1
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Liu S, Li J, Li Y, Liu Y, Wang K, Pan W. Correlation of CRP genotypes with serum CRP levels and the risk of rheumatoid arthritis in Chinese Han population. Clin Rheumatol 2022; 41:3325-3330. [PMID: 35896901 DOI: 10.1007/s10067-022-06306-9] [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: 03/26/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE C-reactive protein (CRP) is an important index for evaluating the disease activity of rheumatoid arthritis (RA). CRP may play a direct role in bone destruction in RA. Studies have demonstrated that serum CRP levels had a close correlation with tissue inflammation scores in patients with RA. In addition, genetic factors play a crucial role in the development of RA. In this study, we aimed to investigate the relationship between the CRP gene variants (rs1205 polymorphism) and the risk of RA in Chinese Han population. METHODS 502 RA patients and 581 controls were included in this study. The associations between CRP gene variants and CRP levels and RA risk were investigated. RESULTS We found that TT/ TT + CT genotype was significantly related with an increased risk of RA (TT vs CC: OR, 1.56, 95%CI, 1.01-2.40, P = 0.045; TT + CT vs CC: OR, 1.30, 95%CI, 1.02-1.65, P = 0.032). In addition, T allele was shown to associate with an elevated risk of RA. After subgroup analysis, we found that rs1205 polymorphism was significantly related with an enhanced risk of RA among females, individuals lower than 60 years, and subjects with a BMI > 25 kg/m2. Furthermore, data showed that the CRP gene rs1205 polymorphism correlated with CRP and ESR levels. Furthermore, the TT genotype was significantly associated with a reduction of CRP levels compared with CT or CC genotype. CONCLUSIONS To sum up, this study reveals that rs1205 polymorphism of the CRP gene is related with an increased risk of RA and CRP levels in Chinese Han population. Key Points • The CRP gene rs1205 polymorphism is related with a higher risk of RA. • The CRP gene rs1205 polymorphism correlates with CRP and ESR levels. • The TT genotype of rs1205 polymorphism is linked with a reduction of CRP levels.
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Affiliation(s)
- Shanshan Liu
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China.
| | - Ju Li
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Yongsheng Li
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Yan Liu
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Kai Wang
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Wenyou Pan
- Department of Rheumatology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
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2
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Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Semin Arthritis Rheum 2020; 51:219-229. [PMID: 33385862 DOI: 10.1016/j.semarthrit.2020.11.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
C-reactive protein (CRP) is routinely assessed as a marker of systemic inflammation in rheumatoid arthritis (RA). However, it is also an immune regulator that plays an important role in inflammatory pathways associated with RA and promotes atherogenic effects. Comorbidities linked to systemic inflammation are common in RA, and CRP has been associated with the risk for cardiovascular disease, diabetes, metabolic syndrome, pulmonary diseases, and depression. The relationship between systemic inflammation, CRP, and comorbidities in RA is complex, and it is challenging to determine how changing CRP levels may affect the risk or progression of these comorbidities. We review the biological role of CRP in RA and its implications for disease activity and treatment response. We also discuss the impact of treatment on CRP levels and whether reducing systemic inflammation and inhibiting CRP-mediated inflammatory pathways may have an impact on conditions commonly comorbid with RA.
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Affiliation(s)
- Janet E Pope
- Janet E. Pope: Schulich School of Medicine, University of Western Ontario, St. Joseph's Health Care, London, ON, Canada
| | - Ernest H Choy
- Ernest H. Choy: Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom.
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3
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Kasapoğlu Aksoy M, Altan L, Görükmez O, Güner A, Ayar K. The relationship between CRP gene polymorphism (rs2794521, rs3091244), ASDAS-CRP and ASDAS-ESR in ankylosing spondylitis. Mod Rheumatol 2019; 30:715-720. [PMID: 31267817 DOI: 10.1080/14397595.2019.1639916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: We aimed to investigate the haplotypes and alleles of two variants (rs2794521 and rs3091244) in AS patients and to examine their relationship with ASDAS-CRP and ASDAS-ESR values.Methods: We evaluated 160 AS patients diagnosed according to the ASAS criteria. ASDAS-CRP and ASDAS-ESR values were calculated. ESR and CRP were examined. The restriction fragment length polymorphism (RFLP) method was used for detecting the rs2794521 and rs3091244 regions on the CRP gene.Results: As a result of the evaluation of rs2794521 gene polymorphism using PCR, TT, TC and CC genotypes were observed in 90, 81 and 9 individuals, respectively. As a result of the evaluation of rs3091244 gene polymorphism, CC, AC and TT genotypes were observed in 104, 51 and 5 individuals, respectively. T allele and C allele were found in rs2794521 gene by 75% and 25%, respectively. In addition, T allele, C allele and A allele were found in rs3091244 gene by 80%, 17% and 3%, respectively. With the help of regression equation, ASDAS-CRP level was 0.34 units higher in cases with rs3091244 C allele than cases without rs3091244 C alleles.Conclusion: CRP rs3091244 C allele may be associated with the increased relative risk for ASDAS-CRP.
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Affiliation(s)
- Meliha Kasapoğlu Aksoy
- Department of Physical Medicine and Rehabilitation, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey.,Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Orhan Görükmez
- Department of Genetics, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Altuğ Güner
- Department of Physical Medicine and Rehabilitation, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Koray Ayar
- Department of Romatology, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
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Liu Y, Han Y, Qu H, Fang J, Ye M, Yin W. Correlation of microRNA expression profile with clinical response to tumor necrosis factor inhibitor in treating rheumatoid arthritis patients: A prospective cohort study. J Clin Lab Anal 2019; 33:e22953. [PMID: 31245894 PMCID: PMC6757134 DOI: 10.1002/jcla.22953] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to explore the correlation of circulating microRNA (miRNA) expression profile with clinical response to tumor necrosis factor (TNF) inhibitor in treating rheumatoid arthritis (RA) patients. Methods Baseline PBMC samples from eight responders and eight non‐responders after 24‐week TNF inhibitor (etanercept) treatment were subjected to miRNA microarray. Then, top 10 dysregulated miRNAs were selected and further validated by quantitative polymerase chain reaction (qPCR) in baseline PBMC samples from 92 RA patients treated with 24‐week TNF inhibitor (etanercept). Responders and non‐responders were divided referring to the decline in disease activity score in 28 joints. Results In microarray assay, total 59 upregulated and 78 downregulated miRNAs were identified in responders compared to non‐responders, which were mainly enriched in regulating immune‐ and inflammation‐related biological processes and pathways. The top 10 dysregulated miRNAs were as follows: miR‐192‐5p, miR‐146a‐5p, miR‐19b‐3p, miR‐320c, miR‐335‐5p, miR‐149‐3p, miR‐766‐3p, let‐7a‐5p, miR‐24‐3p, and miR‐1226‐5p. In qPCR validation, miR‐146a‐5p was increased, while let‐7a‐5p was decreased in responders compared with non‐responders. Multivariate logistic analysis illuminated that miR‐146a‐5p and CRP independently correlated with higher clinical response, while let‐7a‐5p and biologics history independently associated with lower clinical response. Subsequently, receiver operating characteristic curve showed that combination of these four independent factors presented with a great predictive value for clinical response with area under curve: 0.863, 95% CI 0.781‐0.945. Conclusion miRNA expression profile is closely implicated in the treatment efficacy of TNF inhibitor, and combined measurement of miR‐146a‐5p, let‐7a‐5p, CRP, and biologics history disclosed a great predictive value for clinical response to TNF inhibitor in RA patients.
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Affiliation(s)
- Yaqiong Liu
- Department of Geratology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yonghong Han
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huanru Qu
- Department of Rheumatology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingpin Fang
- Department of Rheumatology, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Mei Ye
- General Department, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanling Yin
- Department of Geratology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ling SF, Viatte S, Lunt M, Van Sijl AM, Silva-Fernandez L, Symmons DPM, Young A, Macgregor AJ, Barton A. HLA-DRB1 Amino Acid Positions 11/13, 71, and 74 Are Associated With Inflammation Level, Disease Activity, and the Health Assessment Questionnaire Score in Patients With Inflammatory Polyarthritis. Arthritis Rheumatol 2017; 68:2618-2628. [PMID: 27274008 PMCID: PMC5244675 DOI: 10.1002/art.39780] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 06/01/2016] [Indexed: 02/01/2023]
Abstract
Objective Rheumatoid arthritis (RA) susceptibility HLA–DRB1 haplotypes based on amino acid positions 11/13, 71, and 74 predict radiographic damage. The mechanism of action is unknown, but it may be mediated by inflammation. We undertook this study to systematically investigate the effect of these amino acids on nonradiographic measures of disease activity/outcomes. Methods We tested the association of RA susceptibility HLA–DRB1 amino acids with the C‐reactive protein (CRP) level, the tender joint count (TJC), the swollen joint count (SJC), the Disease Activity Score in 28 joints (DAS28), and the Health Assessment Questionnaire (HAQ) score in the Norfolk Arthritis Register (NOAR) and Early Rheumatoid Arthritis Study (ERAS) cohorts. Longitudinal modeling of disease activity/outcomes was performed using generalized linear latent and mixed models. Mediation analysis was performed using directed acyclic graphs to investigate the paths from genetic factors to outcome. Results A total of 2,158 patients were available for analysis in the NOAR cohort. Valine at position 11 showed the strongest association with the CRP level (P = 2.21 × 10−6), the SJC (P = 7.51 × 10−6), and the DAS28 (P = 0.002); it was marginally associated with the HAQ score (P = 0.044) but not with the TJC. The same amino acid and haplotype risk hierarchy observed for susceptibility and radiographic severity was observed for the CRP level and nonradiographic measures of disease activity/outcome, apart from the TJC. The results were replicated in the ERAS cohort. The effect of valine at position 11 on the SJC was mainly mediated by anti–citrullinated protein antibody status, the effect of which was mainly mediated by inflammation; however, the effect of valine at position 11 was also independent of the CRP level (P = 1.6 × 10−4). Conclusion Genetic markers of RA susceptibility located within HLA–DRB1 determine the levels of clinical and systemic inflammation independently, and also determine all objective measures of disease activity and outcome.
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Affiliation(s)
| | | | - Mark Lunt
- University of Manchester, Manchester, UK
| | - Alper M Van Sijl
- University of Manchester, Manchester, UK, and Jan van Breemen Research Institute Reade, Amsterdam, The Netherlands
| | - Lucia Silva-Fernandez
- University of Manchester, Manchester, UK, and Complexo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Deborah P M Symmons
- University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Adam Young
- St. Albans City Hospital, St. Albans, UK, and University of Hertfordshire, Hatfield, UK
| | | | - Anne Barton
- University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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6
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Giotis D, Aryaei A, Vasilakakos T, Paschos NK. Effectiveness of Biologic Factors in Shoulder Disorders. Open Orthop J 2017; 11:163-182. [PMID: 28400884 PMCID: PMC5366381 DOI: 10.2174/1874325001711010163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 12/17/2022] Open
Abstract
Background: Shoulder pathology can cause significant pain, discomfort, and loss of function that all interfere with activities of daily living and may lead to poor quality of life. Primary osteoarthritis and rotator cuff diseases with its sequalae are the main culprits. Management of shoulder disorders using biological factors gained an increasing interest over the last years. This interest reveals the need of effective treatments for shoulder degenerative disorders, and highlights the importance of a comprehensive and detailed understanding of the rapidly increasing knowledge in the field. Methods: This study will describe most of the available biology-based strategies that have been recently developed, focusing on their effectiveness in animal and clinical studies. Results: Data from in vitro work will also be briefly presented; in order to further elucidate newly acquired knowledge regarding mechanisms of tissue degeneration and repair that would probably drive translational work in the next decade. The role of platelet rich-plasma, growth factors, stem cells and other alternative treatments will be described in an evidence-based approach, in an attempt to provide guidelines for their clinical application. Finally, certain challenges that biologic treatments face today will be described as an initiative for future strategies. Conclusion: The application of different growth factors and mesenchymal stem cells appears as promising approaches for enhancing biologic repair. However, data from clinical studies are still limited, and future studies need to improve understanding of the repair process in cellular and molecular level and evaluate the effectiveness of biologic factors in the management of shoulder disorders.
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Affiliation(s)
- Dimitrios Giotis
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Ashkan Aryaei
- Department of Biomedical Engineering, University of California, Davis, USA
| | - Theofanis Vasilakakos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Nikolaos K Paschos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece; Department of Biomedical Engineering, University of California, Davis, USA
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7
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Kay J, Memon M, Rogozinsky J, Simunovic N, Seil R, Karlsson J, Ayeni OR. Level of evidence of free papers presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy congress from 2008 to 2016. Knee Surg Sports Traumatol Arthrosc 2017; 25:602-607. [PMID: 27896395 DOI: 10.1007/s00167-016-4391-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE The European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) congress is an important venue, and the research presented can be a critical source of information used to impact clinical decisions and health policies. The purpose of this study was to evaluate the level of evidence of clinical free papers presented at the ESSKA congress from 2008 to 2016. Moreover, this study evaluated whether there were any changes in the distribution of level of evidence over time. METHODS Two reviewers screened the free papers presented at the ESSKA biannual congresses 2008-2016 for clinical evidence. Clinical papers included observational studies and trials involving direct interaction between an investigator and human subjects. Biomechanical studies, technique demonstrations, cadaveric studies, and panel discussions were excluded. The reviewers independently graded their level of evidence from level I (e.g. high-quality randomized trials) to level IV (e.g. case series and reports) using the classification system published by the American Academy of Orthopaedic Surgeons. RESULTS Of 1036 free papers that were identified, 729 met the inclusion criteria and were evaluated. Overall, 18% of studies were level I, 24% level II, 25% level III, and 33% level IV evidence. There was a significant improvement in level of evidence over time (p < 0.0001), with the proportion of level I studies increasing most dramatically (9% in 2008, 20% in 2012, 24% in 2016). Free papers studying the knee had higher levels of evidence than those evaluating other joints (p = 0.002). CONCLUSION The level of evidence of clinical free papers presented at the ESSKA congress between 2008 and 2016 is high relative to other orthopaedic meetings. Moreover, there has been a significant improvement in the level of evidence over time. LEVEL OF EVIDENCE Systematic review, Level IV.
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Affiliation(s)
- Jeffrey Kay
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Muzammil Memon
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Joelle Rogozinsky
- Department of Medicine and School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Romain Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Olufemi Rolland Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
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8
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Macías-Hernández SI, Morones-Alba JD, Miranda-Duarte A, Coronado-Zarco R, Soria-Bastida MDLA, Nava-Bringas T, Cruz-Medina E, Olascoaga-Gómez A, Tallabs-Almazan LV, Palencia C. Glenohumeral osteoarthritis: overview, therapy, and rehabilitation. Disabil Rehabil 2016; 39:1674-1682. [DOI: 10.1080/09638288.2016.1207206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
| | | | | | - Roberto Coronado-Zarco
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación, México, D.F., Mexico
| | | | - Tania Nava-Bringas
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación, México, D.F., Mexico
| | - Eva Cruz-Medina
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación, México, D.F., Mexico
| | - Andrea Olascoaga-Gómez
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación, México, D.F., Mexico
| | | | - Chanell Palencia
- Postgraduate Division, Instituto Nacional de Rehabilitación, México, D.F., Mexico
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9
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Thankam FG, Dilisio MF, Agrawal DK. Immunobiological factors aggravating the fatty infiltration on tendons and muscles in rotator cuff lesions. Mol Cell Biochem 2016; 417:17-33. [PMID: 27160936 DOI: 10.1007/s11010-016-2710-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/23/2016] [Indexed: 12/14/2022]
Abstract
Rotator cuff lesions (RCLs) are a common cause of shoulder pain and dysfunction. The rotator cuff tendons can degenerate and/or tear from the greater tuberosity of the humerus, which is associated with several anatomical, physiological, biochemical, and molecular changes in tendon and muscle. In this article, these pathways are critically reviewed and discussed with various management strategies of RCLs. The article also highlights the immunobiological responses following the RCL and the inherent repair mechanisms elicited by the body. The greatest difficulty in treating this pathology is that the muscle can undergo irreversible fatty infiltration in the setting of chronic tears that is associated with poor surgical outcomes. The article also investigates the key molecular pathways of the muscle homeostasis (mTOR, Rho kinase, AMPK, and Ca(2+)) with the energy metabolism to propose a possible mechanism for fatty infiltration. Future research is warranted to target the key players of these pathways in the management of fatty infiltration and thus RCL.
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Affiliation(s)
- Finosh G Thankam
- Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA
| | - Matthew F Dilisio
- Department of Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, USA
| | - Devendra K Agrawal
- Department of Clinical & Translational Science, Creighton University School of Medicine, Omaha, NE, USA.
- Department of Clinical & Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA.
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10
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Lee YC, Hackett J, Frits M, Iannaccone CK, Shadick NA, Weinblatt ME, Segurado OG, Sasso EH. Multibiomarker disease activity score and C-reactive protein in a cross-sectional observational study of patients with rheumatoid arthritis with and without concomitant fibromyalgia. Rheumatology (Oxford) 2015; 55:640-8. [PMID: 26608972 PMCID: PMC4795537 DOI: 10.1093/rheumatology/kev388] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To examine the association between a multibiomarker disease activity (MBDA) score, CRP and clinical disease activity measures among RA patients with and without concomitant FM. METHODS In an observational cohort of patients with established RA, we performed a cross-sectional analysis comparing MBDA scores with CRP by rank correlation and cross-classification. MBDA scores, CRP and clinical measures of disease activity were compared between patients with RA alone and RA with concomitant FM (RA and FM) by univariate and multivariate analyses. RESULTS CRP was ⩽1.0 mg/dl for 184 of 198 patients (93%). MBDA scores correlated with CRP (r = 0.755, P < 0.001), but were often discordant, being moderate or high for 19%, 55% and 87% of patients with CRP ⩽0.1, 0.1 to ⩽0.3, or 0.3 to ⩽1.0 mg/dl, respectively. Among patients with CRP ⩽1.0 mg/dl, swollen joint count (SJC) increased linearly across levels of MBDA score, both with (P = 0.021) and without (P = 0.004) adjustment for CRP, whereas CRP was not associated with SJC. The 28-joint-DAS-CRP, other composite measures, and their non-joint-count component measures were significantly greater for patients with RA and FM (n = 25) versus RA alone (n = 173) (all P ⩽ 0.005). MBDA scores and CRP were similar between groups. CONCLUSION MBDA scores frequently indicated RA disease activity when CRP did not. Neither one was significantly greater among patients with RA and FM versus RA alone. Thus, MBDA score may be a useful objective measure for identifying RA patients with active inflammation when CRP is low (⩽1.0 mg/dl), including RA patients with concomitant FM.
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Affiliation(s)
- Yvonne C Lee
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA,
| | | | - Michelle Frits
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Christine K Iannaccone
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Michael E Weinblatt
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Oscar G Segurado
- Medical and Scientific Affairs, Crescendo Bioscience Inc., South San Francisco, CA, USA
| | - Eric H Sasso
- Medical and Scientific Affairs, Crescendo Bioscience Inc., South San Francisco, CA, USA
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11
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Danila MI, Westfall AO, Raman K, Chen L, Reynolds RJ, Hughes LB, Arnett DK, McGwin G, Szalai AJ, van der Heijde DM, Conn D, Callahan LF, Moreland LW, Bridges SL. The role of genetic variants in CRP in radiographic severity in African Americans with early and established rheumatoid arthritis. Genes Immun 2015. [PMID: 26226010 DOI: 10.1038/gene.2015.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study investigates the association of CRP (C-reactive protein) single-nucleotide polymorphisms (SNPs) with plasma CRP levels and radiographic severity in African Americans with early and established rheumatoid arthritis (RA). Using a cross-sectional case-only design, CRP SNPs were genotyped in two independent sets of African Americans with RA: Consortium for the Longitudinal Evaluation of African Americans with RA (CLEAR 1) and CLEAR 2. Radiographic data and CRP measurements were available for 294 individuals from CLEAR 1 (median (interquartile range (IQR) 25-75) disease duration of 1 (0.6-1.6) year) and in 407 persons from CLEAR 2 (median (IQR 25-75) disease duration of 8.9 (3.5-17.7) years). In CLEAR 1, in adjusted models, the minor allele of rs2808630 was associated with total radiographic score (incident rate ratio 0.37 (95% confidence interval (CI) 0.19-0.74), P-value=0.0051). In CLEAR 2, the minor allele of rs3093062 was associated with increased plasma CRP levels (P-value=0.002). For each rs3093062 minor allele, the plasma CRP increased by 1.51 (95% CI 1.15-1.95) mg dl(-1) when all the other covariates remained constant. These findings have important implications for assessment of the risk of joint damage in African Americans with RA.
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Affiliation(s)
- M I Danila
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A O Westfall
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K Raman
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - L Chen
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R J Reynolds
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - L B Hughes
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D K Arnett
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - G McGwin
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A J Szalai
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D M van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - D Conn
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - L F Callahan
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - L W Moreland
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - S L Bridges
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
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Orthopaedic manual physical therapy for shoulder pain and impaired movement in a patient with glenohumeral joint osteoarthritis: a case report. J Orthop Sports Phys Ther 2015; 45:453-61, A1-3. [PMID: 25927500 DOI: 10.2519/jospt.2015.5887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Comprehensive treatment strategies are needed for individuals with glenohumeral joint osteoarthritis (OA), especially when they are young and active. Prior dislocation, with or without subsequent shoulder stabilization surgery, complicates the clinical presentation and increases the risk of OA progression. The purpose of this case report was to describe an orthopaedic manual physical therapy approach used in a patient with glenohumeral joint OA who presented with shoulder pain and impaired movement. CASE DESCRIPTION A 38-year-old male military officer presented with left-shoulder pain of 2 months in duration that was unrelieved with a subacromial injection. He reported a history of anterior-inferior dislocation with subsequent stabilization surgery 15 years prior and arthroscopic subacromial decompression 2 years prior. Physical examination demonstrated painful limitations in shoulder elevation and internal/external rotation movements, stiffness with testing using accessory glides, and rotator cuff and scapular musculature weakness associated with pain. OUTCOMES Treatment consisted of 5 sessions provided over 4 weeks. The plan of care included manual physical therapy, exercises, and progressive functional activities specifically tailored to the patient's clinical presentation. Shoulder Pain and Disability Index scores decreased from 43% to 17%, and the Patient-Specific Functional Scale average score improved from 3.0 to 7.3 out of 10. After 4 additional weeks of a home exercise program, the Shoulder Pain and Disability Index score was 4% and Patient-Specific Functional Scale average score was 9.0. Improvements in self-reported function were maintained at 6 months. Four "booster" treatment sessions were administered at 9 months, contributing to sustained outcomes through 1 year. DISCUSSION In a young, active patient with glenohumeral joint OA, clinically meaningful short-term improvements in self-reported function and pain, maintained at 1 year, were observed with manual physical therapy and exercise. LEVEL OF EVIDENCE Therapy, level 4.
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Oliver J, Plant D, Webster AP, Barton A. Genetic and genomic markers of anti-TNF treatment response in rheumatoid arthritis. Biomark Med 2015; 9:499-512. [DOI: 10.2217/bmm.15.18] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Despite the success of anti-TNF drugs in the treatment of rheumatoid arthritis, a significant rate of nonresponse remains. Current clinical factors confer little power for predicting response and, in current practice, an unsatisfactory ‘trial and error’ approach governs therapeutic decisions. Candidate gene and unbiased genome-wide investigations have sought to identify genetic biomarkers that predict who will respond to anti-TNF drugs before the drug is administered. To date, few studies have yielded robust associations; herein, we discuss currently identified associations and the issues that need to be addressed in future investigations including insufficient power and an inadequate measure of disease activity. The potential for alternative predictors of anti-TNF therapy response from transcriptomic and epigenetic data will also be explored.
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Affiliation(s)
- James Oliver
- Arthritis Research UK Centre for Genetics & Genomics, Centre for Musculoskeletal Research, Institute of Inflammation & Repair, University Of Manchester, Manchester, M13 9PL, UK
| | - Darren Plant
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academy of Health Sciences, Manchester, M13 9PL, UK
| | - Amy P Webster
- Arthritis Research UK Centre for Genetics & Genomics, Centre for Musculoskeletal Research, Institute of Inflammation & Repair, University Of Manchester, Manchester, M13 9PL, UK
| | - Anne Barton
- Arthritis Research UK Centre for Genetics & Genomics, Centre for Musculoskeletal Research, Institute of Inflammation & Repair, University Of Manchester, Manchester, M13 9PL, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academy of Health Sciences, Manchester, M13 9PL, UK
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Ammitzbøll CG, Steffensen R, Bøgsted M, Hørslev-Petersen K, Hetland ML, Junker P, Johansen JS, Pødenphant J, Østergaard M, Ellingsen T, Stengaard-Pedersen K. CRP genotype and haplotype associations with serum C-reactive protein level and DAS28 in untreated early rheumatoid arthritis patients. Arthritis Res Ther 2014; 16:475. [PMID: 25359432 PMCID: PMC4247621 DOI: 10.1186/s13075-014-0475-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 10/17/2014] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Single-nucleotide polymorphisms (SNPs) in the CRP gene are implicated in the regulation of the constitutional C-reactive protein (CRP) expression and its response to proinflammatory stimuli. Previous reports suggest that these effects may have an impact on clinical decision-making tools based on CRP, such as the Disease Activity Score in 28 joints (DAS28). We aimed to investigate the possible association between seven CRP SNPs, their haplotypes and the serum levels of CRP, as well as DAS28 scores, in two cohorts of untreated active early rheumatoid arthritis (RA) patients followed during their initial treatment. METHODS Overall, 315 patients with RA from two randomized controlled trials (the CIMESTRA and OPERA trials) who were naïve to disease-modifying antirheumatic drugs and steroids with disease durations less than 6 months were included. Seven CRP SNPs were investigated: rs11265257, rs1130864, rs1205, rs1800947, rs2808632, rs3093077 and rs876538. The genotype and haplotype associations with CRP and DAS28 levels were evaluated using linear regression analysis adjusted for age, sex and treatment. RESULTS The minor allele of rs1205 C > T was associated with decreased CRP levels at baseline (P = 0.03), with the TT genotype having a 50% reduction in CRP from 16.7 to 8.4 mg/L (P = 0.005) compared to homozygosity of the major allele, but no association was observed at year 1 (P = 0.38). The common H2 haplotype, characterized by the T allele of rs1205, was associated with a 26% reduction in CRP at baseline (P = 0.043), although no effect was observed at year 1 (P = 0.466). No other SNP or haplotype was associated with CRP at baseline or at year 1 (P ≥ 0.09). We observed no associations between SNPs or haplotypes and DAS28 scores at baseline or at year 1 (P ≥ 0.10). CONCLUSION CRP genotype and haplotype were only marginally associated with serum CRP levels and had no association with the DAS28 score. This study shows that DAS28, the core parameter for inflammatory activity in RA, can be used for clinical decision-making without adjustment for CRP gene variants. TRIAL REGISTRATION The OPERA study is registered at Clinicaltrials.gov (NCT00660647). The CIMESTRA study is not listed in a clinical trials registry, because patients were included between October 1999 and October 2002.
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Affiliation(s)
- Christian Gytz Ammitzbøll
- />Department of Rheumatology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
- />Department of Medicine, Randers Regional Hospital, Skovlyvej 1, 8930 Randers, Denmark
| | - Rudi Steffensen
- />Department of Clinical Immunology, Aalborg University Hospital, Urbansgade 32, 9000 Aalborg, Denmark
| | - Martin Bøgsted
- />Department of Haematology, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark
- />Department of Mathematical Sciences, Aalborg University, Fredrik Bajers Vej 7G, 9220 Aalborg, Denmark
| | - Kim Hørslev-Petersen
- />King Christian 10th Hospital for Rheumatic Diseases, Toldbodgade 3, 6300 Gråsten, Denmark
- />South Jutland Hospital, Institute of Regional Health Services Research, University of Southern Denmark, Winsløwparken 19, Odense M, Denmark
| | - Merete L Hetland
- />Copenhagen Center for Arthritis Research, Glostrup Hospital, Glostrup, Nordre Ringvej 57, 2600 Copenhagen, Denmark
- />Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Peter Junker
- />Department of Rheumatology C, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Julia S Johansen
- />Department of Medicine and Oncology, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
- />Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Jan Pødenphant
- />Copenhagen University at Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - Mikkel Østergaard
- />Copenhagen Center for Arthritis Research, Glostrup Hospital, Glostrup, Nordre Ringvej 57, 2600 Copenhagen, Denmark
- />Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Torkell Ellingsen
- />Department of Rheumatology C, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- />Department of Medicine, Silkeborg Regional Hospital, Falkevej 3, 8600 Silkeborg, Denmark
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Gaujoux-Viala C. C-reactive protein versus erythrocyte sedimentation rate in estimating the 28-joint disease activity score. J Rheumatol 2014; 40:1785-7. [PMID: 24187153 DOI: 10.3899/jrheum.131042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Cécile Gaujoux-Viala
- Nîmes University Hospital, Department of Rheumatology, EA 2415, Montpellier I University, Nîmes, France
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Yarwood A, Viatte S, Plant D, Morgan AW, Isaacs J, Wilson AG, Hyrich K, Eyre S, Barton A. Testing the role of vitamin D in response to antitumour necrosis factor α therapy in a UK cohort: a Mendelian randomisation approach. Ann Rheum Dis 2014; 73:938-40. [PMID: 24323394 DOI: 10.1136/annrheumdis-2013-204443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Annie Yarwood
- Arthritis Research UK Epidemiology Unit, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, , Manchester, UK
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Bluett J, Ibrahim I, Plant D, Hyrich KL, Morgan AW, Wilson AG, Isaacs JD, Barton A. Association of a complement receptor 1 gene variant with baseline erythrocyte sedimentation rate levels in patients starting anti-TNF therapy in a UK rheumatoid arthritis cohort: results from the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate cohort. THE PHARMACOGENOMICS JOURNAL 2013; 14:171-5. [PMID: 23856853 PMCID: PMC3965567 DOI: 10.1038/tpj.2013.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/23/2013] [Accepted: 05/29/2013] [Indexed: 11/09/2022]
Abstract
Eligibility for anti-tumour necrosis factor (TNF) therapy in most European countries is restricted to severe, active rheumatoid arthritis (RA). The DAS28 score is a marker of disease severity and incorporates one of two inflammatory markers, erythrocyte sedimentation rate (ESR) or C-reactive protein. We aimed to determine the relation between genetic variants known to affect ESR and levels of ESR in patients with active RA. DNA samples were genotyped for four single-nucleotide polymorphisms (SNPs) rs7527798 (CR1L), rs6691117 (CR1), rs10903129 (TMEM57) and rs1043879 (C1orf63). The association between SNPs and baseline ESR, baseline DAS28-ESR, and change in DAS28-ESR was evaluated. Baseline ESR was significantly associated with CR1 rs6691117 genotype (P=0.01). No correlation was identified between baseline DAS28-ESR or change in DAS28-ESR. In conclusion, genetic variation in the gene encoding CR1 may alter ESR levels but not DAS28-ESR, indicating no adjustment for CR1 genotype is required in the assessment of patients with severe active RA.
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Affiliation(s)
- J Bluett
- Arthritis Research UK Epidemiology Unit, Manchester Academy of Health Science, University of Manchester, Manchester, UK
| | - I Ibrahim
- Arthritis Research UK Epidemiology Unit, Manchester Academy of Health Science, University of Manchester, Manchester, UK
| | - D Plant
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - K L Hyrich
- Arthritis Research UK Epidemiology Unit, Manchester Academy of Health Science, University of Manchester, Manchester, UK
| | - A W Morgan
- 1] NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK [2] Leeds Institute of Molecular Medicine, Wellcome Trust Brenner Building, St. James's University Hospital, Leeds, UK
| | - A G Wilson
- Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, UK
| | - J D Isaacs
- Musculoskeletal Research Group, Newcastle upon Tyne NHS Foundation Trust, Institute of Cellular Medicine, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle-upon-Tyne, UK
| | | | - A Barton
- 1] Arthritis Research UK Epidemiology Unit, Manchester Academy of Health Science, University of Manchester, Manchester, UK [2] NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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