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Elshafie AI, Elkhalifa AD, Elbagir S, Aledrissy MIE, Elagib EM, Nur MAM, Weitoft T, Rönnelid J. Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between Sudan and Sweden. J Rheumatol 2016; 43:1777-1786. [PMID: 27481904 DOI: 10.3899/jrheum.160303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare clinical characteristics and treatment between simultaneously investigated Sudanese and Swedish outpatients with rheumatoid arthritis (RA). METHODS Outpatients with RA from Sudan (n = 281) and Sweden (n = 542) diagnosed according to the 1987 American College of Rheumatology criteria were recruited between December 2008 and September 2010 and compared concerning clinical presentation, treatment, and laboratory findings, including immunoglobulin M with rheumatoid factor (IgM-RF). RESULTS Sudanese patients had lower inclusion age (median 49 vs 68 yrs), disease duration (48 vs 107 mos), and disease onset age (43 vs 56 yrs) as compared with Swedish patients (p < 0.0001 for all). When stratified concerning the age of inclusion, Swedish patients between 41-50 years had, however, a significantly lower age of onset, with a similar trend for all age groups above 30 years. The female preponderance was higher among Sudanese patients (89.3% vs 72.5%, p < 0.0001), and smoking was nonexistent among Sudanese female patients (p < 0.0001). Erythrocyte sedimentation rate levels and number of tender joints were significantly higher among Sudanese patients. The proportion of IgM-RF positivity was lower among Sudanese patients with RA (52.4% vs 75.5%, p < 0.0001). Higher proportions of Sudanese patients with RA were treated with methotrexate (MTX) and disease-modifying antirheumatic drug combinations, but none of them used biologics. Sudanese patients used lower doses of MTX and sulfasalazine (p < 0.0001) and higher doses of prednisolone (p < 0.0001) than Swedish patients. CONCLUSION Sudanese patients with RA have significantly higher disease activity and are often IgM-RF-seronegative. Together with reports from Uganda and Cameroon, our data indicate a cluster of highly active and often seronegative RA in central Africa.
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Affiliation(s)
- Amir I Elshafie
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University.
| | - Abdalla D Elkhalifa
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Sahwa Elbagir
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Mawahib I E Aledrissy
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Elnour M Elagib
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Musa A M Nur
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Tomas Weitoft
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
| | - Johan Rönnelid
- From the Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala; Rheumatology Unit, Gävle Hospital, Gävle; Section of Rheumatology, Center for Research and Development, Uppsala University, Region of Gävleborg, Sweden; Khartoum Fertility Center; Rheumatology Unit, Alribat University Hospital, Khartoum; Rheumatology Unit, Military Hospital, Omdurman, Sudan.A.I. Elshafie, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University; A.D. Elkhalifa, MD, Rheumatology Unit, Gävle Hospital; S. Elbagir, MD, Department of Immunology, Genetics and Pathology, Uppsala University, and Khartoum Fertility Center; M.I. Aledrissy, MD, Rheumatology Unit, Alribat University Hospital; E.M. Elagib, MD, FRCP, Rheumatology Unit, Military Hospital; M.A. Nur, MD, FRCP, Rheumatology Unit, Alribat University Hospital; T. Weitoft, MD, PhD, Rheumatology Unit, Gävle Hospital, and Section of Rheumatology, Center for Research and Development, Uppsala University; J. Rönnelid, MD, PhD, Department of Immunology, Genetics and Pathology, Uppsala University
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Chukkapalli S, Rivera-Kweh M, Gehlot P, Velsko I, Bhattacharyya I, Calise SJ, Satoh M, Chan EKL, Holoshitz J, Kesavalu L. Periodontal bacterial colonization in synovial tissues exacerbates collagen-induced arthritis in B10.RIII mice. Arthritis Res Ther 2016; 18:161. [PMID: 27405639 PMCID: PMC4942913 DOI: 10.1186/s13075-016-1056-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/21/2016] [Indexed: 12/23/2022] Open
Abstract
Background It has been previously hypothesized that oral microbes may be an etiological link between rheumatoid arthritis (RA) and periodontal disease. However, the mechanistic basis of this association is incompletely understood. Here, we investigated the role of periodontal bacteria in induction of joint inflammation in collagen-induced arthritis (CIA) in B10.RIII mice. Methods CIA-prone B10.RIII mice were infected orally with a polybacterial mixture of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia for 24 weeks before induction of CIA. The ability of polybacterial mixture to colonize the periodontium and induce systemic response, horizontal alveolar bone resorption in infected B10.RIII mice was investigated. Arthritis incidence, severity of joint inflammation, pannus formation, skeletal damage, hematogenous dissemination of the infection, matrix metalloproteinase 3 (MMP3) levels, and interleukin-17 expression levels were evaluated. Results B10.RIII mice had gingival colonization with all three bacteria, higher levels of anti-bacterial immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies, significant alveolar bone resorption, and hematogenous dissemination of P. gingivalis to synovial joints. Infected B10.RIII mice had more severe arthritis, and higher serum matrix metalloproteinase 3 levels and activity. Histopathological analysis showed increased inflammatory cell infiltration, destruction of articular cartilage, erosions, and pannus formation. Additionally, involved joints showed had expression levels of interleukin-17. Conclusion These findings demonstrate that physical presence of periodontal bacteria in synovial joints of B10.RIII mice with collagen-induced arthritis is associated with arthritis exacerbation, and support the hypothesis that oral bacteria, specifically P. gingivalis, play a significant role in augmenting autoimmune arthritis due to their intravascular dissemination to the joints. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1056-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sasanka Chukkapalli
- Department of Periodontology and Oral Biology, College of Dentistry, University of Florida Gainesville, Gainesville, FL, 32610, USA
| | - Mercedes Rivera-Kweh
- Department of Periodontology and Oral Biology, College of Dentistry, University of Florida Gainesville, Gainesville, FL, 32610, USA
| | - Prashasnika Gehlot
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Irina Velsko
- Department of Periodontology and Oral Biology, College of Dentistry, University of Florida Gainesville, Gainesville, FL, 32610, USA
| | - Indraneel Bhattacharyya
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - S John Calise
- Departments of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Minoru Satoh
- Division of Rheumatology and Clinical Immunology, College of Medicine, University of Florida, Gainesville, Florida, USA.,Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Edward K L Chan
- Departments of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Joseph Holoshitz
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Lakshmyya Kesavalu
- Department of Periodontology and Oral Biology, College of Dentistry, University of Florida Gainesville, Gainesville, FL, 32610, USA. .,Departments of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida, USA.
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