1
|
Motta F, Bizzaro N, Giavarina D, Franceschini F, Infantino M, Palterer B, Sebastiani GD, Selmi C. Rheumatoid factor isotypes in rheumatoid arthritis diagnosis and prognosis: a systematic review and meta-analysis. RMD Open 2023; 9:e002817. [PMID: 37541740 PMCID: PMC10407415 DOI: 10.1136/rmdopen-2022-002817] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/23/2022] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVE The first biomarker associated with the rheumatoid arthritis is rheumatoid factor (RF) and since the earliest reports a role has been proposed in the diagnosis and in the prediction of clinical features and outcome. The study of RF isotypes has further attempted to improve diagnostic accuracy and identify specific subgroups of patients. The main objective of this study is to provide an analysis of the literature on the role of RF isotypes in the diagnosis and prognosis of rheumatoid arthritis (RA). METHODS We performed a systematic literature review and meta-analysis on the role of RF isotypes in RA (only in English, from PubMed, search terms: "rheumatoid factor isotypes", "diagnosis", "prognosis" and "rheumatoid arthritis", last search 31 July 2022, two independent assessment of quality and biases, results included in tables and in the meta-analysis). RESULTS Thirty-six articles were examined (7517 patients). Testing all RF isotypes with latex test or nephelometry allows for the highest sensitivity (68.6%, 95% CI 66.2% to 71.0%); nonetheless, the determination of IgA isotype provides the highest specificity (91.4%, 95% CI 90.8% to 92.0%) and the highest positive likelihood ratio (7.7, 95% CI 5.7 to 10.4). When testing IgM isotype the highest diagnostic OR (21.7, 95% CI 16.1 to 29.3) is reached. When analysing anti-citrullinated protein antibodies, RF isotype determination increases diagnostic accuracy. On the other hand, these do not provide relevant prognostic information, as results are conflicting. CONCLUSIONS Testing RF allows the highest sensitivity, while IgA isotype the highest specificity and positive likelihood ratio for RA diagnosis. On the other hand, determination of RF isotypes dose not allow prognostic information, as data are limited and heterogeneous.
Collapse
Affiliation(s)
- Francesca Motta
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Davide Giavarina
- Department of Laboratory Medicine, St Bortolo Hospital, Vicenza, Italy
| | - Franco Franceschini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maria Infantino
- Laboratory of Immunology and Allergology, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Boaz Palterer
- Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy
| | | | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| |
Collapse
|
2
|
Waki D, Tamai H, Yokochi R, Kido T, Yagyu Y, Yanai R, Sada KE. Effects of anti-SSA antibodies on the response to methotrexate in rheumatoid arthritis: A retrospective multicenter observational study. PLoS One 2022; 17:e0271921. [PMID: 35867726 PMCID: PMC9307181 DOI: 10.1371/journal.pone.0271921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/10/2022] [Indexed: 12/03/2022] Open
Abstract
Comparison of clinical response to methotrexate between anti-SSA antibody-positive and -negative patients with methotrexate-naïve rheumatoid arthritis and investigate the reasons for the differences in the response. For this multicenter retrospective cohort study, a total of 210 consecutive patients with rheumatoid arthritis who newly initiated methotrexate were recruited. The effects of anti-SSA antibody positivity on achieving a low disease activity according to the 28-joint Disease Activity Score based on C-reactive protein after 6 months of methotrexate administration were investigated using a logistic regression analysis. This study involved 32 and 178 anti-SSA antibody-positive and -negative patients, respectively. The rate of achieving low disease activity according to the 28-joint Disease Activity Score based on C-reactive protein at 6 months was significantly lower in the anti-SSA antibody-positive group than in the anti-SSA antibody-negative group (56.2% vs. 75.8%, P = 0.030). After 6 months, anti-SSA antibody-positive patients had significantly higher scores on the visual analogue scale (median [interquartile range]: 22 [15–41] vs. 19 [5–30], P = 0.038) and were frequently prescribed nonsteroidal anti-inflammatory drugs (37.5% vs. 18.0%, P = 0.018). In conclusion, the presence of anti-SSA antibodies might be a predictive factor for insufficient responses to treat-to-target strategy in rheumatoid arthritis. Residual pain might contribute to the reduced clinical response to methotrexate in anti-SSA antibody-positive patients with rheumatoid arthritis.
Collapse
Affiliation(s)
- Daisuke Waki
- Department of Endocrinology and Rheumatology, Kurashiki Central Hospital, Okayama, Japan
- * E-mail:
| | - Hiroya Tamai
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ritsuko Yokochi
- Division of Hematology and Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Toshiki Kido
- The First Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Yuriko Yagyu
- Department of Internal Medicine, Tokyo Kyōsai Hospital, Tokyo, Japan
| | - Ryo Yanai
- Division of Rheumatology, Showa University Hospital, Tokyo, Japan
| | - Ken-Ei Sada
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Kochi, Japan
| |
Collapse
|
3
|
Kawashiri SY, Endo Y, Okamoto M, Tsuji S, Shimizu T, Sumiyoshi R, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Kawakami A. Contributing factors of clinical outcomes at 1 year post-diagnosis in early rheumatoid arthritis patients with tightly controlled disease activity in clinical practice: a retrospective study. Mod Rheumatol 2020; 31:343-349. [PMID: 32654596 DOI: 10.1080/14397595.2020.1795392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine whether specific parameters contribute to clinical outcomes at 1 year post-diagnosis in early rheumatoid arthritis (RA) patients under the 'treat-to-target' strategy in clinical practice. METHODS We retrospectively analyzed 125 RA patients selected according to the following criteria; the patients' symptom duration was ≤6 months, and none had experience with DMARDs. We evaluated the patients' clinical disease activity at baseline and 1 year of treatment and the musculoskeletal ultrasound (MSUS)-detected synovitis activity at baseline. We performed an analysis to identify parameters that contribute to SDAI remission and the use of biologic/targeted synthetic (b/ts) DMARDs at 1 year post-diagnosis. RESULTS Forty-seven patients received b/tsDMARDs therapy, and 58 patients achieved SDAI remission at 1 year post-diagnosis. Rheumatoid factor positivity, low patient's/evaluator's global assessment at baseline, and methotrexate use at 1 year post-diagnosis were associated with SDAI remission. The baseline clinical disease activity and MSUS scores were not associated with SDAI remission. Anti-cyclic citrullinated peptide antibody positivity/high titer and high swollen joint counts or the presence of severe synovial hypertrophy at baseline were associated with the use of b/tsDMARDs therapy. CONCLUSION The value of the expected poor-prognosis factors may be diminished by intensive therapy within the 'windows of opportunity'.
Collapse
Affiliation(s)
- Shin-Ya Kawashiri
- Departments of Community Medicine, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan.,Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Yushiro Endo
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Momoko Okamoto
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Sosuke Tsuji
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Toshimasa Shimizu
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Remi Sumiyoshi
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Tomohiro Koga
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Naoki Iwamoto
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Kunihiro Ichinose
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Mami Tamai
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Hideki Nakamura
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Tomoki Origuchi
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| |
Collapse
|
4
|
Holers VM, Borodovsky A, Scheinman RI, Ho N, Ramirez JR, Dobó J, Gál P, Lindenberger J, Hansen AG, Desai D, Pihl R, Thiel S, Banda NK. Key Components of the Complement Lectin Pathway Are Not Only Required for the Development of Inflammatory Arthritis but Also Regulate the Transcription of Factor D. Front Immunol 2020; 11:201. [PMID: 32153567 PMCID: PMC7046807 DOI: 10.3389/fimmu.2020.00201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/27/2020] [Indexed: 12/12/2022] Open
Abstract
The complement system plays an important role in the pathogenesis of rheumatoid arthritis (RA). Besides driving lectin pathway (LP) activation, the mannan-binding lectin (MBL)-associated serine proteases (MASPs) also play a key role in regulating the alternative pathway (AP). We evaluated the effects of N-acetylgalactosamine (GalNAc)-conjugated MASP-1 and MASP-2 duplexes in vitro and in mice with and without arthritis to examine whether knockdown of MASP-1 and MASP-2 expression affects the development of arthritis. GalNAc-siRNAs for MASP-1 and MASP-2 demonstrated robust silencing of MASP-1 or MASP-2 at pM concentrations in vitro. To evaluate the impact of silencing in arthritic mice, we used the collagen antibody-induced arthritis (CAIA) mouse model of RA. Mice were injected a 10 mg/kg dose of GalNAc-siRNAs 3x s.q. prior to the induction of CAIA. Liver gene expression was examined using qRT-PCR, and protein levels were confirmed in the circulation by sandwich immunoassays and Western blot. At day 10, CAIA mice separately treated with MASP-1 and MASP-2 duplexes had a specific reduction in expression of liver MASP-1 (70–95%, p < 0.05) and MASP-2 (90%, p < 0.05) mRNA, respectively. MASP-1-siRNA treatment resulted in a 95% reduction in levels of MASP-1 protein in circulation with no effect on MASP-2 levels and clinical disease activity (CDA). In mice injected with MASP-2 duplex, there was a significant (p < 0.05) 90% decrease in ex vivo C4b deposition on mannan, with nearly complete elimination of MASP-2 in the circulation. MASP-2 silencing initially significantly decreased CDA by 60% but subsequently changed to a 40% decrease vs. control. Unexpectedly, GalNAc-siRNA-mediated knockdown of MASP-1 and MASP-2 revealed a marked effect of these proteins on the transcription of FD under normal physiological conditions, whereas LPS-induced inflammatory conditions reversed this effect on FD levels. LPS is recognized by Toll-like receptor 4 (TLR4), we found MBL not only binds to TLR4 an interaction with a Kd of 907 nM but also upregulated FD expression in differentiated adipocytes. We show that MASP-2 knockdown impairs the development of RA and that the interrelationship between proteins of the LP and the AP may extend to the transcriptional modulation of the FD gene.
Collapse
Affiliation(s)
- V Michael Holers
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Robert I Scheinman
- Skaggs School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nhu Ho
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Joseline Ramos Ramirez
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - József Dobó
- Research Centre for Natural Sciences, Institute of Enzymology, Budapest, Hungary
| | - Péter Gál
- Research Centre for Natural Sciences, Institute of Enzymology, Budapest, Hungary
| | - Jared Lindenberger
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, United States
| | - Annette G Hansen
- Department of Biomedicine, University of Aarhus, Aarhus, Denmark
| | - Dhruv Desai
- Alnylam Pharmaceutical Inc., Boston, MA, United States
| | - Rasmus Pihl
- Department of Biomedicine, University of Aarhus, Aarhus, Denmark
| | - Steffen Thiel
- Department of Biomedicine, University of Aarhus, Aarhus, Denmark
| | - Nirmal K Banda
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
5
|
Raffield LM, Iyengar AK, Wang B, Gaynor SM, Spracklen CN, Zhong X, Kowalski MH, Salimi S, Polfus LM, Benjamin EJ, Bis JC, Bowler R, Cade BE, Choi WJ, Comellas AP, Correa A, Cruz P, Doddapaneni H, Durda P, Gogarten SM, Jain D, Kim RW, Kral BG, Lange LA, Larson MG, Laurie C, Lee J, Lee S, Lewis JP, Metcalf GA, Mitchell BD, Momin Z, Muzny DM, Pankratz N, Park CJ, Rich SS, Rotter JI, Ryan K, Seo D, Tracy RP, Viaud-Martinez KA, Yanek LR, Zhao LP, Lin X, Li B, Li Y, Dupuis J, Reiner AP, Mohlke KL, Auer PL. Allelic Heterogeneity at the CRP Locus Identified by Whole-Genome Sequencing in Multi-ancestry Cohorts. Am J Hum Genet 2020; 106:112-120. [PMID: 31883642 PMCID: PMC7042494 DOI: 10.1016/j.ajhg.2019.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022] Open
Abstract
Whole-genome sequencing (WGS) can improve assessment of low-frequency and rare variants, particularly in non-European populations that have been underrepresented in existing genomic studies. The genetic determinants of C-reactive protein (CRP), a biomarker of chronic inflammation, have been extensively studied, with existing genome-wide association studies (GWASs) conducted in >200,000 individuals of European ancestry. In order to discover novel loci associated with CRP levels, we examined a multi-ancestry population (n = 23,279) with WGS (∼38× coverage) from the Trans-Omics for Precision Medicine (TOPMed) program. We found evidence for eight distinct associations at the CRP locus, including two variants that have not been identified previously (rs11265259 and rs181704186), both of which are non-coding and more common in individuals of African ancestry (∼10% and ∼1% minor allele frequency, respectively, and rare or monomorphic in 1000 Genomes populations of East Asian, South Asian, and European ancestry). We show that the minor (G) allele of rs181704186 is associated with lower CRP levels and decreased transcriptional activity and protein binding in vitro, providing a plausible molecular mechanism for this African ancestry-specific signal. The individuals homozygous for rs181704186-G have a mean CRP level of 0.23 mg/L, in contrast to individuals heterozygous for rs181704186 with mean CRP of 2.97 mg/L and major allele homozygotes with mean CRP of 4.11 mg/L. This study demonstrates the utility of WGS in multi-ethnic populations to drive discovery of complex trait associations of large effect and to identify functional alleles in noncoding regulatory regions.
Collapse
Affiliation(s)
- Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Apoorva K Iyengar
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Biqi Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Sheila M Gaynor
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | | | - Xue Zhong
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University, Nashville, TN 37232, USA
| | - Madeline H Kowalski
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Shabnam Salimi
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Linda M Polfus
- Department of Preventive Medicine, Center for Genetic Epidemiology, University of Southern California, Los Angeles, CA 90089, USA
| | - Emelia J Benjamin
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - Joshua C Bis
- Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA 98101, USA
| | - Russell Bowler
- Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Brian E Cade
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Medicine, Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | | | - Alejandro P Comellas
- Department of Medicine, Division of Pulmonary and Critical Care, University of Iowa, Iowa City, IA 52242, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Pedro Cruz
- Illumina Laboratory Services, Illumina Inc., San Diego, CA 92122, USA
| | - Harsha Doddapaneni
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Peter Durda
- Department of Pathology & Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT 05446, USA
| | | | - Deepti Jain
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | | | - Brian G Kral
- GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Leslie A Lange
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Martin G Larson
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - Cecelia Laurie
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Jiwon Lee
- Department of Medicine, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
| | | | - Joshua P Lewis
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Ginger A Metcalf
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Braxton D Mitchell
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD 21201, USA
| | - Zeineen Momin
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Donna M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nathan Pankratz
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Stephen S Rich
- Department of Public Health Sciences, Center for Public Health Genomics, University of Virginia, Charlottesville, VA 22908, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Kathleen Ryan
- Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | | | - Russell P Tracy
- Department of Pathology & Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT 05446, USA; Department of Biochemistry, Larner College of Medicine, University of Vermont, Burlington, VT 05446, USA
| | | | - Lisa R Yanek
- GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Lue Ping Zhao
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - Xihong Lin
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Department of Statistics, Harvard University, Cambridge, MA 02138, USA
| | - Bingshan Li
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN 37232, USA
| | - Yun Li
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27599, USA; Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27599, USA; Department of Computer Science, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - Alexander P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Karen L Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Paul L Auer
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI 53205, USA.
| |
Collapse
|
6
|
Conventional radiography of the hands and wrists in rheumatoid arthritis. What a rheumatologist should know and how to interpret the radiological findings. Rheumatol Int 2019; 39:1331-1341. [DOI: 10.1007/s00296-019-04326-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/15/2019] [Indexed: 01/06/2023]
|
7
|
Sakkas LI, Tronzas P. The Greek (Hellenic) rheumatology over the years: from ancient to modern times. Rheumatol Int 2019; 39:947-955. [PMID: 30805680 DOI: 10.1007/s00296-019-04261-4] [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] [Received: 01/07/2019] [Accepted: 02/20/2019] [Indexed: 01/19/2023]
Abstract
Rheumatology has its roots in ancient Greece. Hippocrates and other prominent Greek (Hellenes) physicians in ancient times, Hellenistic, Roman, and Byzantine period were acute observers of disease course and of patients and were able to define many disorders. They wrote books on various aspects of medicine and these writings were the basis of medical practice and education in Europe and the Arabic world well into the seventeenth century. In 1821, Greece emerged from a long occupation by the Turks. In 1930, Adamantiades, a Greek Ophthalmologist, before Behcet of Turkey, described what is known as (Adamantiades)-Behcet disease. The first scientific Hellenic Society for Rheumatology (ERE) was established in 1960 and today ERE having been merged with the Professional Union of Greek rheumatologists (EPERE) is known as ERE-EPERE. Rheumatology is a strong specialty with 348 rheumatologists for a population of around 11 million. Greek rheumatologists have contributed to rheumatology science and practice, and are active physicians participating in the American College of Rheumatology and the EULAR annual congresses and in many educational postgraduate courses. ERE-EPERE formed therapeutic protocols for inflammatory and autoimmune rheumatic diseases which were incorporated in the electronic National prescription system. Rheumatologists are authorized to use this platform to prescribe biologicals free of charge for patients. ERE-EPERE publishes a peer-reviewed English language journal, the Mediterranean Journal of Rheumatology (MJR), an open access journal with no publication fees. MJR is a quarterly journal with international Editorial Board.
Collapse
Affiliation(s)
- Lazaros I Sakkas
- Faculty of Medicine, University of Thessaly Biopolis, 41 110, Larissa, Greece.
| | | |
Collapse
|
8
|
Nakajima A, Terayama K, Sonobe M, Aoki Y, Takahashi H, Akatsu Y, Taniguchi S, Yamada M, Kubota A, Nakagawa K. Predictive factors for radiographic progression of large joint damage in patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs (bDMARDs): Results of 3 to 4 years of follow-up. Mod Rheumatol 2018; 29:903-909. [PMID: 30285585 DOI: 10.1080/14397595.2018.1532544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Little information is available regarding long-term follow-up of radiographic progression of damage (RPD) to large joints during treatment of rheumatoid arthritis (RA) with biological disease-modifying antirheumatic drugs (bDMARDs). We evaluated 3- to 4-year follow-up results and the associations between RPD and patient background and Larsen grade (LG) of joints.Methods: Seventy-one RA patients receiving bDMARDs for 3 to 4 years or who achieved bDMARD-free status were included. The mean age and disease duration at the start of bDMARDs were 62.4 years and 10.8 years, respectively. A total of 314 joints, including shoulders, elbows, hips, knees, and ankles, were evaluated to determine whether RPD was present by comparing radiographs before and after treatment.Results: RPD was observed in 24 patients (33.8%) and 34 joints (10.8%). Joints with an LG of III or higher had significantly higher rates of RPD than those with LGs I and II. Multivariate logistic regression analysis revealed that stage and health assessment questionnaire (HAQ) score at 18-months were independent risk factors for RPD (cut-off value: 2.5, odds ratio: 7.222 for stage; cut-off value: 0.9375, odds ratio: 6.278 for HAQ at 18-months).Conclusion: Stage, HAQ at 18-months, and LG at the start of bDMARDs were predictive of RPD after 3 to 4 years. bDMARDs should be started before both stage and LG exceed III and the therapeutic strategy should be determined so that HAQ does not exceed 1.0 during treatment.
Collapse
Affiliation(s)
- Arata Nakajima
- Departments of Orthopaedics, Toho University Sakura Medical Center, Chiba, Japan.,Departments of Rheumatology, Toho University Sakura Medical Center, Chiba, Japan
| | - Keiichiro Terayama
- Departments of Rehabilitation, Toho University Sakura Medical Center, Chiba, Japan
| | - Masato Sonobe
- Departments of Orthopaedics, Toho University Sakura Medical Center, Chiba, Japan
| | - Yasuchika Aoki
- Department of General Medical Sciences, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan
| | - Hiroshi Takahashi
- Departments of Orthopaedics, Toho University Sakura Medical Center, Chiba, Japan
| | - Yorikazu Akatsu
- Departments of Orthopaedics, Toho University Sakura Medical Center, Chiba, Japan
| | - Shinji Taniguchi
- Departments of Orthopaedics, Toho University Sakura Medical Center, Chiba, Japan
| | - Manabu Yamada
- Departments of Orthopaedics, Toho University Sakura Medical Center, Chiba, Japan
| | - Ayako Kubota
- Department of Orthopaedics, Toho University Omori Medical Center, Tokyo, Japan
| | - Koichi Nakagawa
- Departments of Orthopaedics, Toho University Sakura Medical Center, Chiba, Japan
| |
Collapse
|
9
|
Banda NK, Desai D, Scheinman RI, Pihl R, Sekine H, Fujita T, Sharma V, Hansen AG, Garred P, Thiel S, Borodovsky A, Holers VM. Targeting of Liver Mannan-Binding Lectin-Associated Serine Protease-3 with RNA Interference Ameliorates Disease in a Mouse Model of Rheumatoid Arthritis. Immunohorizons 2018; 2:274-295. [PMID: 30417171 PMCID: PMC6220895 DOI: 10.4049/immunohorizons.1800053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Mannan-binding lectin–associated serine protease 3 (MASP-3) regulates the alternative pathway of complement and is predominantly synthesized in the liver. The role of liver-derived MASP-3 in the pathogenesis of rheumatoid arthritis (RA) is unknown. We hypothesized that liver-derived MASP-3 is essential for the development of joint damage and that targeted inhibition of MASP-3 in the liver can attenuate arthritis. We used MASP-3–specific small interfering RNAs (siRNAs) conjugated to N-acetylgalactosamine (GalNAc) to specifically target the liver via asialoglycoprotein receptors. Active GalNAc–MASP3–siRNA conjugates were identified, and in vivo silencing of liver MASP-3 mRNA was demonstrated in healthy mice. The s.c. treatment with GalNAc–MASP-3–siRNAs specifically decreased the expression of MASP-3 in the liver and the level of MASP-3 protein in circulation of mice without affecting the levels of the other spliced products. In mice with collagen Ab–induced arthritis, s.c. administration of GalNAc–MASP-3–siRNA decreased the clinical disease activity score to 50% of controls, with decrease in histopathology scores and MASP-3 deposition. To confirm the ability to perform MASP-3 gene silencing in human cells, we generated a lentivirus expressing a short hairpin RNA specific for human MASP-3 mRNA. This procedure not only eliminated the short-term (at day 15) expression of MASP-3 in HepG2 and T98G cell lines but also diminished the long-term (at day 60) synthesis of MASP-3 protein in T98G cells. Our study demonstrates that isoform-specific silencing of MASP-3 in vivo modifies disease activity in a mouse model of RA and suggests that liver-directed MASP3 silencing may be a therapeutic approach in human RA.
Collapse
Affiliation(s)
- Nirmal K Banda
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Dhruv Desai
- Alnylam Pharmaceuticals Inc., Boston, MA 02142
| | - Robert I Scheinman
- Skaggs School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Rasmus Pihl
- Department of Biomedicine, University of Aarhus, DK-8000 Aarhus, Denmark
| | - Hideharu Sekine
- Department of Immunology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Teizo Fujita
- Department of Immunology, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Vibha Sharma
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| | - Annette G Hansen
- Department of Biomedicine, University of Aarhus, DK-8000 Aarhus, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, University Hospital of Copenhagen, 2200 Copenhagen, Denmark
| | - Steffen Thiel
- Department of Biomedicine, University of Aarhus, DK-8000 Aarhus, Denmark
| | | | - V Michael Holers
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045
| |
Collapse
|
10
|
Nakajima A, Aoki Y, Terayama K, Sonobe M, Takahashi H, Saito M, Nakagawa K. Health assessment questionnaire-disability index (HAQ-DI) score at the start of biological disease-modifying antirheumatic drug (bDMARD) therapy is associated with radiographic progression of large joint damage in patients with rheumatoid arthritis. Mod Rheumatol 2017; 27:967-972. [PMID: 28271947 DOI: 10.1080/14397595.2017.1294302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Radiographic progression of damage (RPD) to large joints in patients with rheumatoid arthritis (RA) has not been fully studied. We previously demonstrated that Larsen grade of the large joints was associated with RPD of large joints in patients treated with biological disease-modifying anti-rheumatic drugs (bDMARDs); however, no factors associated with background characteristics of patients were identified. METHODS A total of 400 large joints in the upper and lower extremities, including the shoulder, elbow, knee, and ankle, of 88 patients with RA treated with bDMARDs for 1-3 years were investigated. Radiographs of tender and/or swollen large joints were acquired at least twice during the study period (mean, 16.4 months), and the RPD was evaluated. RESULTS A multivariate analysis revealed that health assessment questionnaire-disability index (HAQ-DI) score at the start of bDMARD treatment was associated with RPD. The cutoff value that discriminated progression from non-progression, determined by a receiver operating characteristic (ROC) curve, was 1.4375 (sensitivity: 0.778, specificity: 0.894). CONCLUSIONS HAQ-DI score at the start of bDMARD treatment was associated with RPD to large joints during a therapeutic period of 1-3 years. Progressive damage is expected to increase when functional disability exceeds an HAQ-DI score of 1.5.
Collapse
Affiliation(s)
- Arata Nakajima
- a Departments of Orthopaedics , Toho University Sakura Medical Center , Chiba , Japan.,b Departments of Rheumatology , Toho University Sakura Medical Center , Chiba , Japan
| | - Yasuchika Aoki
- c Department of General Medical Sciences, Graduate School of Medicine , Chiba University , Chiba , Japan.,d Department of Orthopaedic Surgery , Eastern Chiba Medical Center , Chiba , Japan
| | - Keiichiro Terayama
- e Departments of Rehabilitation , Toho University Sakura Medical Center , Chiba , Japan
| | - Masato Sonobe
- a Departments of Orthopaedics , Toho University Sakura Medical Center , Chiba , Japan
| | - Hiroshi Takahashi
- a Departments of Orthopaedics , Toho University Sakura Medical Center , Chiba , Japan
| | - Masahiko Saito
- a Departments of Orthopaedics , Toho University Sakura Medical Center , Chiba , Japan
| | - Koichi Nakagawa
- a Departments of Orthopaedics , Toho University Sakura Medical Center , Chiba , Japan
| |
Collapse
|
11
|
Eder L, Chandran V, Cook R, Gladman DD. The Risk of Developing Diabetes Mellitus in Patients with Psoriatic Arthritis: A Cohort Study. J Rheumatol 2017; 44:286-291. [PMID: 28148695 DOI: 10.3899/jrheum.160861] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate the prevalence of diabetes mellitus (DM) in patients with psoriatic arthritis (PsA) in comparison with the general population and to assess whether the level of disease activity over time predicts the development of DM in these patients. METHODS A cohort analysis was conducted in patients followed in a large PsA clinic from 1978 to 2014. The prevalence of DM in the patients was compared with the general population of Ontario, Canada, and the age-standardized prevalence ratio (SPR) was calculated. For the assessment of risk factors for DM, time-weighted arithmetic mean (AM) levels of PsA-related disease activity measures were assessed as predictors for the development of DM. Multivariable Cox proportional hazards models were used to compute HR for incident DM after controlling for potential confounders. RESULTS A total of 1305 patients were included in the analysis. The SPR of DM in PsA compared with the general population in Ontario was 1.43 (p = 0.002). Of the 1065 patients who were included in the time-to-event analysis, 73 patients were observed to develop DM. Based on multivariable analyses, AM tender joint count (HR 1.53, 95% CI 1.08-2.18, p = 0.02) and AM erythrocyte sedimentation rate (HR 1.21, 95% CI 1.03-1.41, p = 0.02) predicted the development of DM. CONCLUSION The prevalence of DM is higher in patients with PsA compared with the general population. Patients with elevated levels of disease activity are at higher risk of developing DM.
Collapse
Affiliation(s)
- Lihi Eder
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada. .,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; R. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, PhD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network.
| | - Vinod Chandran
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; R. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, PhD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network
| | - Richard Cook
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; R. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, PhD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network
| | - Dafna D Gladman
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; R. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, PhD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network
| |
Collapse
|
12
|
Katchamart W, Narongroeknawin P, Chevaisrakul P, Dechanuwong P, Mahakkanukrauh A, Kasitanon N, Pakchotanon R, Sumethkul K, Ueareewongsa P, Ukritchon S, Bhurihirun T, Duangkum K, Intapiboon P, Intongkam S, Jangsombatsiri W, Jatuworapruk K, Kositpesat N, Leungroongroj P, Lomarat W, Petcharat C, Sittivutworapant S, Suebmee P, Tantayakom P, Tipsing W, Asavatanabodee P, Chiowchanwisawakit P, Foocharoen C, Koolvisoot A, Louthrenoo W, Siripaitoon B, Totemchokchyakarn K, Kitumnuaypong T. Evidence-based recommendations for the diagnosis and management of rheumatoid arthritis for non-rheumatologists: Integrating systematic literature research and expert opinion of the Thai Rheumatism Association. Int J Rheum Dis 2016; 20:1142-1165. [DOI: 10.1111/1756-185x.12905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Wanruchada Katchamart
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Pongthorn Narongroeknawin
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Parawee Chevaisrakul
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Ramathibodi Hospital; Mahidol; Bangkok Thailand
| | - Pornchai Dechanuwong
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Vajira Hospital; Navamindradhiraj University; Bangkok Thailand
| | - Ajanee Mahakkanukrauh
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Nuntana Kasitanon
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Rattapol Pakchotanon
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Kittiwan Sumethkul
- Rheumatology Unit; Department of Internal Medicine; Rajavithi Hospital; Bangkok Thailand
| | - Parichat Ueareewongsa
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Sittichai Ukritchon
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Thitirat Bhurihirun
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Kittikorn Duangkum
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Porntip Intapiboon
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Samanan Intongkam
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Wimol Jangsombatsiri
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Ramathibodi Hospital; Mahidol; Bangkok Thailand
| | - Kanon Jatuworapruk
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Naravadee Kositpesat
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Pawinee Leungroongroj
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Ramathibodi Hospital; Mahidol; Bangkok Thailand
| | - Wiyanoot Lomarat
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Chonachan Petcharat
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | | | - Patcharawan Suebmee
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Pongchirat Tantayakom
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Worakan Tipsing
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Vajira Hospital; Navamindradhiraj University; Bangkok Thailand
| | - Paijit Asavatanabodee
- Division of Rheumatology; Department of Medicine; Pramongkutklao and College of Medicine; Bangkok Thailand
| | - Praveena Chiowchanwisawakit
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Chingching Foocharoen
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Ajchara Koolvisoot
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Siriraj hospital; Mahidol University; Bangkok Thailand
| | - Worawit Louthrenoo
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Boonjing Siripaitoon
- Division of Rheumatology; Department of Medicine; Faculty of Medicine; Prince of Songkla University; Songkla Thailand
| | - Kitti Totemchokchyakarn
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Faculty of Medicine; Ramathibodi Hospital; Mahidol; Bangkok Thailand
| | - Tasanee Kitumnuaypong
- Rheumatology Unit; Department of Internal Medicine; Rajavithi Hospital; Bangkok Thailand
| | | |
Collapse
|
13
|
Nawata M, Saito K, Fukuyo S, Hirata S, Tanaka Y. Clinically relevant radiographic progression in joint destruction in RA patients with abnormal MMP-3 or high levels of CRP despite 1-year treatment with infliximab. Mod Rheumatol 2016; 26:807-812. [PMID: 26915532 DOI: 10.3109/14397595.2016.1158386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Identify the independently related factors of joint destruction progression in RA patients despite of infliximab treatment. METHODS The subjects were cases who underwent infliximab treatment for one year or longer in our department (n = 244). Patients in which modified total sharp score (mTSS), joint erosion (JE), and joint space narrowing (JSN) had advanced to the standard value (3.0) or more for one year were defined as mTSS- Clinically-Relevant-Rapid Progression (CRRP) (n = 20), JE-CRRP (n = 20), and JSN-CRRP (n = 23), and the respective related factors at baseline and week 54 were defined by multiple logistic regression. RESULTS The median disease duration was 24 months and median mTSS 9.0 at baseline. The median DAS28, CRP, and yearly progression of mTSS improved from 5.8 to 2.6, 1.2 to 0.1 mg/dL, and 4.4 to 0.0 point/year, respectively. The related factor in each of mTSS-CRRP, JE-CRRP, and JSN-CRRP was high CRP levels at baseline. At week 54, the related factor of mTSS-CRRP and JSN-CRRP was high MMP-3 titer; however, the related factor of JE-CRRP was high CRP levels. CONCLUSION High CRP levels at baseline were an independent predictive factor of joint destruction advancement during infliximab treatment. Moreover, it was believed that abnormal MMP-3 at week 54 was the index for mTSS and JSN advancement, while high CRP levels were the index for JE advancement.
Collapse
Affiliation(s)
- Masao Nawata
- a The First Department of Internal Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Kazuyoshi Saito
- a The First Department of Internal Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Shunsuke Fukuyo
- a The First Department of Internal Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Shintaro Hirata
- a The First Department of Internal Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Yoshiya Tanaka
- a The First Department of Internal Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| |
Collapse
|
14
|
Yamanaka H. [Programs for Continuing Medical Education: A session; 6. Management of rheumatoid arthritis--Perspective from internists]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2016; 105:451-456. [PMID: 27319192 DOI: 10.2169/naika.105.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
15
|
Nakajima A, Aoki Y, Sonobe M, Takahashi H, Saito M, Terayama K, Nakagawa K. Radiographic progression of large joint damage in patients with rheumatoid arthritis treated with biological disease-modifying anti-rheumatic drugs. Mod Rheumatol 2015; 26:517-21. [PMID: 26473376 DOI: 10.3109/14397595.2015.1109785] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Radiographic progression of damage to the small joints in patients with rheumatoid arthritis (RA) is well known; however, it has not been studied fully in the large joints. In this study, we looked at the prevalence of radiographic progression of large joint damage in patients with RA treated with biological disease-modifying anti-rheumatic drugs (bDMARDs). METHODS A total of 273 large joints in the upper and lower extremities of 67 patients with RA treated with bDMARDs were investigated. Radiographs for tender and/or swollen large joints were taken at least twice during the study period (mean 18.6 months), and the progression of damage was evaluated. RESULTS Progressive damage was found in 20.9% of patients and 6.2% of joints. A multivariate analysis revealed that the Larsen grade (LG) alone was a risk factor for progressive damage. The LG cutoff value was determined to be 2.5 (sensitivity: 0.529, specificity: 0.805). CONCLUSIONS The only factor to predict progressive damage was the LG of the joints with symptoms, and the damage must be stopped within LG II. Regular radiographic examinations for large joints should be performed in addition to routine examinations for small joints, such as the hand and foot.
Collapse
Affiliation(s)
- Arata Nakajima
- a Department of Orthopedics and.,b Department of Rheumatology , Toho University Sakura Medical Center , Sakura-shi, Chiba , Japan
| | - Yasuchika Aoki
- c Department of General Medical Sciences , Graduate School of Medicine, Chiba University , Chuo-ku, Chiba-shi, Chiba , Japan .,d Department of Orthopedic Surgery , Eastern Chiba Medical Center , Togane-shi, Chiba , Japan , and
| | | | | | | | - Keiichiro Terayama
- e Department of Rehabilitation , Toho University Sakura Medical Center , Sakura-shi, Chiba , Japan
| | | |
Collapse
|
16
|
Kapetanovic MC, Lindqvist E, Nilsson JÅ, Geborek P, Saxne T, Eberhardt K. Development of functional impairment and disability in rheumatoid arthritis patients followed for 20 years: relation to disease activity, joint damage, and comorbidity. Arthritis Care Res (Hoboken) 2015; 67:340-8. [PMID: 25186552 DOI: 10.1002/acr.22458] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 08/26/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study the course of impairment measured by Signals of Functional Impairment (SOFI) and disability measured by the Health Assessment Questionnaire (HAQ) over 20 years in rheumatoid arthritis (RA) patients followed from the time of diagnosis, and to explore the contribution of disease activity, joint damage, and comorbidity to variation of SOFI and HAQ over time. METHODS Patients diagnosed with RA from 1985-1989 were prospectively monitored. There were 183 patients, 63% women, mean ± SD age 52 ± 12 years. Disease activity was measured by the 44-joint Disease Activity Score (DAS), joint damage by Larsen score, and comorbidity by the Charlson Comorbidity Index. The contribution of comorbidity, DAS, and joint damage on development of SOFI and HAQ was studied at 0, 5, 10, 15, and 20 years followup (hierarchical regression model) and over the total study period using a longitudinal regression model. RESULTS SOFI progressed over 20 years while progression of HAQ levelled off after 10 years. For SOFI, DAS and joint damage contributed the most (2-28% and 3-31%, respectively). Over 20 years, SOFI was explained by DAS (20%), joint damage (20%), age (7%), and comorbidity (4%). For HAQ, DAS contributed the most (4-24%). Over 20 years, HAQ was explained by DAS (20%), joint damage (2%), sex (7%), comorbidity (6%), and age (4%). CONCLUSION Over 20 years, 51% of the variation of SOFI and 39% of the variation of HAQ could be explained by age, sex, variations in comorbidity, disease activity, and joint damage. Over time, disease activity contributed significantly to both SOFI and HAQ. Joint damage contributed predominantly to SOFI.
Collapse
|
17
|
Alarcon RT, Fernandes ADRC, Laurindo IM, Bértolo MB, Pinheiro GC, Andrade LE. Characterization of cumulative joint damage patterns in patients with rheumatoid arthritis: a clinical, serological, and gene polymorphism perspective. J Rheumatol 2015; 42:405-12. [PMID: 25641888 DOI: 10.3899/jrheum.131177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To characterize cumulative joint damage (CJD) patterns in rheumatoid arthritis (RA) and determine their associations with demographic/clinical features and HLA-DRB1 gene polymorphism. METHODS Hand and foot radiographs were obtained from 404 patients with RA. CJD patterns were determined by 3 derivations from Sharp/van der Heijde scores, obtained by the mathematical division of scores for hands/feet (Sharp-h/f score), fingers/wrists (Sharp-f/w score), and erosion/space narrowing (Sharp-e/sn score), respectively. DNA and serum were obtained for determination of HLA-DRB1 polymorphism, rheumatoid factor (RF), and anticitrullinated protein antibodies (ACPA). RESULTS Patients with wrist-dominant CJD pattern were more likely to have severe RA than those with finger-dominant pattern (68.4% vs 46.0%; p = 0.036) as were those with foot-dominant vs hand-dominant CJD pattern (76.5% vs 56.4%; p = 0.044). HLA-DRB1 shared epitope (SE) alleles were associated with erosion-dominant CJD pattern (p = 0.021). Patients with erosion-dominant CJD pattern had higher levels of RF and ACPA than those with space-narrowing-dominant CJD pattern (median RF 71.35 U/ml vs 22.05 U/ml, respectively; p = 0.003; median ACPA 187.9 U/ml vs 143.2 U/ml, respectively; p < 0.001). The majority of triple-positive patients (SE+, RF+, ACPA+) had erosion-dominant CJD pattern (62.3%) while the majority of triple-negative patients (SE-, FR-, ACPA-) had space narrowing-dominant CJD pattern (75%; p = 0.017). ACPA was associated with HLA-DRB1 SE alleles (p < 0.05). Patients with foot-dominant CJD pattern were taller than those with hand-dominant CJD pattern (p = 0.002); those with erosion-dominant CJD pattern had higher weight and body mass index than those with space narrowing-dominant CJD pattern (p = 0.014, p = 0.001). CONCLUSION CJD patterns were associated with disease severity, HLA-DRB1 SE status, presence and titer of ACPA and RF, and morphometric features.
Collapse
Affiliation(s)
- Renata Trigueirinho Alarcon
- From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP
| | - Artur da Rocha Corrêa Fernandes
- From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP
| | - Ieda Maria Laurindo
- From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP
| | - Manoel Barros Bértolo
- From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP
| | - Geraldo Castelar Pinheiro
- From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP
| | - Luís Eduardo Andrade
- From the Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo; Rheumatology Division, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro; Rheumatology Division, Universidade de São Paulo (USP); Rheumatology Division, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brazil.Dr. Alarcon received an academic grant from CAPES (Brazilian Agency for Scientific Development) and Dr. Andrade receives a research grant from CNPq (Brazilian Agency for Research Development). Partially supported by grant # 07/50523-9 from the São Paulo Research Foundation.R.T. Alarcon, PhD, Research Fellow, Biol.; A.R.C. Fernandes, MD, PhD, Associate Professor, UNIFESP; I.M. Laurindo, MD, PhD, Associate Researcher, USP; M.B. Bértolo, MD, PhD, Associate Professor, UNICAMP; G.C. Pinheiro, MD, PhD, Associate Professor, UERJ; L.E. Andrade, MD, PhD, Associate Professor, UNIFESP.
| |
Collapse
|
18
|
de Punder YM, Jansen TL, van Ede AE, den Broeder AA, van Riel PL, Fransen J. Personalizing Treatment Targets in Rheumatoid Arthritis by Using a Simple Prediction Model. J Rheumatol 2015; 42:398-404. [DOI: 10.3899/jrheum.140085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective.To develop a personalized treatment target approach in patients with rheumatoid arthritis (RA) based on baseline risk factors for joint damage progression in combination with disease activity over time.Methods.Data were used from the Nijmegen early RA cohort. Presence or absence of anticyclic citrullinated peptide antibodies (anti-CCP), high erythrocyte sedimentation rate, and erosions were translated into 4 risk profiles: 0, 1, 2, and 3. Joint damage progression was assessed with the Ratingen score, and disease activity with the original Disease Activity Score (DAS) over 3 years. The probability for joint damage progression was calculated for each risk profile and each DAS category using logistic regression models. The probabilities were translated into personalized disease activity treatment targets.Results.More risk factors at baseline as well as a higher DAS level resulted in a higher probability for joint damage progression in a dose-dependent way. Low DAS corresponded with a probability of 0.0, 0.08, 0.20, and 0.58 in patients with 0, 1, 2, and 3 risk factors, respectively. Moderate DAS corresponded with a probability of 0.06 in patients with 0 risk factors and 0.35 with 1 risk factor. High DAS resulted in a probability of 0.50 with no risk factors present at baseline.Conclusion.Presence of anti-CCP, acute-phase response, and erosions at baseline can be used to set individual treatment targets in RA. In patients without these risk factors, a moderate DAS as a target is sufficient, while for patients with all 3 risk factors, a low DAS is not strict enough to limit the risk for joint damage.
Collapse
|
19
|
Navarro-Compán V, Gherghe AM, Smolen JS, Aletaha D, Landewé R, van der Heijde D. Relationship between disease activity indices and their individual components and radiographic progression in RA: a systematic literature review. Rheumatology (Oxford) 2014; 54:994-1007. [PMID: 25416711 DOI: 10.1093/rheumatology/keu413] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between different disease activity indices (DAIs) and their individual components and radiographic progression in patients with RA. METHODS A systematic literature review until July 2013 was performed by two independent reviewers using the Medline and Embase databases. Longitudinal studies assessing the relationship between DAIs and single instruments and radiographic progression were included. The results were grouped based on the means of measurement (baseline vs time integrated) and analysis (univariable or multivariable). RESULTS Fifty-seven studies from 1232 hits were included. All published studies that assessed the relationship between any time-integrated DAI including joint count and radiographic progression reached a statistically significant association. Among the single instruments, only swollen joint count and ESR were associated with radiographic progression, while no significant association was found for tender joint count. Data with respect to CRP are conflicting. Data on patient's global health, pain assessment and evaluator's global assessment are limited and do not support a positive association with progression of joint damage. CONCLUSION Published data indicate that all DAIs that include swollen joints are related to radiographic progression while, of the individual components, only swollen joints and acute phase reactants are associated. Therefore composite DAIs are the optimal tool to monitor disease activity in patients with RA.
Collapse
Affiliation(s)
- Victoria Navarro-Compán
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Ana Maria Gherghe
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Josef S Smolen
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Daniel Aletaha
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Robert Landewé
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| | - Désirée van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands, Department of Rheumatology, University Hospital La Paz, Madrid, Spain, Department of Rheumatology and Internal Medicine, Cantacuzino Clinical Hospital, Bucharest, Romania, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Second Department of Medicine, Hietzing Hospital, Vienna, Austria and Amsterdam Rheumatology Center, Amsterdam, and Atrium Medical Center, Heerlen, The Netherlands
| |
Collapse
|
20
|
Ali AM, Habeeb RA, El-Azizi NO, Khattab DA, Abo-Shady RA, Elkabarity RH. [Higher nitric oxide levels are associated with disease activity in Egyptian rheumatoid arthritis patients]. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 54:446-51. [PMID: 25445628 DOI: 10.1016/j.rbr.2014.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/17/2014] [Accepted: 07/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oxidative stress generated within inflammatory joints can produce autoimmune phenomena and joint destruction. Radical species with oxidative activity, including reactive nitrogen species, represent mediators of inflammation and cartilage damage. OBJECTIVES To assess serum nitric oxide as a marker of oxidative stress in Egyptian patients with rheumatoid arthritis and its relation to disease activity. METHODS 80 patients with rheumatoid arthritis were divided into 2 groups, according to the DAS-28 score: Group I: 42 patients with disease activity, and Group II: 38 patients with no disease activity. Forty age- and sex-matched individuals were included as control group (Group III). Routine laboratory investigations were done, and nitric oxide was measured using Elisa. Hand plain radiographies were done for radiological status scoring using the Sharp method. RESULTS A comparison between nitric oxide in all three groups showed a highly significant difference (p < 0.001), significantly higher levels were obtained among rheumatoid arthritis patients in comparison to controls, and higher levels were obtained in patients with active disease (mean±SD 82.38±20.46) in comparison to patients without active disease (35.53±7.15). Nitric oxide in Group I showed a significant positive correlation with morning stiffness (r=0.45), arthritis (r=0.43), platelet count (r=0.46), erythrocyte sedimentation rate (r=0.83), C-reactive protein (r=0.76) and Disease Activity Score (r=0.85). Nitric oxide showed a significant positive correlation (r=0.43) with hand radiographies (Sharp score) in Group I. CONCLUSION There are increased levels of nitric oxide in the serum of patients with rheumatoid arthritis. Nitric oxide correlates significantly with disease activity, inflammatory markers and radiological joint status.
Collapse
Affiliation(s)
- Adel Mahmoud Ali
- Departamento de Medicina Interna, Divisão de Reumatologia e Departamento de Patologia Clínica, Universidade Ain Shams, Cairo, Egito
| | - Reem Abdelmonem Habeeb
- Departamento de Medicina Interna, Divisão de Reumatologia e Departamento de Patologia Clínica, Universidade Ain Shams, Cairo, Egito.
| | - Noran Osama El-Azizi
- Departamento de Medicina Interna, Divisão de Reumatologia e Departamento de Patologia Clínica, Universidade Ain Shams, Cairo, Egito
| | - Dina Aziz Khattab
- Departamento de Medicina Interna, Divisão de Reumatologia e Departamento de Patologia Clínica, Universidade Ain Shams, Cairo, Egito
| | - Rania Ahmed Abo-Shady
- Departamento de Medicina Interna, Divisão de Reumatologia e Departamento de Patologia Clínica, Universidade Ain Shams, Cairo, Egito
| | - Rania Hamdy Elkabarity
- Departamento de Medicina Interna, Divisão de Reumatologia e Departamento de Patologia Clínica, Universidade Ain Shams, Cairo, Egito
| |
Collapse
|
21
|
Clinical and radiological dissociation of anti-TNF plus methotrexate treatment in early rheumatoid arthritis in routine care: results from the ABRAB study. BMC Musculoskelet Disord 2014; 15:251. [PMID: 25059769 PMCID: PMC4114796 DOI: 10.1186/1471-2474-15-251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 07/01/2014] [Indexed: 01/23/2023] Open
Abstract
Background Rheumatoid arthritis (RA) is a chronic autoinflammatory joint disease which leads to the destruction of joints and disability of the patients. Anti-tumour necrosis factor (anti-TNF) drugs can halt radiological progression better than conventional DMARDs even in clinical non-responders. Methods The efficacy of anti-TNF plus methotrexate (MTX) treatment versus MTX monotherapy on clinical and radiological outcomes were compared in early rheumatoid arthritis (RA) patients in clinical practice by retrospective analysis of an observational cohort. 49 early RA patients (group A) on first-line MTX monotherapy and 35 early RA patients (group B) on anti-TNF plus MTX treatment were selected from an observational cohort and evaluated retrospectively focusing on their first twelve months of treatment. Data on disease activity (DAS28) and functional status (HAQ-DI) were collected three monthly. One-yearly radiological progression was calculated according to the van der Heijde modified Sharp method (vdHS). Clinical non-responder patients in both groups were selectively investigated from a radiological point of view. Results Disease activity was decreased and functional status was improved significantly in both groups. One-yearly radiological progression was significantly lower in group B than in group A. The percentage of patients showing radiological non-progression or rapid radiological progression demonstrated a significant advantage for group B patients. In addition non-responder patients in group B showed similar radiological results as responders, while a similar phenomenon was not observed in patients in group A. Conclusions Clinical efficacy within our study was similar for tight-controlled MTX monotherapy as well as for combination treatment with anti-TNF and MTX. However MTX monotherapy was accompanied by more rapid radiological progression and less radiological non-progression. Anti-TNF plus MTX decreased radiological progression even in clinical non-responders supporting the advantage of anti-TNF plus MTX combination in dissociating clinical and radiological effects.
Collapse
|
22
|
Siebuhr AS, He Y, Gudmann NS, Gram A, Kjelgaard-Petersen CF, Qvist P, Karsdal MA, Bay-Jensen AC. Biomarkers of cartilage and surrounding joint tissue. Biomark Med 2014; 8:713-31. [DOI: 10.2217/bmm.13.144] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The identification and clinical demonstration of efficacy and safety of osteo- and chondro-protective drugs are met with certain difficulties. During the last few decades, the pharmaceutical industry has, in the field of rheumatology, experienced disappointments associated with the development of disease modification. Today, the vast amount of patients suffering from serious, chronic joint diseases can only be offered treatments aimed at improving symptoms, such as pain and acute inflammation, and are not aimed at protecting the joint tissue. This huge, unmet medical need has been the driver behind the development of improved analytical techniques allowing better and more efficient clinical trial design, implementation and analysis. With this review, we aim to provide a brief and general overview of biochemical markers of joint tissue, with special focus on neoepitopes. Furthermore, we highlight recent studies applying biochemical markers in joint degenerative diseases. These disorders, including osteoarthritis, rheumatoid arthritis and spondyloarthropathies, are the most predominant disorders in Europe and the USA, and have enormous socioeconomical impact.
Collapse
Affiliation(s)
- Anne S Siebuhr
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Yi He
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Natasja S Gudmann
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Aurelie Gram
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | | | - Per Qvist
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Morten A Karsdal
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| | - Anne C Bay-Jensen
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 207, Herlev DK-2730, Denmark
| |
Collapse
|
23
|
Black RJ, Spargo L, Schultz C, Chatterton B, Cleland L, Lester S, Hill CL, Proudman SM. Decline in hand bone mineral density indicates increased risk of erosive change in early rheumatoid arthritis. Arthritis Care Res (Hoboken) 2014; 66:515-22. [PMID: 24127342 DOI: 10.1002/acr.22199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/01/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Despite better disease suppression with combination disease-modifying antirheumatic drugs (DMARDs), some patients with rheumatoid arthritis (RA) have progressive erosive disease. The objective of this study was to determine whether hand bone mineral density (BMD) loss in the first 6 months of treatment indicates increased risk of erosions at 12 months. METHODS Patients with DMARD-naive early RA receiving treat-to-target therapy were studied (n = 106). Hand BMD was measured at baseline and 6 months by dual x-ray absorptiometry. Hand and feet radiographs were performed at baseline and 12 months and scored using the van der Heijde modification of the Sharp method. A K-means clustering algorithm was used to divide patients into 2 groups: the BMD loss group or the no loss group, according to their absolute change in BMD from baseline to 6 months. Multiple regression analysis (hurdle model) was performed to determine the risk factors for both erosive disease and erosion scores. RESULTS Hand BMD loss at 6 months was associated with erosion scores at 12 months (P = 0.021). In a multiple regression analysis, hand BMD loss (P = 0.046) and older age at onset (≥50 years; P = 0.014) were associated with erosive disease, whereas baseline erosion scores (P = 0.001) and anti-cyclic citrullinated peptide (P = 0.024) were correlated with erosion severity/progression. CONCLUSION In RA patients receiving treat-to-target therapy, early hand BMD loss could identify patients who are at risk of developing erosive disease at 12 months, potentially allowing intensification of treatment to prevent erosive damage.
Collapse
Affiliation(s)
- R J Black
- Royal Adelaide Hospital, Adelaide, Australia
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Reiche BE, Ohrndorf S, Feist E, Messerschmidt J, Burmester GR, Backhaus M. Usefulness of power Doppler ultrasound for prediction of re-therapy with rituximab in rheumatoid arthritis: a prospective study of longstanding rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 2014; 66:204-16. [PMID: 23925935 DOI: 10.1002/acr.22103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 07/30/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the value of gray-scale (GS) and power Doppler (PD) ultrasound (US) in detecting inflammatory/destructive changes and for prediction of necessity of re-therapy with rituximab (RTX) in patients with rheumatoid arthritis (RA) over 1 year of followup. METHODS GSUS and PDUS were performed to assess synovitis, tenosynovitis, and erosions on the clinically dominant hand and forefoot of 20 patients with RA before and after therapy with RTX. US parameters were compared with clinical (Disease Activity Score in 28 joints, tender/swollen joint counts, and patients' visual analog scale of disease activity) and laboratory parameters (C-reactive protein level and erythrocyte sedimentation rate). Results were compared for patients with and without re-therapy with RTX. RESULTS Significant decreases in clinical and laboratory parameters were observed after 6 and 12 months. US synovitis scores significantly decreased after 6 and 12 months (P < 0.05 for each). Regarding patients who received re-therapy between 6 and 9 months after the start of therapy (n = 9), a fair therapy response was still detectable before re-therapy. In these patients, PD-positive synovitis was the only parameter that increased up to the 6-month examination. All patients negative for rheumatoid factor and anti-cyclic citrullinated peptide (n = 4) were in the group of patients receiving a second course of treatment. Seropositive patients showed a better response to treatment with less need for re-therapy. CONCLUSION Response to therapy was measurable by clinical and laboratory parameters as well as by US. Since PDUS was able to detect the onset of disease activity before worsening of clinical symptoms occurred, PDUS is most helpful in evaluating disease activity and making earlier therapy decisions.
Collapse
Affiliation(s)
- B E Reiche
- Charite University Hospital, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
25
|
Bhagat M, Sehra ST, Shahane A, Kwan M. Utility of immunologic testing in suspected rheumatologic disease. Curr Allergy Asthma Rep 2014; 14:405. [PMID: 24370946 DOI: 10.1007/s11882-013-0405-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The use of diagnostic testing in the clinical practice of medicine has been a shifting landscape from the time that the first blood test was utilized. This is no different in the field of immunology and in particular rheumatology. As the field of immunology is relatively young, the clinical tests are not well established and therefore guidelines for use are still under debate. In this review, we seek to look at some of the key autoantibodies, as well as other tests that are available to diagnose suspected rheumatologic disease, and examine how to best use these tests in the clinic. In particular, we will focus on the anti-nuclear antibodies, anti-neutrophil cytoplasmic antibodies, complement, cryoglobulins, rheumatoid factor, and anti-citrullinated protein antibodies.
Collapse
Affiliation(s)
- Monica Bhagat
- Division of Pulmonary, Allergy, and Critical Care, Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
26
|
|
27
|
Davis JM, Knutson KL, Skinner JA, Strausbauch MA, Crowson CS, Therneau TM, Wettstein PJ, Matteson EL, Gabriel SE. A profile of immune response to herpesvirus is associated with radiographic joint damage in rheumatoid arthritis. Arthritis Res Ther 2012; 14:R24. [PMID: 22293286 PMCID: PMC3392817 DOI: 10.1186/ar3706] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 12/23/2011] [Accepted: 01/31/2012] [Indexed: 12/18/2022] Open
Abstract
Introduction Progression of joint damage despite appropriate therapy remains a significant problem for patients with rheumatoid arthritis (RA). This study was undertaken to identify profiles of immune response that correlate with radiographic joint damage as a first step toward the discovery of new pathogenic mechanisms of joint destruction in RA. Methods The study included 58 patients with RA and 15 healthy controls. The profiles of cytokine release from peripheral blood mononuclear cells (PBMC) in response to stimulation for 48 hours with one of six stimuli, or in media alone, were measured. Immune response profiles identified for each stimulus were correlated with radiographic joint damage as defined by the Sharp-van der Heijde score (SHS), before and after multivariable adjustment. For profiles correlated with the SHS, the distributions of individual cytokines were evaluated in patients according to the severity of joint damage and compared to healthy controls. Results The immune response profile for cytomegalovirus (CMV)/Epstein-Barr virus (EBV) stimulation was correlated with both the SHS total and erosion scores (r = 0.31, P = 0.018 and r = 0.33, P = 0.011, respectively). After adjusting for age, sex, disease duration, autoantibody status, CMV/EBV serological status, current disease activity, disability and treatments, the correlation of the CMV/EBV immune response and the SHS erosion score became stronger (r = 0.43, P < 0.003). The CMV/EBV immune response correlated with CMV IgG (r = 0.44, P < 0.001), but not with EBV IgG. The most important cytokines for the CMV/EBV immune response profile were IFN-γ, IL-2, IL-4, IL-5, IL-13 and IL-17A, all of which are associated with T-cell immunity. Both the summary immune response score and the individual responses of IFN-γ and IL-13 to CMV/EBV stimulation were associated with greater joint damage. Conclusions A profile of immune response to purified CMV/EBV lysates is associated with radiographic joint damage. The correlation of this immune response to CMV serology implies possible involvement of latent CMV infection. Therefore, the findings suggest that the immune response to latent CMV infection could play a fundamental role in the progression of inflammation and structural joint damage in patients with RA.
Collapse
Affiliation(s)
- John M Davis
- Division of Rheumatology, Department of Medicine, College of Medicine, Mayo Clinic; 200 First Street SW, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Esalatmanesh K, Jamali R, Jamali A, Jamali B, Nikbakht M. Serum anti-cyclic citrullinated peptide antibodies may predict disease activity in rheumatoid arthritis. Rheumatol Int 2011; 32:3799-805. [PMID: 22187060 DOI: 10.1007/s00296-011-2282-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 12/10/2011] [Indexed: 10/14/2022]
Abstract
To define the relationship between serum anti-cyclic citrullinated peptide antibodies (anti-CCP) and disease activity, and to construct a new disease activity index by using anti-CCP in rheumatoid arthritis (RA). One hundred and five RA patients were included. Disease activity based on DAS28-ESR and serum anti-CCP was measured. There was correlation between serum anti-CCP and DAS28-ESR. (R (2) = 0.71, P value < 0.01). New disease activity index was developed by replacing anti-CCP with ESR in DAS28-ESR. There was correlation between new model and DAS28-ESR. (R (2) = 0.91, P value < 0.01) The new composite index best cut-off values corresponding to DAS28-ESR values of 2.6, 3.2, and 5.1 were 3.21, 3.38, and 4.74, respectively. There was agreement between new model and DAS28-ESR for determination of patients in different disease activity categories. (Kappa = 0.71, P value < 0.01). The new disease activity index that applies serum anti-CCP may predict disease activity in RA.
Collapse
Affiliation(s)
- Kamal Esalatmanesh
- Internal Medicine Ward, Division of Rheumatology, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | | | | | | | | |
Collapse
|
29
|
Kuna AT. Mutated citrullinated vimentin antibodies in rheumatoid arthritis. Clin Chim Acta 2011; 413:66-73. [PMID: 22037509 DOI: 10.1016/j.cca.2011.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/11/2011] [Accepted: 10/13/2011] [Indexed: 12/17/2022]
Abstract
Rheumatoid arthritis (RA) is the most common inflammatory systemic autoimmune disease, primarily affecting the peripheral joints. The past decade has been marked with revolutionary changes both in the therapeutic and diagnostic perspectives of RA. The discovery of an RA-specific citrullination-driven immune reaction gave a substantial contribution in the diagnostic approach to RA. Efforts directed towards the identification of the antigenic target specifically recognized by these autoantibodies resulted in the identification of vimentin in citrullinated form as the potential native antigen, among other proteins. Furthermore, it was found that the mutation of vimentin represents an independent trigger of antigenic properties, in addition to citrullination. As a result of this discovery, a commercial ELISA using mutated citrullinated vimentin (MCV) was developed. Increasingly, data now support the use of anti-MCV in RA diagnosis and prognosis for errosion. This review summarizes the research to date on the use of anti-MCV in RA diagnosis and prognosis and its potential use as a therapeutic marker. The pathologic role of these antibodies in RA disease is also discussed.
Collapse
Affiliation(s)
- Andrea Tesija Kuna
- Clinical Institute of Chemistry, University Hospital Sestre Milosrdnice, Zagreb, Croatia.
| |
Collapse
|
30
|
Papagoras C, Drosos AA. Abatacept: a biologic immune modulator for rheumatoid arthritis. Expert Opin Biol Ther 2011; 11:1113-29. [DOI: 10.1517/14712598.2011.592825] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
31
|
Serum adenosine deaminase may predict disease activity in rheumatoid arthritis. Rheumatol Int 2011; 32:1967-75. [PMID: 21461854 DOI: 10.1007/s00296-011-1912-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 03/13/2011] [Indexed: 12/23/2022]
Abstract
To determine the relationship between serum adenosine deaminase (ADA) and disease activity, and to develop a new disease activity index based on serum ADA in rheumatoid arthritis (RA). Seventy RA patients were included. Disease activity based on Disease Activity Score 28-ESR (DAS28-ESR) and Disease Activity Score 28-CRP (DAS28-CRP) and serum ADA were measured. There were correlations when serum ADA compared with DAS28-ESR and DAS28-CRP. (R (2) = 0.014, 0.175, respectively, P values < 0.00). New disease activity index was developed by replacing ADA with ESR and CRP in DAS28-ESR and DAS28-CRP. There were strong correlations when new model compared with DAS28-ESR and DAS28-CRP. (R (2) = 0.94 and 0.95, respectively, P values < 0.00) The best new model values corresponding to DAS28-ESR values of 2.6, 3.2, and 5.1 were 2.79, 3.4, and 4.82, respectively; and new model values corresponding to DAS28-CRP values of 2.3, 2.7, and 4.1 were 2.1, 2.9, and 4, respectively. There were agreements when the new model compared with DAS28-ESR and DAS28-CRP for determination of patients in different disease activity categories. (Kappa = 0.81 and 0.71, respectively, P values < 0.00). The new disease activity index that applies serum ADA may help in predicting disease activity in RA.
Collapse
|