungs are one of the most common extra-articular organs involved in rheumatoid arthritis (RA), which is reported to occur in up to 60% to 80% of RA patients. Respiratory complications are the second leading cause of death due to RA. Although there is a wide spectrum of RA-associated respiratory diseases, interstitial lung disease is the most common manifestation and it impacts the prognosis of RA. There has been progress in understanding the management and progression of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and RA-associated respiratory diseases recently, for example, opportunistic pulmonary infectious diseases and toxicity from RA therapies. From a chest physicians' perspective, we will update the diagnosis and treatment of RA-associated ILD, methotrexate-associated lung disease, and the complication of Pneumocystis jiroveci pneumonia in RA in this review.
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Affiliation(s)
- Hui Huang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Ruxuan Chen
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Chi Shao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zuojun Xu
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Paul J. Wolters
- Department of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA 94117, USA
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Zheng W, Hu X, Zou M, Hu N, Song W, Wang R, Liu Y, Hou Q, Liu Y, Chen X, Cheng Z. Plasma IL-36α and IL-36γ as Potential Biomarkers in Interstitial Lung Disease Associated with Rheumatoid Arthritis: a Pilot Study in the Chinese Population. Inflammation 2023; 46:285-296. [PMID: 36044099 DOI: 10.1007/s10753-022-01733-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
Abstract
Interstitial lung disease (ILD) is a frequent extra-articular manifestation of rheumatoid arthritis (RA) and increases mortality in patients with RA. Early identification of ILD, especially the usual interstitial pneumonia (UIP) pattern with a poor prognosis, is important for guiding treatment of RA-ILD and preventing damage resulting from a delay in diagnosis. Interleukin-36 (IL-36) cytokines are involved in connective tissue diseases. However, IL-36 expression in RA-ILD is unknown. In this study, the clinical relevance of plasma IL-36 cytokines was evaluated in 39 patients with RA-ILD and three other groups (30 healthy controls [HCs], 35 RA patients without ILD, and 27 patients with idiopathic pulmonary fibrosis [IPF]) in the Chinese population. Plasma IL-36α and IL-36γ concentrations were elevated in patients with RA-ILD compared with those in HCs and patients with RA. RA-ILD patients with UIP pattern had higher plasma IL-36γ concentrations than those with RA-ILD without UIP, but these were lower than those in patients with IPF. Receiver operating curve analysis suggested that IL-36α and IL-36γ were potential biomarkers for identifying ILD in patients with RA. Additionally, the optimal cutoff value of IL-36γ for distinguishing RA-ILD with the UIP pattern from RA-ILD without UIP was 555.40 pg/mL and that for distinguishing RA-ILD from IPF was 655.10 pg/mL. No significant difference in plasma IL-36β or IL-36Ra concentrations was found between patients with RA-ILD and the three other groups. We also found that the lungs originating from different types of patients with PF, including RA-ILD and IPF, and those from mice following bleomycin-induced PF were characterized by increased IL-36γ expression. Our findings suggest that using IL-36 cytokines to identify patients with RA for further ILD workups may provide additional diagnostic value to the current clinically available assays. Moreover, IL-36γ may help to identify the presence of the UIP pattern in patients with RA-ILD and to discriminate RA-ILD from IPF.
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Affiliation(s)
- Weishuai Zheng
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xingxing Hu
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Menglin Zou
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Nie Hu
- Department of Rheumatology and Immunology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Weiwei Song
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rui Wang
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying Liu
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qinhui Hou
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuan Liu
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Xiaoqi Chen
- Department of Rheumatology and Immunology, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Zhenshun Cheng
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, China.
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9
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Nasonov EL, Ananyeva LP, Avdeev SN. Interstitial lung disease in rheumatoid arthritis: A multidisciplinary problem in rheumatology and pulmonology. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Rheumatoid arthritis (RA) is an immune-mediated rheumatic disease (IMRDs) characterized by chronic erosive arthritis and systemic damage to internal organs, leading to early disability and reduced life expectancy in patients. A particularly important place among the systemic manifestations of RA is occupied by interstitial lung diseases (ILD) – the most severe form of pulmonary pathology in RA, defined as RA-ILD, which is pathogenetically associated with risk factors (smoking, etc.) and autoimmune mechanisms underlying RA. RA-ILD is a subtype of RA characterized by a severe course and a poor prognosis и неблагоприятным прогнозом. The review presents new data regarding risk factors and biomarkers for RA-ILD; modern diagnostic capabilities based on the use of functional lung tests, high-resolution computed tomography, ultrasound examination of the lungs. Particular attention is paid to the efficacy and safety of pharmacotherapy, including methotrexate, biologics, JAK inhibitors, and antifibrotic therapy. An algorithm for the pharmacotherapy of RA-ILD has been proposed.
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Affiliation(s)
- E. L. Nasonov
- V.A. Nasonova Research Institute of Rheumatology; I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)
| | | | - S. N. Avdeev
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health Care of Russian Federation (Sechenov University)
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Calcium-Permeable Channels Cooperation for Rheumatoid Arthritis: Therapeutic Opportunities. Biomolecules 2022; 12:biom12101383. [PMID: 36291594 PMCID: PMC9599458 DOI: 10.3390/biom12101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Rheumatoid arthritis is a common autoimmune disease that results from the deposition of antibodies–autoantigens in the joints, leading to long-lasting inflammation. The main features of RA include cartilage damage, synovial invasion and flare-ups of intra-articular inflammation, and these pathological processes significantly reduce patients’ quality of life. To date, there is still no drug target that can act in rheumatoid arthritis. Therefore, the search for novel drug targets has become urgent. Due to their unique physicochemical properties, calcium ions play an important role in all cellular activities and the body has evolved a rigorous calcium signaling system. Calcium-permeable channels, as the main operators of calcium signaling, are widely distributed in cell membranes, endoplasmic reticulum membranes and mitochondrial membranes, and mediate the efflux and entry of Ca2+. Over the last century, more and more calcium-permeable channels have been identified in human cells, and the role of this large family of calcium-permeable channels in rheumatoid arthritis has gradually become clear. In this review, we briefly introduce the major calcium-permeable channels involved in the pathogenesis of RA (e.g., acid-sensitive ion channel (ASIC), transient receptor potential (TRP) channel and P2X receptor) and explain the specific roles and mechanisms of these calcium-permeable channels in the pathogenesis of RA, providing more comprehensive ideas and targets for the treatment of RA.
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11
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Manifestaciones pulmonares de la artritis reumatoide, una revisión en tiempos de pandemia por SARS-CoV-2. REVISTA COLOMBIANA DE REUMATOLOGÍA 2022. [PMCID: PMC7934669 DOI: 10.1016/j.rcreu.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
La artritis reumatoide (AR) es una de las patologías crónicas de origen autoinmune más frecuentes. Su prevalencia varía del 0,5 al 1%, con un compromiso primario a nivel articular, generando gran discapacidad por las deformidades secundarias derivadas de un estado inflamatorio persistente. Considerando el alto impacto en la calidad de vida de quienes la padecen, sumado al alto costo de las intervenciones terapéuticas, se vuelve imperativo para el personal de salud sumar todos los esfuerzos para promover un diagnóstico temprano y reconocer las potenciales complicaciones con el fin de impactar positivamente en los desenlaces clínicos. Alrededor del 50% de los pacientes con AR pueden tener compromiso extraarticular, siendo el pulmón uno de los órganos más afectados. En época de pandemia por el virus SARS-CoV-2 es necesario recordar los tipos de compromiso pulmonar en pacientes con AR y tener en cuenta la susceptibilidad de estos pacientes a cuadros infecciosos que pueden generar una gran morbimortalidad.
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12
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Laria A, Lurati AM, Zizzo G, Zaccara E, Mazzocchi D, Re KA, Marrazza M, Faggioli P, Mazzone A. Interstitial Lung Disease in Rheumatoid Arthritis: A Practical Review. Front Med (Lausanne) 2022; 9:837133. [PMID: 35646974 PMCID: PMC9136053 DOI: 10.3389/fmed.2022.837133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disease, which primarily causes symmetric polyarthritis. An extrarticolar involvement is common, and the commonly involved organ is lungs. Although cardiac disease is responsible for most RA-related deaths, pulmonary disease is also a major contributor, accounting for ~10-20% of all mortality. Pulmonary disease is a common (60-80% of patients with RA) extra-articular complication of RA. Optimal screening, diagnostic, and treatment strategies of pulmonary disease remain uncertain, which have been the focus of an ongoing investigation. Clinicians should regularly assess patients with RA for the signs and symptoms of pulmonary disease and, reciprocally, consider RA and other connective tissue diseases when evaluating a patient with pulmonary disease of an unknown etiology. RA directly affects all anatomic compartments of the thorax, including the lung parenchyma, large and small airways, pleura, and less commonly vessels. In addition, pulmonary infection and drug-induced lung disease associated with immunosuppressive agents used for the treatment of RA may occur.
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Affiliation(s)
- Antonella Laria
- Asst Ovest Milanese–Rheumatology Unit, Magenta Hospital, Milan, Italy
| | | | - Gaetano Zizzo
- Asst Ovest Milanese–Internal Medicine Department, Cuggiono Hospital, Milan, Italy
| | - Eleonora Zaccara
- Asst Ovest Milanese–Internal Medicine Unit, Legnano Hospital, Milan, Italy
| | - Daniela Mazzocchi
- Asst Ovest Milanese–Rheumatology Unit, Magenta Hospital, Milan, Italy
| | - Katia Angela Re
- Asst Ovest Milanese–Rheumatology Unit, Magenta Hospital, Milan, Italy
| | | | - Paola Faggioli
- Asst Ovest Milanese–Internal Medicine Unit, Legnano Hospital, Milan, Italy
| | - Antonino Mazzone
- Asst Ovest Milanese–Internal Medicine Unit, Legnano Hospital, Milan, Italy
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Bonilla Hernán M, Gómez-Carrera L, Fernández-Velilla Peña M, Álvarez-Sala Walther R, Balsa A. Prevalencia y características clínicas de la enfermedad pulmonar intersticial difusa sintomática en la artritis reumatoide en una población española. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Autoantibodies and interstitial lung disease in rheumatoid arthritis: towards a ‘mix-and-match’ approach? Ann Rheum Dis 2022; 81:e53. [DOI: 10.1136/annrheumdis-2020-217410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/03/2022]
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15
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Torun S, Karaman I. Acute Exacerbation of Rheumatoid Arthritis Misdiagnosed as COVID-19: A Case Report. Front Med (Lausanne) 2022; 9:844609. [PMID: 35360748 PMCID: PMC8960299 DOI: 10.3389/fmed.2022.844609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/16/2022] [Indexed: 02/05/2023] Open
Abstract
Background Rheumatoid arthritis (RA) is a systemic inflammatory connective tissue disease that affects 1–2% of the population worldwide. Pulmonary manifestations including interstitial lung disease (ILD), airway disease, pleural and vascular disease can be seen in up to 30–40% of patients with RA, which are recognized as the second most frequent cause of death in RA patients. The simultaneous occurrence of COVID-19 in RA patients with or without ILD, and the similarities and differences between RA-related ILD and COVID-19 lung findings have been reported in the literature. However, there was no reported case on differentiation of clinical findings of a patient with RA exacerbation causing a new diagnosis of ILD during the pandemic conditions. Case Presentation Here, we presented a patient with RA who was misdiagnosed as COVID-19 twice due to non-specific respiratory symptoms and ground-glass opacities observed in high-resolution CT. The misdiagnosis led to a delayed diagnosis of ILD and prolonged pulmonary symptoms. Discussion Clinicians must critically review patients throughout the diagnostic workup by thinking other diseases besides COVID-19, particularly in the absence of a confirmatory result. The link between ILD or ILD exacerbation and COVID-19 remains to be determined. While research continues in the field, it is important to consider the importance of COVID-19 in cases of ILD exacerbation, and vice versa. Conclusion Distinguishing lung imaging findings of COVID-19 from ILD is a major concern. Even though the primary manifestation of COVID-19 consists of respiratory symptoms, clinicians should be vigilant for other common conditions having the same symptoms. Clinicians should carefully distinguish a differential diagnosis between COVID-19 and a flare of rheumatic disease.
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Affiliation(s)
- Serife Torun
- Department of Pulmonary Diseases, Konya Training and Research Hospital, Konya, Turkey
- *Correspondence: Serife Torun,
| | - Irem Karaman
- School of Medicine, Bahcesehir University, Istanbul, Turkey
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16
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Liang L, Chen J, Di C, Zhan M, Bao H, Xia C, Fan C, Liu Y. Serum Human Epididymis Protein 4 as a Novel Biomarker in Identifying Patients With Interstitial Lung Disease in Rheumatoid Arthritis. Front Med (Lausanne) 2021; 8:755268. [PMID: 34765622 PMCID: PMC8575793 DOI: 10.3389/fmed.2021.755268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023] Open
Abstract
Objective: Human epididymis protein 4 (HE4) have been implicated in the pulmonary involvements. We aimed to investigate the clinical utility of HE4 in clinical stratification in patients with rheumatoid arthritis (RA). Methods: This study included a discovery cohort comprising 70 RA patients and 64 healthy controls (HCs), and a validation cohort comprising 98 RA patients and 75 HCs. Human epididymis protein 4 were determined by electrochemical luminescence analyzer. Results: The levels of HE4 were significantly elevated in patients with RA compared to HCs. The positive rates of HE4 in patients with RA and HCs were 50.0% and 0, respectively, in the discovery cohort and 53.1 and 1.3%, respectively, in the validation cohort. When RA patients were subgrouped according to HE4 status, HE4-positive group displayed higher prevalence of interstitial lung disease (ILD) compared to HE4-negative group (28.6 vs. 11.4% in discovery cohort and 57.7 vs. 8.7% in the validation cohort). A positive correlation between the levels of HE4 with the degree of lung impairment was identified. Receiver operating curve (ROC) analysis revealed an optimal cut-off value of 104.3 pmol/L in HE4 for distinguishing RA-ILD from RA-non ILD with the areas under the curve (AUC) of 0.790. Multivariate logistic regression analysis illustrated that high levels of HE4 independently identified patients with RA-ILD (OR, 9.080, p < 0.001). Conclusion: Our findings showed a novel role of HE4 in RA risk stratification, suggest that introducing HE4 to the current RA test panel may serve as an indicator in identifying RA patients for further RA-ILD workups, such as high-resolution computed tomography (HRCT).
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Affiliation(s)
- Liu Liang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China.,Department of Clinical Laboratory, The Second People's Hospital of Qinzhou, Qinzhou, China
| | - Jiali Chen
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chun Di
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Minghua Zhan
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Huizhang Bao
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Changsheng Xia
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Chunhong Fan
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Yudong Liu
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
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17
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Prevalence and clinical characteristics of symptomatic diffuse interstitial lung disease in rheumatoid arthritis in a Spanish population. Rev Clin Esp 2021; 222:281-287. [PMID: 34583914 DOI: 10.1016/j.rceng.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/31/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES In Spain, epidemiological studies of the prevalence of diffuse interstitial lung disease (ILD) in rheumatoid arthritis (RA) are limited. Our objective was to estimate the prevalence of symptomatic ILD in RA and its characteristics in our area. MATERIALS AND METHODS In our hospital's interdisciplinary rheumatology and pulmonology clinic, a prospective longitudinal observational study was designed in which we included RA with respiratory symptoms and ILD confirmed by high resolution computed tomography. RESULTS Of the 2729 people with RA in our area, 47 had symptomatic ILD, estimating a prevalence of symptomatic ILD in RA of 1.72% (95% CI 1.26-2.29) with an age at diagnosis of RA of 57.3 ± 13.3 years. It was more frequent in men, 60.6% had a history of smoking, and 84.3% and 84.7% had rheumatoid factor (RF) and anti-cyclic citrullinated peptide (Anti-CCP) antibodies, respectively. The most frequent pattern was usual interstitial pneumonitis (UIP), appearing in 28 (31.1%). Nonspecific interstitial pneumonia (NSIP) was more frequent in women, while the combined pulmonary fibrosis-emphysema (CPFE) syndrome presented exclusively in men. CONCLUSIONS We have analysed the prevalence of symptomatic RA-ILD in our area, which is lower than expected, probably in relation to the definitions used. We have also described that the UIP pattern is the most frequent in RA in our environment, followed by the NSIP. Lastly, we have analysed the prevalence of CPFE in RA, which reaches 13%, for the first time.
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18
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Respiratory Manifestations in Systemic Lupus Erythematosus. Pharmaceuticals (Basel) 2021; 14:ph14030276. [PMID: 33803847 PMCID: PMC8003168 DOI: 10.3390/ph14030276] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by a wide spectrum of clinical manifestations. The respiratory system can be involved in up to 50-70% of patients and be the presenting manifestation of the disease in 4-5% of cases. Every part of the respiratory part can be involved, and the severity can vary from mild self-limiting to life threatening forms. Respiratory involvement can be primary (caused by SLE itself) or secondary (e.g., infections or drug toxicity), acute or chronic. The course, treatment and prognosis vary greatly depending on the specific pattern of the disease. This review article aims at providing an overview of respiratory manifestations in SLE along with an update about therapeutic approaches including novel biologic therapies.
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Groner LK, Green DB, Weisman SV, Legasto AC, Toy D, Gruden JF, Escalon JG. Thoracic Manifestations of Rheumatoid Arthritis. Radiographics 2021; 41:32-55. [PMID: 33411607 DOI: 10.1148/rg.2021200091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Rheumatoid arthritis (RA) is one of the most common chronic systemic inflammatory diseases and the most common chronic inflammatory arthritis. Classically a progressive symmetric polyarthritis, RA is characterized by inflammation, erosions, bone loss, and joint destruction. Up to half of patients with RA exhibit extra-articular manifestations (EAMs), which may precede articular disease and are more common in patients with seropositive RA (patients with detectable serum levels of rheumatoid factor and/or anticitrullinated peptide antibodies). Cardiovascular and pulmonary EAMs are the largest contributors to morbidity and mortality in RA and may be especially devastating. Imaging has a significant role in diagnosing these EAMs and assessing response to treatment. Although treatment with disease-modifying antirheumatic drugs has redefined the natural history of RA and helped many patients achieve low disease activity, patients are at risk for treatment-related complications, as well as infections. The clinical features of drug-induced lung disease and infection can overlap considerably with those of EAMs, presenting a diagnostic challenge. Radiologists, by recognizing the imaging characteristics and evolution of these various processes, are essential in diagnosing and distinguishing among EAMs, treatment-related complications, and unrelated processes and formulating an appropriate differential diagnosis. Moreover, recognizing these disease processes at imaging and contextualizing imaging findings with clinical information and laboratory and pathologic findings can facilitate definitive diagnosis and proper treatment. The authors review the articular and extra-articular thoracic imaging manifestations of RA, including cardiovascular, respiratory, and pleural diseases, as well as treatment-related complications and common infections. ©RSNA, 2021.
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Affiliation(s)
- Lauren K Groner
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Daniel B Green
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Stacey V Weisman
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Alan C Legasto
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Dennis Toy
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - James F Gruden
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Joanna G Escalon
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
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20
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Conforti A, Di Cola I, Pavlych V, Ruscitti P, Berardicurti O, Ursini F, Giacomelli R, Cipriani P. Beyond the joints, the extra-articular manifestations in rheumatoid arthritis. Autoimmun Rev 2020; 20:102735. [PMID: 33346115 DOI: 10.1016/j.autrev.2020.102735] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/18/2020] [Indexed: 12/24/2022]
Abstract
Rheumatoid arthritis (RA) is an inflammatory disease typically affecting the joints, but the systemic inflammatory process may involve other tissues and organs. Many extra-articular manifestations are recognized, which are related to worse long outcomes. Rheumatoid nodules are the most common extra-articular feature, found in about 30% of patients. Secondary Sjögren's syndrome and pulmonary manifestations are observed in almost 10% of patients, also in the early disease. Active RA with high disease activity has been associated with an increased risk of such features. Male gender, smoking habit, severe joint disease, worse function, high pro-inflammatory markers levels, high titer of rheumatoid factor, and HLA-related shared epitope have been reported as clinical predictors of occurrence of these rheumatoid complications. In addition, there is a little evidence deriving from randomized controlled trials in this field, thus the therapeutic strategy is mainly empiric and based on small case series and retrospective studies. However, considering that these extra-articular manifestations are usually related to the more active and severe RA, an aggressive therapeutic strategy is usually employed in view of the poor outcomes of these patients. The extra-articular features of RA remain, despite the improvement of joint damage, a major diagnostic and therapeutic challenge, since these are associated with a poor prognosis and need to be early recognized and promptly managed.
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Affiliation(s)
- Alessandro Conforti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ilenia Di Cola
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Viktoriya Pavlych
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Piero Ruscitti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Onorina Berardicurti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Ursini
- IRRCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Roberto Giacomelli
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Cipriani
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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21
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Imaging of Cardiopulmonary Involvement in Systemic Immune-mediated Diseases: A Comprehensive Review. J Thorac Imaging 2020; 36:W35-W51. [PMID: 32205818 DOI: 10.1097/rti.0000000000000496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic immune-mediated diseases (SID) are a large group of disorders characterized by complex inflammatory and autoimmune damage to various organs and tissues. Among the possible manifestations, SIDs may potentially involve each structure of the cardiopulmonary system. Each disease is characterized by a specific clinical presentation. Coronary artery disease, myocarditis, pericarditis, valvular disease, pulmonary arterial hypertension, and interstitial lung disease represent characteristic findings of cardiopulmonary involvement in these disorders and their prompt recognition is crucial for the diagnosis of SIDs and the patient's prognosis. In this setting, chest high-resolution computed tomography and cardiac magnetic resonance are the most important noninvasive techniques for the assessment of these diseases and their complications. The knowledge of various cardiac and pulmonary radiologic patterns increases the likelihood of diagnosing these disorders and can lead to improved understanding of the underlying pathophysiology to personalize the treatment for each patient.
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22
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Chu X, Wang X, Tian C, Liu L, Xia M, Jiang J, Gui S. Dual drug-loaded cubic liquid crystal gels for transdermal delivery: inner structure and percutaneous mechanism evaluations. Drug Dev Ind Pharm 2019; 45:1879-1888. [DOI: 10.1080/03639045.2019.1672716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Xiaoqin Chu
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, Hefei, People’s Republic of China
- Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei, People’s Republic of China
- School of Chinese Medicine, China Pharmaceutical University, Nanjing, People’s Republic of China
| | - Xingqi Wang
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, Hefei, People’s Republic of China
| | - Chunling Tian
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, Hefei, People’s Republic of China
| | - Liu Liu
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, Hefei, People’s Republic of China
| | - Mengqiu Xia
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, Hefei, People’s Republic of China
| | - Jianqin Jiang
- School of Chinese Medicine, China Pharmaceutical University, Nanjing, People’s Republic of China
| | - Shuangying Gui
- Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, Hefei, People’s Republic of China
- Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei, People’s Republic of China
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23
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Wu Y, Dittmar PC. Atypical presentation of rheumatoid arthritis: a case of massive bilateral pleural effusions in a patient with Caplan syndrome. BMJ Case Rep 2019; 12:12/10/e231899. [PMID: 31653636 DOI: 10.1136/bcr-2019-231899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rheumatoid arthritis (RA) is a common connective tissue disorder affecting the synovial joints. In patients with RA, involvement of the lungs occurs in 30%-40% of cases while pleural effusions occur in only 3%-5%. However, the majority of RA-associated pleural effusions are small, unilateral and asymptomatic. We present a case of massive bilateral pleural effusions in a patient with established rheumatoid pneumoconiosis (Caplan syndrome). Interestingly, the pleural effusion occurred following recent treatment for minimal change disease and atrial fibrillation.
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Affiliation(s)
- Yinglun Wu
- School of Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Philip C Dittmar
- Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
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24
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Post-Translational Modifications of Proteins: Novel Insights in the Autoimmune Response in Rheumatoid Arthritis. Cells 2019; 8:cells8070657. [PMID: 31261953 PMCID: PMC6678491 DOI: 10.3390/cells8070657] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 12/15/2022] Open
Abstract
Post-translational modifications (PTM) are chemical changes mostly catalyzed by enzymes that recognize specific target sequences in specific proteins. These modifications play a key role in regulating the folding of proteins, their targeting to specific subcellular compartments, their interaction with ligands or other proteins, and eventually their immunogenic properties. Citrullination is the best characterized PTM in the field of rheumatology, with antibodies anticyclic citrullinated peptides being the gold standard for the diagnosis of rheumatoid arthritis (RA). In recent years, growing evidence supports not only that a wide range of proteins are subject to citrullination and can trigger an autoimmune response in RA, but also that several other PTMs such as carbamylation and acetylation occur in patients with this disease. This induces a wide spectrum of autoantibodies, as biomarkers, with different sensitivity and specificity for diagnosis, which may be linked to peculiar clinical manifestations and/or response to treatment. The purpose of this review article is to critically summarize the available literature on antibodies against post-translationally modified proteins, in particular antibodies against citrullinated proteins (ACPA) and antibodies against modified proteins (AMPA), and outline their diagnostic and prognostic role to be implemented in clinical practice for RA patients.
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25
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Kurata I, Tsuboi H, Terasaki M, Shimizu M, Toko H, Honda F, Ohyama A, Yagishita M, Osada A, Ebe H, Kawaguchi H, Takahashi H, Hagiwara S, Asashima H, Kondo Y, Matsumoto I, Sumida T. Effect of Biological Disease-modifying Anti-rheumatic Drugs on Airway and Interstitial Lung Disease in Patients with Rheumatoid Arthritis. Intern Med 2019; 58:1703-1712. [PMID: 30799358 PMCID: PMC6630137 DOI: 10.2169/internalmedicine.2226-18] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective Biological disease-modifying anti-rheumatic drugs (bDMARDs) represent an important advance in alleviating rheumatoid arthritis (RA), but their effect on rheumatic airway disease (AD) and interstitial lung disease (ILD) is still unclear. This study was performed to evaluate the association of the use of different bDMARDs with new-onset or worsening of RA-AD/ILD. Methods We performed a retrospective cohort study of RA patients who received bDMARDs and assessed their AD/ILD before and after drug initiation in our hospital over the past 10 years. We evaluated the serial changes in computed tomography (CT), classified patients according to AD/ILD progression, and analyzed associations between clinical characteristics and outcomes. Results We enrolled 49 patients. Thirty patients received tumor necrosis factor inhibitors (TNFis), 12 received abatacept (ABT), and the remaining 7 received tocilizumab (TCZ). Seventeen patients had ILD, 10 had AD, and 6 had both AD and ILD before the initiation of bDMARDs. New emergence or exacerbation of AD/ILD was observed in 18 patients after drug initiation, while the remaining 31 remained stable or improved. Multiple logistic regression analyses revealed that pre-existing AD was an independent risk factor against the emergence or exacerbation of RA-AD/ILD, and ABT use was a protective factor against it. Conclusion Our study showed that pre-existing RA-AD is associated with future worsening of RA-AD/ILD, and ABT over other bDMARDs was associated with a better prognosis. Future studies to confirm our results are needed.
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Affiliation(s)
- Izumi Kurata
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Mayu Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Masaru Shimizu
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hirofumi Toko
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Fumika Honda
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Ayako Ohyama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Mizuki Yagishita
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Atsumu Osada
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroshi Ebe
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hoshimi Kawaguchi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroyuki Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Shinya Hagiwara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiromitsu Asashima
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
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Kusmirek JE, Kanne JP. Thoracic Manifestations of Connective Tissue Diseases. Semin Ultrasound CT MR 2019; 40:239-254. [DOI: 10.1053/j.sult.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Wan J, Wang SM, Gui ZP, Yang ZZ, Shan QQ, Chu XQ, Gui SY, Yang Y. Phytantriol-based lyotropic liquid crystal as a transdermal delivery system. Eur J Pharm Sci 2018; 125:93-101. [DOI: 10.1016/j.ejps.2018.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022]
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