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Heřmánková B, Oreská S, Špiritović M, Štorkánová H, Komarc M, Pavelka K, Šenolt L, Vencovský J, Bečvář R, Tomčík M. Sexual function and pelvic floor function in men with systemic sclerosis compared to healthy controls: a cross-sectional study. Aging Male 2024; 27:2336630. [PMID: 38584363 DOI: 10.1080/13685538.2024.2336630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVES This cross-sectional study aimed to compare the sexual function (SF) and pelvic floor function of men with systemic sclerosis (SSc) with age-matched healthy controls (HC) and to identify the implications of clinical features on SF. MATERIAL AND METHOD Twenty SSc males and 20 HC aged 18-70 years completed eleven questionnaires assessing SF [International Index of Erectile Function (IIEF), Male Sexual Health Questionnaire (MSHQ)]; sexual quality of life: Sexual Quality of Life Questionnaire-Male (SQoL-M); pelvic floor function: Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), fatigue, depression, physical fitness, functional disability, and quality of life. Clinical data were collected. RESULTS Significantly worse SF was observed in patients (median IIEF erectile function 12 in SSc versus 29 in HC, p < 0.001), with 70% reporting erectile dysfunction (ED) compared to 15% in HC. However, no significant difference was observed regarding pelvic floor function (median PFIQ7 8.8 in SSc versus 7.0 in HC, p = 0.141). Impaired SF was associated with higher disease activity, increased systemic inflammation, more pronounced fatigue, reduced physical fitness, severe depression, impaired overall quality of life, dyspepsia, and arthralgias (p < 0.05 for all). CONCLUSIONS Sexual dysfunction is highly prevalent in our SSc patients, whereas pelvic floor dysfunction is unlikely to be associated with these problems.
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Affiliation(s)
- Barbora Heřmánková
- Institute of Rheumatology, Prague, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maja Špiritović
- Institute of Rheumatology, Prague, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radim Bečvář
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Hellamand P, van de Sande MGH, Ørnbjerg LM, Klausch T, Eklund KK, Relas H, Santos MJ, Vieira-Sousa E, Loft AG, Glintborg B, Østergaard M, Lindström U, Wallman JK, Michelsen B, Fagerli KM, Castrejón I, Gudbjornsson B, Love TJ, Vencovský J, Nekvindová L, Rotar Ž, Tomšič M, Díaz-González F, Kenar G, Tuğsal HY, Iannone F, Ramonda R, Codreanu C, Mogosan C, Nissen MJ, Möller B, Hetland ML, van der Horst-Bruinsma IE. Sex Differences in the Effectiveness of First-Line Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis: Results From the European Spondyloarthritis Research Collaboration Network. Arthritis Rheumatol 2024; 76:587-598. [PMID: 37975166 DOI: 10.1002/art.42758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/23/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Women with psoriatic arthritis (PsA) may have reduced tumor necrosis factor inhibitor (TNFi) effectiveness compared to men. We examined sex differences in treatment response and retention rates during 24 months of follow-up among patients with PsA initiating their first TNFi. METHODS Data from patients with PsA across 13 European Spondyloarthritis Research Collaboration Network registries starting their first TNFi were pooled. Logistic regression was used to analyze the association between sex and treatment response using low disease activity (LDA) according to the Disease Activity Score in 28 joints using the C-reactive protein level (DAS28-CRP) (<3.2) at six months as the primary outcome. Analyses were adjusted for age, country, conventional synthetic disease-modifying antirheumatic drug treatment, and TNFi start year. Retention rates were explored using the Kaplan-Meier estimator. RESULTS We analyzed the treatment response of 7,679 patients with PsA (50% women) with available data on LDA at six months. At baseline, women and men had similar characteristics, including mean DAS28-CRP (women vs men, 4.4 [SD 1.2] vs 4.2 [SD 1.2]), though patient-reported outcome measures were worse in women. At six months, 64% of women and 78% of men had LDA (relative risk [RR] 0.82; 95% confidence interval [CI] 0.80-0.84). This difference was similar after adjustment (RR 0.83; 95% CI 0.81-0.85). TNFi retention rates were evaluated in 17,842 patients with PsA. Women had significantly lower retention rates than men at all time points (women 79%, 64%, and 50% vs men 88%, 77%, and 64% at 6, 12, and 24 months, respectively). CONCLUSION Despite comparable disease characteristics at baseline, women with PsA have reduced treatment response and retention rates to their first TNFi, highlighting the need to consider sex differences in PsA research and management.
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Affiliation(s)
- Pasoon Hellamand
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Lykke M Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
| | - Thomas Klausch
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Kari K Eklund
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heikki Relas
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | | | | | - Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ulf Lindström
- Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Brigitte Michelsen
- Diakonhjemmet Hospital, Oslo and Sørlandet Hospital, Kristiansand, Norway
| | | | | | - Bjorn Gudbjornsson
- Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | - Thorvardur J Love
- Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | - Jiří Vencovský
- Institute of Rheumatology and Charles University, Prague, Czech Republic
| | | | - Žiga Rotar
- University Medical Centre Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Gökçe Kenar
- Dokuz Eylul University School of Medicine, Izmir, Turkey
| | | | | | | | | | | | | | - Burkhard Möller
- Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Merete L Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopedics, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark
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Švec X, Štorkánová H, Trinh-Minh T, Tran MC, Štorkánová L, Hulejová H, Oreská S, Heřmánková B, Bečvář R, Pavelka K, Vencovský J, Klingelhöfer J, Hussain RI, Hallén J, Šenolt L, Distler JHW, Tomčík M. S100A4-neutralizing monoclonal antibody 6B12 counteracts the established experimental skin fibrosis induced by bleomycin. Rheumatology (Oxford) 2024; 63:817-825. [PMID: 37314987 PMCID: PMC10907816 DOI: 10.1093/rheumatology/kead295] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/07/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Our previous studies have demonstrated that the Damage Associated Molecular Pattern (DAMP) protein, S100A4, is overexpressed in the involved skin and peripheral blood of patients with SSc. It is associated with skin and lung involvement, and disease activity. By contrast, lack of S100A4 prevented the development of experimental dermal fibrosis. Herein we aimed to evaluate the effect of murine anti-S100A4 mAb 6B12 in the treatment of preestablished experimental dermal fibrosis. METHODS The effects of 6B12 were assessed at therapeutic dosages in a modified bleomycin-induced dermal fibrosis mouse model by evaluating fibrotic (dermal thickness, proliferation of myofibroblasts, hydroxyproline content, phosphorylated Smad3-positive cell count) and inflammatory (leukocytes infiltrating the lesional skin, systemic levels of selected cytokines and chemokines) outcomes, and transcriptional profiling (RNA sequencing). RESULTS Treatment with 7.5 mg/kg 6B12 attenuated and might even reduce pre-existing dermal fibrosis induced by bleomycin as evidenced by reduction in dermal thickness, myofibroblast count and collagen content. These antifibrotic effects were mediated by the downregulation of TGF-β/Smad signalling and partially by reducing the number of leukocytes infiltrating the lesional skin and decrease in the systemic levels of IL-1α, eotaxin, CCL2 and CCL5. Moreover, transcriptional profiling demonstrated that 7.5 mg/kg 6B12 also modulated several profibrotic and proinflammatory processes relevant to the pathogenesis of SSc. CONCLUSION Targeting S100A4 by the 6B12 mAb demonstrated potent antifibrotic and anti-inflammatory effects on bleomycin-induced dermal fibrosis and provided further evidence for the vital role of S100A4 in the pathophysiology of SSc.
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Affiliation(s)
- Xiao Švec
- Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Thuong Trinh-Minh
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
| | - Manh Cuong Tran
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
| | | | | | - Sabína Oreská
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Barbora Heřmánková
- Institute of Rheumatology, Prague, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Radim Bečvář
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Rizwan I Hussain
- Arxx Therapeutics, Oslo, Norway
- Agiana Pharmaceuticals, Oslo, Norway
| | | | - Ladislav Šenolt
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jörg H W Distler
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
| | - Michal Tomčík
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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4
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Linde L, Ørnbjerg LM, Georgiadis S, H. Rasmussen S, Lindström U, Askling J, Michelsen B, Di Giuseppe D, Wallman JK, Gudbjornsson B, Love TJ, Nordström DC, Yli-Kerttula T, Nekvindová L, Vencovský J, Iannone F, Cauli A, Loft AG, Glintborg B, Laas K, Rotar Z, Tomšič M, Macfarlane GJ, Möller B, van de Sande M, Codreanu C, Nissen MJ, Birlik M, Erten S, Santos MJ, Vieira-Sousa E, Hetland ML, Østergaard M. Predictors of DAPSA28 remission in patients with psoriatic arthritis initiating a first TNF inhibitor: results from 13 European registries. Rheumatology (Oxford) 2024; 63:751-764. [PMID: 37314967 PMCID: PMC10907817 DOI: 10.1093/rheumatology/kead284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES In bio-naïve patients with PsA initiating a TNF inhibitor (TNFi), we aimed to identify baseline predictors of Disease Activity index for PsA in 28 joints (DAPSA28) remission (primary objective) and DAPSA28 moderate response at 6 months, as well as drug retention at 12 months across 13 European registries. METHODS Baseline demographic and clinical characteristics were retrieved and the three outcomes investigated per registry and in pooled data, using logistic regression analyses on multiply imputed data. In the pooled cohort, selected predictors that were either consistently positive or negative across all three outcomes were defined as common predictors. RESULTS In the pooled cohort (n = 13 369), 6-month proportions of remission, moderate response and 12-month drug retention were 25%, 34% and 63% in patients with available data (n = 6954, n = 5275 and n = 13 369, respectively). Five common baseline predictors of remission, moderate response and 12-month drug retention were identified across all three outcomes. The odds ratios (95% CIs) for DAPSA28 remission were: age, per year: 0.97 (0.96-0.98); disease duration, years (<2 years as reference): 2-3 years: 1.20 (0.89-1.60), 4-9 years: 1.42 (1.09-1.84), ≥10 years: 1.66 (1.26-2.20); men vs women: 1.85 (1.54-2.23); CRP of >10 vs ≤10 mg/l: 1.52 (1.22-1.89) and 1 mm increase in patient fatigue score: 0.99 (0.98-0.99). CONCLUSION Baseline predictors of remission, response and adherence to TNFi therapy were identified, of which five were common for all three outcomes, indicating that the predictors emerging from our pooled cohort may be considered generalizable from country level to disease level.
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Affiliation(s)
- Louise Linde
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Lykke M Ørnbjerg
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Stylianos Georgiadis
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Simon H. Rasmussen
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Michelsen
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Research Unit, Sørlandet Hospital, Kristiansand, Norway
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali, University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department for Science and Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Dan C Nordström
- Departments of Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Timo Yli-Kerttula
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - Lucie Nekvindová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences and Public Health, AOU and University of Cagliari, Monserrato, Italy
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bente Glintborg
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karin Laas
- Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Burkhard Möller
- Department for Rheumatology and Immunology, Inselspital, University Hospital Bern, on behalf of the Swiss Clinical Quality Management for Rheumatic Diseases, SCQM, Zürich, Switzerland
| | - Marleen van de Sande
- Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam, The Netherlands
| | - Catalin Codreanu
- Center for Rheumatic Diseases, University of Medicine and Pharmacy, Romanian Registry of Rheumatic Diseases, Bucharest, Romania
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Merih Birlik
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Sukran Erten
- Department of Rheumatology, Ankara Yıldırım Beyazıt University Ankara City Hospital, Ankara, Turkey
| | - Maria J Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
- Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Department of Rheumatology, Hospital de Santa Maria, CHULN, Instituto Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Merete L Hetland
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Charles-Schoeman C, Giles JT, Lane NE, Choy E, Furst DE, Vencovský J, Wilson AG, Burmester GR, Coombs D, Penn SK, Khan N, Yee JB, Rahawi K, McInnes IB. Impact of Upadacitinib on Laboratory Parameters and Related Adverse Events in Patients with RA: Integrated Data Up to 6.5 Years. Rheumatol Ther 2024; 11:157-175. [PMID: 38180720 PMCID: PMC10796877 DOI: 10.1007/s40744-023-00624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/26/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Upadacitinib (UPA) is a Janus kinase inhibitor that has demonstrated efficacy in moderate-to-severe rheumatoid arthritis (RA) with an acceptable safety profile. We investigated laboratory parameter changes in UPA RA clinical trials. METHODS Pooled data from six randomized trials in the SELECT phase 3 program were included. Key laboratory parameters and safety data were measured for UPA 15 and 30 mg once daily (QD), adalimumab (ADA) 40 mg every other week + methotrexate (MTX), and MTX monotherapy. Exposure-adjusted event rates (EAERs) of adverse events were calculated. RESULTS A total of 3209 patients receiving UPA 15 mg QD (10 782.7 patient-years [PY]), 1204 patients receiving UPA 30 mg QD (3162.5 PY), 579 patients receiving ADA + MTX (1573.2 PY), and 314 patients receiving MTX monotherapy (865.1 PY) were included, representing up to 6.5 years of total exposure. Decreases in mean levels of hemoglobin, neutrophils, and lymphocytes, and increases in mean levels of liver enzymes and creatinine phosphokinase were observed with UPA, with grade 3 or 4 changes observed in some patients. Mean low- and high-density lipoprotein cholesterol ratios remained stable for patients receiving UPA 15 mg QD. EAERs of anemia and neutropenia occurred at generally consistent rates between UPA and active comparators (3.1-4.3 and 1.7-5.0 events [E]/100 PY across treatment groups, respectively). Rates of hepatic disorder were higher with MTX monotherapy, UPA 15 mg and UPA 30 mg (10.8, 9.7, and 11.0 E/100 PY, respectively) versus ADA + MTX (6.4 E/100 PY). Rates of lymphopenia were highest with MTX monotherapy (3.2 E/100 PY). Treatment discontinuations due to laboratory-related events were rare, occurring in 1.1% and 2.2% of patients treated with UPA 15 and 30 mg QD, respectively. CONCLUSIONS The results of this integrated long-term analysis of laboratory parameters continue to support an acceptable safety profile of UPA 15 mg QD for moderate-to-severe RA.
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Affiliation(s)
| | | | - Nancy E Lane
- University of California Davis, Sacramento, CA, USA
| | - Ernest Choy
- CREATE Centre, Cardiff University, Cardiff, UK
| | - Daniel E Furst
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jiří Vencovský
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Rheumatology, Na Slupi 4, 12850, Prague, Czech Republic
| | - Anthony G Wilson
- Center for Arthritis Research, Conway Institute, University College Dublin, Dublin, Ireland
| | | | | | | | | | | | | | - Iain B McInnes
- College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
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6
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Linde L, Ørnbjerg LM, Rasmussen SH, Love TJ, Loft AG, Závada J, Vencovský J, Laas K, Nordstrom D, Sokka-Isler T, Gudbjornsson B, Gröndal G, Iannone F, Ramonda R, Hellamand P, Kristianslund EK, Kvien TK, Rodrigues AM, Santos MJ, Codreanu C, Rotar Z, Tomšič M, Castrejon I, Díaz-Gonzáles F, Di Giuseppe D, Ljung L, Nissen MJ, Ciurea A, Macfarlane GJ, Heddle M, Glintborg B, Østergaard M, Hetland ML. Commonalities and differences in set-up and data collection across European spondyloarthritis registries - results from the EuroSpA collaboration. Arthritis Res Ther 2023; 25:205. [PMID: 37858143 PMCID: PMC10585911 DOI: 10.1186/s13075-023-03184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In European axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) clinical registries, we aimed to investigate commonalities and differences in (1) set-up, clinical data collection; (2) data availability and completeness; and (3) wording, recall period, and scale used for selected patient-reported outcome measures (PROMs). METHODS Data was obtained as part of the EuroSpA Research Collaboration Network and consisted of (1) an online survey and follow-up interview, (2) upload of real-world data, and (3) selected PROMs included in the online survey. RESULTS Fifteen registries participated, contributing 33,948 patients (axSpA: 21,330 (63%), PsA: 12,618 (37%)). The reported coverage of eligible patients ranged from 0.5 to 100%. Information on age, sex, biological/targeted synthetic disease-modifying anti-rheumatic drug treatment, disease duration, and C-reactive protein was available in all registries with data completeness between 85% and 100%. All PROMs (Bath Ankylosing Spondylitis Disease Activity and Functional Indices, Health Assessment Questionnaire, and patient global, pain and fatigue assessments) were more complete after 2015 (68-86%) compared to prior (50-79%). Patient global, pain and fatigue assessments showed heterogeneity between registries in terms of wording, recall periods, and scale. CONCLUSION Important heterogeneity in registry design and data collection across fifteen European axSpA and PsA registries was observed. Several core measures were widely available, and an increase in data completeness of PROMs in recent years was identified. This study might serve as a basis for examining how differences in data collection across registries may impact the results of collaborative research in the future.
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Affiliation(s)
- Louise Linde
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark.
| | - Lykke M Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
| | - Simon H Rasmussen
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
| | | | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Jakub Závada
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karin Laas
- Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia
| | - Dan Nordstrom
- Departments of Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Gerdur Gröndal
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Pasoon Hellamand
- Department of Clinical Immunology and Rheumatology, Amsterdam Medical Center, Amsterdam, Netherlands
| | - Eirik K Kristianslund
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ana M Rodrigues
- Sociedade Portuguesa de Reumatologia, Reuma.pt, Lisbon, Portugal
| | - Maria J Santos
- Department of Rheumatology, Hospital Garcia de Orta, Almada, Lisbon, Portugal
| | - Catalin Codreanu
- Center for Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Isabel Castrejon
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Ljung
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Maureen Heddle
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Bente Glintborg
- Center for Rheumatology and Spine Diseases, DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
| | - Merete L Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
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Štorkánová H, Štorkánová L, Navrátilová A, Bečvář V, Hulejová H, Oreská S, Heřmánková B, Špiritović M, Bečvář R, Pavelka K, Vencovský J, Distler JHW, Šenolt L, Tomčík M. Correction: Štorkánová et al. Inhibition of Hsp90 Counteracts the Established Experimental Dermal Fibrosis Induced by Bleomycin. Biomedicines 2021, 9, 650. Biomedicines 2023; 11:2736. [PMID: 37893244 PMCID: PMC10604650 DOI: 10.3390/biomedicines11102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
In the original publication [...].
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Affiliation(s)
- Hana Štorkánová
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Lenka Štorkánová
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
| | - Adéla Navrátilová
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Viktor Bečvář
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
| | - Hana Hulejová
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
| | - Sabína Oreská
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 16252 Prague, Czech Republic;
| | - Maja Špiritović
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 16252 Prague, Czech Republic;
| | - Radim Bečvář
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Jörg H. W. Distler
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Ladislav Šenolt
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
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de Visser M, Carlier P, Vencovský J, Kubínová K, Preusse C. 255th ENMC workshop: Muscle imaging in idiopathic inflammatory myopathies. 15th January, 16th January and 22nd January 2021 - virtual meeting and hybrid meeting on 9th and 19th September 2022 in Hoofddorp, The Netherlands. Neuromuscul Disord 2023; 33:800-816. [PMID: 37770338 DOI: 10.1016/j.nmd.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023]
Abstract
The 255th ENMC workshop on Muscle Imaging in Idiopathic Inflammatory myopathies (IIM) aimed at defining recommendations concerning the applicability of muscle imaging in IIM. The workshop comprised of clinicians, researchers and people living with myositis. We aimed to achieve consensus on the following topics: a standardized protocol for the evaluation of muscle images in various types of IIMs; the exact parameters, anatomical localizations and magnetic resonance imaging (MRI) techniques; ultrasound as assessment tool in IIM; assessment methods; the pattern of muscle involvement in IIM subtypes; the application of MRI as biomarker in follow-up studies and clinical trials, and the place of MRI in the evaluation of swallowing difficulty and cardiac manifestations. The following recommendations were formulated: In patients with suspected IIM, muscle imaging is highly recommended to be part of the initial diagnostic workup and baseline assessment. MRI is the preferred imaging modality due to its sensitivity to both oedema and fat accumulation. Ultrasound may be used for suspected IBM. Repeat imaging should be considered if patients do not respond to treatment, if there is ongoing diagnostic uncertainty or there is clinical or laboratory evidence of disease relapse. Quantitative MRI is established as a sensitive biomarker in IBM and could be included as a primary or secondary outcome measure in early phase clinical trials, or as a secondary outcome measure in late phase clinical trials. Finally, a research agenda was drawn up.
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Affiliation(s)
- Marianne de Visser
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Jiří Vencovský
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Corinna Preusse
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Department of Neuropathology, Berlin, Germany
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Heřmánková B, Špiritović M, Oreská S, Štorkánová H, Mann H, Pavelka K, Šenolt L, Vencovský J, Bečvář R, Tomčík M. Effect of an 8-Week Tailored Physiotherapy Program on Sexual Health in Women with Scleroderma and Myositis: A Controlled Pilot Study. Rheumatol Ther 2023; 10:1089-1105. [PMID: 37221419 PMCID: PMC10326194 DOI: 10.1007/s40744-023-00559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM) are very rare rheumatic diseases burdened by a high prevalence of sexual dysfunctions. However, no specific treatment has been proposed to date. To our knowledge, this is the first (pilot) study aiming to investigate the effect of an 8-week tailored physiotherapy program on the sexual health of women with SSc and IIM. METHODS In total, 12 women with SSc and 4 women with IIM were enrolled in the study. Based on the patients' capability to participate in the program, they were divided into an intervention group (IG) (mean ± SD age 46.8 ± 8.6 years) and a control group (CG) (mean ± SD age 46.3 ± 8.5 years). IG underwent the 8-week program (1 h of supervised physiotherapy twice weekly), whereas CG received no physiotherapy. At weeks 0 and 8, all patients filled in questionnaires assessing sexual function (Female Sexual Function Index [FSFI], Brief Index of Sexual Functioning for Women [BISF-W]), sexual quality of life (Sexual Quality of Life-Female [SQoL-F]), functional ability (Health Assessment Questionnaire [HAQ]), quality of life (Medical Outcomes Short Form-36 [SF-36]), and depression (Beck's Depression Inventory-II [BDI-II]). The changes were analyzed with two-way ANOVA and Friedmann's test. RESULTS Compared to the statistically significant deterioration in CG over weeks 0-8, we found statistically significant improvements in the total scores of FSFI and BISF-W, and some of their domains, functional status, and the physical component of quality of life. CONCLUSION Our 8-week physiotherapy program not only prevented the natural course of progressive deterioration of functional ability but also led to a significant improvement in sexual function and quality of life in women with SSc and IIM. However, due to the lack of randomization and a relatively small sample size resulting from the strict inclusion criteria, further validation of our results is needed. TRIAL REGISTRATION NUMBER ISRCTN91200867 (prospectively registered).
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Affiliation(s)
- Barbora Heřmánková
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Maja Špiritović
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radim Bečvář
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Na Slupi 4, Prague 2, 128 50, Czech Republic.
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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Navrátilová A, Bečvář V, Hulejová H, Tomčík M, Štolová L, Mann H, Růžičková O, Šléglová O, Závada J, Pavelka K, Vencovský J, Šenolt L, Andrés Cerezo L. New pro-inflammatory cytokine IL-40 is produced by activated neutrophils and plays a role in the early stages of seropositive rheumatoid arthritis. RMD Open 2023; 9:rmdopen-2022-002894. [PMID: 37208028 DOI: 10.1136/rmdopen-2022-002894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/07/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE Interleukin (IL)-40 is a new cytokine related to immune system function and malignancies. Recently, an association of IL-40 with rheumatoid arthritis (RA) and externalisation of neutrophil extracellular traps (NETosis) was found. As neutrophils are implicated in RA development, we investigated IL-40 in early stages of RA (ERA). METHODS IL-40 was determined in serum of treatment naïve patients with ERA at baseline (n=60) and 3 months after initiation of conventional therapy and in healthy controls (HC; n=60). Levels of IL-40, cytokines and NETosis markers were measured by ELISA. NETosis was visualised by immunofluorescence. In vitro experiments were performed on peripheral blood neutrophils from ERA patients (n=14). Cell-free DNA was analysed in serum and supernatants. RESULTS Serum IL-40 was elevated in ERA compared with HC (p<0.0001) and normalised after 3 months of therapy (p<0.0001). Baseline serum IL-40 correlated with rheumatoid factor (IgM) (p<0.01), anti-cyclic citrullinated peptide (p<0.01) autoantibodies and NETosis markers (proteinase 3; neutrophil elastase (NE); myeloperoxidase) (p<0.0001). Levels of NE significantly decreased after therapy (p<0.01) and correlated with the decrease of serum IL-40 (p<0.05). In vitro, neutrophils enhanced IL-40 secretion following NETosis induction (p<0.001) or after exposure to IL-1β, IL-8 (p<0.05), tumour necrosis factor or lipopolysaccharide (p<0.01). Recombinant IL-40 up-regulated IL-1β, IL-6 and IL-8 (p<0.05 for all) in vitro. CONCLUSION We showed that IL-40 is significantly up-regulated in seropositive ERA and decreases after conventional therapy. Moreover, neutrophils are an important source of IL-40 in RA, and its release is potentiated by cytokines and NETosis. Thus, IL-40 may play a role in ERA.
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Affiliation(s)
- Adéla Navrátilová
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Viktor Bečvář
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Hana Hulejová
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Michal Tomčík
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Štolová
- Department of Paediatric Haematology and Oncology, Motol University Hospital, Prague, Czech Republic
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Růžičková
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Šléglová
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Závada
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Andrés Cerezo
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
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11
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Vencovský J, Klein M, Mann H, Kubínová K, Kryštůfková O, Šmucrová H. 4th Global Conference on Myositis (GCOM). Clin Exp Rheumatol 2023; 41:405-542. [PMID: 36861741 DOI: 10.55563/clinexprheumatol/zka1xq] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Jiří Vencovský
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czezh Republic
| | - Martin Klein
- Institute of Rheumatology, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czezh Republic
| | - Olga Kryštůfková
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czezh Republic
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Zhou D, King EH, Rothwell S, Krystufkova O, Notarnicola A, Coss S, Abdul-Aziz R, Miller KE, Dang A, Yu GR, Drew J, Lundström E, Pachman LM, Mamyrova G, Curiel RV, De Paepe B, De Bleecker JL, Payton A, Ollier W, O'Hanlon TP, Targoff IN, Flegel WA, Sivaraman V, Oberle E, Akoghlanian S, Driest K, Spencer CH, Wu YL, Nagaraja HN, Ardoin SP, Chinoy H, Rider LG, Miller FW, Lundberg IE, Padyukov L, Vencovský J, Lamb JA, Yu CY. Low copy numbers of complement C4 and C4A deficiency are risk factors for myositis, its subgroups and autoantibodies. Ann Rheum Dis 2023; 82:235-245. [PMID: 36171069 PMCID: PMC9887400 DOI: 10.1136/ard-2022-222935] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/02/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases characterised by myositis-related autoantibodies plus infiltration of leucocytes into muscles and/or the skin, leading to the destruction of blood vessels and muscle fibres, chronic weakness and fatigue. While complement-mediated destruction of capillary endothelia is implicated in paediatric and adult dermatomyositis, the complex diversity of complement C4 in IIM pathology was unknown. METHODS We elucidated the gene copy number (GCN) variations of total C4, C4A and C4B, long and short genes in 1644 Caucasian patients with IIM, plus 3526 matched healthy controls using real-time PCR or Southern blot analyses. Plasma complement levels were determined by single radial immunodiffusion. RESULTS The large study populations helped establish the distribution patterns of various C4 GCN groups. Low GCNs of C4T (C4T=2+3) and C4A deficiency (C4A=0+1) were strongly correlated with increased risk of IIM with OR equalled to 2.58 (2.28-2.91), p=5.0×10-53 for C4T, and 2.82 (2.48-3.21), p=7.0×10-57 for C4A deficiency. Contingency and regression analyses showed that among patients with C4A deficiency, the presence of HLA-DR3 became insignificant as a risk factor in IIM except for inclusion body myositis (IBM), by which 98.2% had HLA-DR3 with an OR of 11.02 (1.44-84.4). Intragroup analyses of patients with IIM for C4 protein levels and IIM-related autoantibodies showed that those with anti-Jo-1 or with anti-PM/Scl had significantly lower C4 plasma concentrations than those without these autoantibodies. CONCLUSIONS C4A deficiency is relevant in dermatomyositis, HLA-DRB1*03 is important in IBM and both C4A deficiency and HLA-DRB1*03 contribute interactively to risk of polymyositis.
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Affiliation(s)
- Danlei Zhou
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Emily H King
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Simon Rothwell
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Olga Krystufkova
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Antonella Notarnicola
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, University Hospital Karolinska, Stockholm, Sweden
| | - Samantha Coss
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Rabheh Abdul-Aziz
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA,Division of Allergy/Immunology and Rheumatology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Katherine E Miller
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Amanda Dang
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - G Richard Yu
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joanne Drew
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Emeli Lundström
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, University Hospital Karolinska, Stockholm, Sweden
| | - Lauren M Pachman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gulnara Mamyrova
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rodolfo V Curiel
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Boel De Paepe
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Antony Payton
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - William Ollier
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Terrance P O'Hanlon
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health, Bethesda, MD, USA
| | - Ira N Targoff
- Veteran’s Affairs Medical Center, University of Oklahoma Health Sciences Center, and Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Willy A Flegel
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Vidya Sivaraman
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Edward Oberle
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Shoghik Akoghlanian
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Kyla Driest
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | | | - Yee Ling Wu
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA,Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL, USA
| | - Haikady N Nagaraja
- Division of Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Stacy P Ardoin
- Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health, Bethesda, MD, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health, Bethesda, MD, USA
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, University Hospital Karolinska, Stockholm, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, University Hospital Karolinska, Stockholm, Sweden
| | - Jiří Vencovský
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Janine A Lamb
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chack-Yung Yu
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA,Division of Rheumatology, Nationwide Children’s Hospital and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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Navrátilová A, Becvar V, Hulejova H, Pavelka K, Vencovský J, Šenolt L, Andres Cerezo L. AB0068 INTERLEUKIN 40 SERUM LEVELS ARE ELEVATED IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS AND ASSOCIATE WITH NEUTROPHIL ACTIVATION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIL-40 is a newly described cytokine associated with immune system function and malignant transformation. We have recently shown that IL-40 is up-regulated in rheumatoid arthritis (RA) and associates with disease activity, autoantibodies and NETosis1.ObjectivesAs autoantibodies and neutrophil activation are factors thought to drive the pathological processes at early phase of RA development, we aimed to investigate IL-40 in relation to neutrophils and early stages of RA (ERA).MethodsThe levels of serum IL-40 were determined in a cohort of treatment naïve patients with ERA at baseline (n=60) and three months after initiation of conventional treatment (n=60). Serum IL-40 was also determined in sex- and age- matched healthy controls (n=60). Levels of IL-40, cytokines and NETosis markers (proteinase 3, PR3 and neutrophil elastase, NE) were measured by commercially available ELISA kits. The levels of autoantibodies were analysed by routine laboratory techniques. In vitro experiments were performed on peripheral blood neutrophils from patients with ERA (n=15).ResultsLevels of IL-40 were elevated in ERA patients at baseline compared to healthy controls (p<0.0001) and normalised after three months of the treatment (p<0.0001). Baseline serum IL-40 was associated with the levels of autoantibodies RF (IgM) (p<0.01) and anti-CCP (p<0.01) and markers of NETosis PR3 and NE) (both p<0.0001). Moreover, significant decreases in the serum IL-40 following the therapy correlated with the decrease of NETosis markers PR3 (p<0.01) and NE (p<0.05). In vitro, neutrophils from patients with ERA significantly enhanced the release of IL-40 following NETosis induction (p<0.05) or after exposure to pro-inflammatory cytokines such as IL-1β, IL-8 (p<0.05), TNF (p<0.01) or to LPS (p<0.05). Lastly, recombinant IL-40 induced the secretion of IL-1β (p<0.05) and TNF (p<0.05) by ERA neutrophils.ConclusionWe demonstrated for the first time that IL-40 is upregulated in ERA and decreases after three months of conventional therapy. Moreover, we showed that neutrophils are an important source of IL-40 in RA and its release is potentiated by pro-inflammatory cytokines and NETosis. Our results suggest that IL-40 may play an important role in early stages of RA.References[1]Navrátilová A, Andrés Cerezo L, Hulejová H, Bečvář V, Tomčík M, Komarc M, et al. IL-40: A New B Cell-Associated Cytokine Up-Regulated in Rheumatoid Arthritis Decreases Following the Rituximab Therapy and Correlates With Disease Activity, Autoantibodies, and NETosis. Front Immunol. 2021 Oct 21;12:745523. doi: 10.3389/fimmu.2021.745523.AcknowledgementsSupported by AZV-NU21-05-00276, MHCR 023728, SVV 260 523 and BBMRI-CZ LM2018125Disclosure of InterestsNone declared
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Vokurková M, Vernerová L, Oreska S, Špiritović M, Klein M, Verner Z, Nemec M, Ukropec J, Ukropcová B, Tomčík M, Vencovský J. POS0912 THE EFFECT OF A 24-WEEK TRAINING ON METABOLIC PARAMETERS OF SKELETAL MUSCLE CELLS DERIVED FROM PATIENTS WITH ESTABLISHED IDIOPATHIC INFLAMMATORY MYOPATHIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPersistent muscle weakness after reduction of inflammation and resistance to immunosuppressive therapy in some patients with idiopathic inflammatory myopathies (IIM) suggest that not only immune but also non-immune mechanisms, such as mitochondrial abnormalities and metabolic disturbance, contribute to the pathogenesis of myositis. Exercise improves muscle function in IIM patients.ObjectivesTo evaluate the effect of activities-of-daily-living, resistance and stability training on metabolic parameters of primary tissue culture myotubes established from muscle biopsies obtained from patients with established IIM.MethodsSeven patients with established IIM underwent a 24-week supervised training focused on activities of daily living, muscle-strengthening and stability. Muscle biopsy was performed before and after the 24-week program in patients, and in healthy controls (n=9). Isolated skeletal muscle cells were grown and differentiated into myotubes for 6 days. After differentiation, the myotubes were cultured for another 24 hours in fresh medium, and then the conditioned media were collected, and the cells were harvested in TRIzol. A relative number of mitochondria was quantified by the ratio between mitochondrial gene (NADH dehydrogenase subunit 1) and reference nuclear gene (lipoprotein lipase) and determined by qPCR. Glucose, pyruvate, lactate, citrate, and fumarate were assessed in a conditioned medium using the comprehensive two-dimensional gas chromatography coupled to time of flight mass spectrometer.ResultsPatients significantly improved their muscle strength and endurance during the 24-week training [1]. There was no difference in the relative number of mitochondria in muscle tissue and myotubes between IIM patients and controls. A significant increase in the number of muscle tissue mitochondria was found in IIM patients after 24 weeks of training (p = 0.004), on average twofold. A similar effect was observed in cultured myotubes, with at least 4 of 7 IIM patients showing a twofold increase in mitochondria number.Compared with myotubes from HC, myotubes derived from IIM patients consumed non-significantly more glucose and pyruvate from the culture medium; however, their glucose and pyruvate utilization were significantly reduced as a result of the 24-week training (p = 0.016 and p = 0.030, respectively). Skeletal muscle cells from IIM patients before training intervention did not differ from HC cells in the amount of released lactate; however, the lactate concentration in the conditioned medium from myotubes obtained from patients after the 24-week training was significantly lower (p = 0.016). When measuring citrate cycle products released into the culture medium, no difference in citrate and fumarate secretion was observed between myotubes of myositis patients and myotubes of healthy controls. In contrast, their release was significantly (p < 0.05) lower in myotubes from IIM patients after 24 weeks of training compared to muscle cells isolated prior to intervention.ConclusionIn conclusion, 24 weeks of rehabilitation training in patients with IIM significantly increases the number of mitochondria in muscle tissue. Lower release of lactate and citrate cycle intermediates (citrate and fumarate) by myotubes obtained from patients after training intervention indicates an increase in mitochondrial functional capacity and confirms a positive response to exercise in muscles previously affected by the inflammatory process in IIM.References[1]Špiritović M, et al. Arthritis Res Ther. 2021;23(1):173.AcknowledgementsThis work was supported by the Ministry of Health of the Czech Republic grants nr. NU21-05-00322.Disclosure of InterestsNone declared
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Pekacova A, Baloun J, Bubova K, Gregová M, Forejtova S, Horinkova J, Husakova M, Tomčík M, Gatterova J, Vencovský J, Pavelka K, Šenolt L. OP0105 miRNOME PROFILE IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundmicroRNAs (miRNAs) are small non-coding RNAs regulating up to 60 % of human mRNAs, including genes related to axial spondyloarthritis (axSpA) (1).ObjectivesThis study aims to profile miRNome and to identify candidate miRNAs determining disease severity in patietns with non-radiographic (nr) and radiographic (r) axSpA.MethodsThe miRNome profiling experiment included peripheral blood mononuclear cells (PBMCs) of 96 subjects (38 patients with nr-axSpA, 38 patients with r-axSpA and 20 healthy controls). Firstly, massive parallel sequencing on NextSeq 500 (MPS, Illumina) was performed for miRNA screening. Selected candidate miRNAs were further validated using the qRT-PCR system (SmartChip) on the validation cohort of 141 subjects (47 patients with nr-axSpA, 44 patients with r-axSpA and 50 healthy controls). We employed the DESeq2 algorithm and generalized linear modelling with a negative binomial assumption (GLM-NB) to evaluate the association of candidate miRNAs to axSpA subtype and clinical disease activity (ASDAS and CRP).ResultsMPS revealed 432 unique miRNAs in all samples. We identified 13 differently expressed miRNAs in axSpA patients compared to healthy controls, and 14 differently expressed miRNAs in axSpA patients with high to very high ASDAS compared to patients with inactive disease. Data from validation cohort revealed that the expression level of miR-4286 was higher in patients with very high disease activity compared to patients with inactive disease. Simultaneously, miR-4286 positively correlated with ASDAS. miR-4286 has been recently associated with osteogenesis and angiogenesis (2). None of the validated miRNAs was associated with the levels of CRP.ConclusionIn this study, we identified that miR-4286 is related to disease activity and could play a role in the pathogenesis of axSpA.References[1]Prajzlerová K, Grobelná K, Hušáková M, et al. Association between circulating miRNAs and spinal involvement in patients with axial spondyloarthritis. PLoS One. 2017 Sep 22;12(9):e0185323.[2]Yu H, Wang K, Liu P, et al. miR-4286 functions in osteogenesis and angiogenesis via targeting histone deacetylase 3 and alleviates alcohol-induced bone loss in mice. Cell Prolif. 2021 Jun;54(6):e13054.AcknowledgementsSupported by MHCR No. 023728, BBMRI-CZ LM2018125 and SVV 260 523.Disclosure of InterestsNone declared
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Baloun J, Pekacova A, Mann H, Vencovský J, Pavelka K, Šenolt L. POS0444 PROFILING OF CIRCULATING miRNAs IN DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundBiologic (b-) and targeted synthetic (ts-) disease-modifying antirheumatic drugs (DMARDs) have brought significant progress in the treatment of rheumatoid arthritis (RA), but a significant proportion of RA patients still remain symptomatic despite treatment according to current recommendations. These patients have recently been defined as “difficult-to-treat (D2T)” RA (1). There is evidence that miRNA expression may play a role in the diagnosis and therapy of RA (2).ObjectivesIn a retrospective study, we analyzed patients’ blood samples prior to b-/ts-DMARD treatment and profiled circulating miRNAs to predict the development of D2T-RA.MethodsA total of 36 patients fulfilling the EULAR definition of D2T-RA (1) (mean age 59.1±10.7 yrs, 78% females), 36 patients with RA in sustained clinical remission on b-/ts-DMARDs at two consecutive examinations 12 wks apart (mean age 66.3±9.6 yrs, 78% females), and 36 healthy controls (mean age 61.1±7.7 yrs, 68% females) were included in the study. Blood samples were collected before initiation of b-/ts-DMARD. We profiled circulating miRNAs using the sequencing approach and differential expression analysis was performed using DESeq2 algorithm.ResultsThe massive parallel sequencing of circulating miRNAs detected 814 quantifiable miRNAs and DESeq2 algorithm revealed 35 miRNAs with different concentrations in patients who developed D2T-RA compared to patients with RA who achieved sustained remission or healthy controls. Out of these miRNAs, miR-16-5p (1.5x) and miR-451a (2.1x) were downregulated and miR-126-3p (1.4x) was upregulated in D2T RA patients compared to controls. In addition, miR-101-3p (1.5x) was downregulated in D2T RA compared to RA patients. Except for miR-101-3p, these miRNAS have been previously associated with RA and might predict development of D2T disease prior to initiation of b-/ts-DMARD therapy.ConclusionWe found four miRNAs as potential biomarkers differentiating patients who are at risk to develop difficult-to-treat disease compared to patients who have a chance of sustained remission even before initiation of biological or targeted synthetic DMARDs. Further studies with larger sample size are needed to validated these data.References[1]Nagy G, Roodenrijs NMT, Welsing PM, et al. EULAR definition of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis. 2021 Jan;80(1):31-35.[2]Filková M, Jüngel A, Gay RE, Gay S. MicroRNAs in rheumatoid arthritis: potential role in diagnosis and therapy. BioDrugs. 2012 Jun 1;26(3):131-41.AcknowledgementsThis work was supported by the project SVV 260 523, BBMRI-CZ LM2018125, and a project of the MHCR for conceptual research development No. 023728.Disclosure of InterestsNone declared.
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Oreska S, Štorkánová H, Kudlicka J, Tuka V, Mikeš O, Krupičková Z, Satny M, Chytilova E, Špiritović M, Heřmánková B, Cesak P, Rybar M, Pavelka K, Šenolt L, Mann H, Vencovský J, Vrablik M, Tomčík M. AB0678 Subclinical Atherosclerosis and Cardiovascular Risk in Myositis Patients and Healthy Controls: Preliminary Data From a Single-center Cross-sectional Study. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIdiopathic inflammatory myopathies (IIM) are associated with systemic inflammation, limited mobility, and glucocorticoid (GC) therapy, which can negatively impact metabolic disorders, atherogenesis, and increase the cardiovascular (CV) risk.ObjectivesThis study aimed to evaluate CV risk in IIM patients compared to healthy controls (HC) and explore its associations with disease-specific features.Methods39 patients with IIM (32 females; mean age 56; mean disease duration 4.8 years; dermatomyositis 16, polymyositis 7, immune-mediated necrotizing myopathy 8, antisynthetase syndrome 8) and 39 age-/sex-matched HC (32 females, mean age 56) were included. Subjects with a history of CV disease (angina pectoris, myocardial infarction, cerebrovascular, and peripheral arterial vascular events) were excluded in both groups. Disease activity, damage, and muscle involvement (Manual Muscle Test (MMT)-8, Myositis Intention to Treat Activity Index (MITAX), Myositis Damage Index (MDI)) were assessed. Comorbidities and current treatment were recorded. All participants underwent examinations of carotid intima-media thickness (CIMT), pulse wave velocity (PWV), ankle-brachial index (ABI), and body composition (densitometry: iDXA Lunar, bioelectric impedance: BIA2000-M). The risk of fatal CV events was evaluated by the Systematic COronary Risk Evaluation (SCORE and SCORE2, charts for the European population; modified mSCORE according to the 2015 EULAR recommendation for inflammatory arthritis - only in IIM patients).ResultsIn IIM, disease activity and damage were predominantly mild (MITAX 0.13, MDI 0.05). Compared to HC, there was no significant difference in the prevalence of traditional risk factors. Only PWV was significantly increased in IIM compared to HC (p=0.015). No other significant difference was observed between the IIM and HC regarding the CV examinations (CIMT, ABI, carotid plaques) and calculated SCORE and SCORE2 (p>0.05 for all). In IIM, age and mean arterial pressure were the most significant parameters that correlated positively with SCORE, SCORE2, and mSCORE; arterial hypertension was significantly associated with a higher SCORE, carotid plaque count/thickness, and PWV. Lipid profile parameters, body composition, and disease activity were significantly associated with CIMT and carotid plaques (p<0.05 for all). Antihypertensive treatment was associated with an increase in carotid plaque count (p=0.020), higher (favorable) ABI (p=0.004), while hypolipidemic treatment was associated with an increase in carotid plaque count/thickness (p=0.009, p=0.008). Diabetes was associated with lower (worse) ABI values (p=0.034), prediabetes with a higher carotid plaque count (p=0.036) and thickness (p=0.011), and a worse ultrasound examination related CV risk (p=0.006). Anti-Jo-1 positivity was associated with a lower (better) CIMT and lower SCORE (p<0.05 for all). There were no significant associations of CV risk with clinical manifestations, immunosuppressive treatment, and GC cumulative dose. However, exposure time to GC therapy was significantly associated with the carotid plaques count (p<0.001) and the carotid plaque thickness (p=0.003). In multivariate analysis, the age of the patients was the most significant factor affecting most of the parameters analyzed (SCORE and its modifications, PVW, CIMT, and the total count of carotid plaques). Other significant predictors were total cholesterol and atherogenic index of plasma (for ABI), mean arterial pressure (for PWV), and disease duration (for the total count of carotid plaques).ConclusionNo significant differences in CV risk factors between IIM patients and HC were observed.In IIM, CV risk was associated with age, disease duration, duration of glucocorticoid therapy, lipid profile, and body composition, but not with clinical manifestations and disease activity.AcknowledgementsSupported by AZV NV18-01-00161A, MHCR-00023728, SVV-260523. GAUK 1578119Disclosure of InterestsNone declared
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Vernerová L, Vokurková M, Oreska S, Špiritović M, Klein M, Kropackova T, Horvathova V, Tomčík M, Ukropec J, Ukropcová B, Vencovský J. POS0480 VITAMIN D AND ITS RECEPTOR (VDR) GENE EXPRESSION IN SKELETAL MUSCLE ASSOCIATE WITH DISEASE AND MUSCLE FUNCTION PARAMETERS IN IDIOPATHIC INFLAMMATORY MYOPATHIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIdiopathic inflammatory myopathies (IIM) are chronic inflammatory disorders characterised, apart from extramuscular manifestations, by symmetrical progressive muscle weakness that may persist even after pharmacological suppression of inflammation, suggesting a significant involvement of nonimmune mechanisms. Low levels of vitamin D have been associated with several autoimmune diseases. Vitamin D is essential for the maintenance of skeletal muscle, and mounting evidence supports its relation to muscle damage, regeneration, and energy metabolism.ObjectivesThe aim was to analyse vitamin D and the mediators of its function in muscle tissue of IIM patients, and to associate it with muscle health parameters.MethodsA total of 46 IIM patients (40 females, 6 males; mean age 56.7±12.4; disease duration 6.5±6.0 years; dermatomyositis (21), polymyositis (18), necrotizing myopathy (7)) and 67 healthy controls (HC) (56 females, 11 males; mean age 50.9±14.7) were recruited. In total, 27 IIM patients participated in a 24-week intervention combining activities-of-daily-life, resistance and stability training [1]. Muscle biopsies from m. vastus lateralis (by Bergström needle) were obtained from 7 IIM patients before/after the 24-week training program, and from 13 control IIM patients, and 21 HC. Primary muscle cell cultures were established from these samples. Disease-associated parameters were evaluated by MYOACT/MITAX, MDI, VAS, HAQ, MMT8, FI-2 and CK, myoglobin, LD, ALT, AST, and CRP levels. Myostatin, as a myokine involved in muscle atrophy, was determined from serum samples by ELISA. Circulating concentrations of 25(OH) vitamin D (calcidiol) and active 1,25(OH) vitamin D (calcitriol) were measured by routine biochemistry techniques. Gene expression of vitamin D receptor (VDR) and 25-hydroxyvitamin D 1-alpha-hydroxylase (CYP27B1), an enzyme catalysing calcidiol conversion to hormonally active calcitriol, was determined by real-time PCR in muscle tissue and primary muscle cell cultures. Data are presented as mean ± standard deviation.ResultsDecreased levels of active 1,25(OH)D were observed in IIM patients compared to HC (125.0±45.4 vs. 164.7±49.2 pmol/l; p<0.0001). No difference was found for 25(OH)D. The 24-week training program did not have an effect on 25(OH)D or 1,25(OH)D serum levels. 25(OH)D was significantly associated with CRP (r=-0.322, p=0.040), MITAX (r=-0.380, p=0.021) and HAQ (r=-0.370, p=0.017) in IIM patients, even after correction for BMI, gluccocorticoid (GC) and vitamin D daily supplementation dose. After 24 weeks of exercise, active 1,25(OH)D was positively associated with MMT8 (r=0.866, p<0.0001), FI2 (r=0.608, p=0.013) and HAQ (r=-0.537, p=0.032) (corrected for BMI, GC and vit.D supplementation). Numerically higher gene expression of VDR and CYP27B1 was found in muscle tissue and primary muscle cells in IIM compared to HC. After the 24-week training, gene expression of both VDR and CYP27B1 in primary muscle cells decreased (p=0.031 and p=0.078, respectively). Associations of VDR gene expression with myoglobin (IIM: r=0.510, p=0.026; HC: r=0.473, p=0.035), MMT8 (IIM: r=-0.559, p=0.013), myostatin (IIM: r=-0.519, p=0.023; HC: r=0.586, p=0.005), and CK (HC: r=0.484, p=0.031) were observed in muscle tissue. CYP27B1 gene expression in the muscle was also associated with myoglobin (HC: r=0.501, p=0.024), MMT8 (IIM: r=-0.555, p=0.011) and VDR (IIM: r=0.561, p=0.012; HC: r=0.632, p=0.002).ConclusionDecrease of the biologically active form of vitamin D in circulation suggests an impairment of its metabolism in IIM. Vitamin D serum levels and gene expression of its receptor and activating enzyme in muscle tissue associate with disease activity and muscle function parameters indicating an important role of vitamin D in physical fitness and disease manifestations in IIM patients.References[1]Špiritović M, et al. Arthritis Res Ther. 2021;23(1):173.AcknowledgementsThis work was supported by the Ministry of Health of the Czech Republic grant nr. NU21-05-00322.Disclosure of InterestsNone declared.
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Hellamand P, Van de Sande MGH, Midtbøll Ørnbjerg L, Klausch T, Nurmohamed M, Van Vollenhoven R, Nordström D, Hokkanen AM, Santos MJ, Vieira-Sousa E, Loft AG, Glintborg B, Østergaard M, Lindström U, Wallman JK, Michelsen B, Ciurea A, Nissen MJ, Codreanu C, Mogosan C, Macfarlane G, Jones GT, Laas K, Rotar Z, Tomsic M, Castrejon I, Pombo-Suarez M, Gudbjornsson B, Geirsson AJ, Kristianslund E, Vencovský J, Nekvindova L, Gulle S, Zengin B, Hetland ML, Van der Horst-Bruinsma I. OP0020 SEX DIFFERENCES IN EFFECTIVENESS OF FIRST-LINE TUMOR NECROSIS FACTOR INHIBITORS IN AXIAL SPONDYLOARTHRITIS; RESULTS FROM FIFTEEN COUNTRIES IN THE EuroSpA RESEARCH COLLABORATION NETWORK. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundEvidence reveals sex differences in physiology, disease presentation and response to treatment in axial spondyloarthritis (axSpA). Pooled data from four randomized controlled trials demonstrated reduced treatment efficacy of a tumor necrosis factor inhibitor (TNFi) in females compared to males with ankylosing spondylitis1. However, real-life evidence confirming these data in large cohorts is scarce. We sought to validate prior studies using data from a large multinational cohort based on real-life clinical practice.ObjectivesTo investigate sex differences in treatment response and drug retention rates in clinical practice among patients with axSpA, treated with their first TNFi.MethodsData from biologic-naïve axSpA patients initiating a TNFi in the EuroSpA registries were pooled. In the primary analysis, propensity-score weighting was applied to assess the causal effect of sex on clinically important improvement (CII) according to ASDAS-CRP at 6 months. A generalized linear regression model was used to estimate the causal risk difference (RD) and relative risk (RR) of sex on CII. Possible covariates influencing the outcome were determined a priori and selected based on availability in the database (<20% missing). The final covariates included in the model were country, age and TNFi start year. In the secondary analysis, drug retention was assessed over 24 months of follow-up by Kaplan-Meier curves and log-rank test.ResultsIn total, 6,451 axSpA patients with available data on ASDAS-CRP at baseline and 6 months were assessed for treatment response. Baseline characteristics are shown in the Table 1. In the adjusted analysis, the probability for females to have CII was 15% (RR, 0.85; 95% confidence interval [CI], 0.82 to 0.89) lower compared to males and the difference in probability for having CII was 9.4 percentage points (RD, 0.094; 95% CI, 0.069 to 0.12). The survival analysis included 28,608 axSpA patients with available data on retention rates. The TNFi 6/12/24-month retention rates were significantly lower in females (81%/69%/58%) compared to males (89%/81%/72%), see Figure 1.Table 1.FemaleMaleMean (SD), Median [IQR] or percentagesMean (SD), Median [IQR] or percentagesAge (years)42.0 (12.1)41.4 (12.3)Fulfilment of mNYC66%80%Disease duration (years)2.0 [1.0, 7.0]3.0 [1.0, 9.0]TNFi start year Start 1999-20097.2%9.8% Start 2010-201326%27% Start 2014-201637%36% Start 2017-202030%27%BASDAI, mm59 (20)54 (21)BASFI, mm48 (25)46 (24)ASDAS, units3.5 (0.9)3.5 (1.0)CRP (mg/L)6.7 [2.5, 16.0]11.9 [4.0, 25.0]SJC (0-28)0 [0, 0]0 [0, 0]TJC (0-28)0 [0, 2]0 [0, 1]VAS pain, mm63 (22)59 (24)VAS fatigue, mm65 (25)59 (26)mNYC, modified New York criteria; TNFi, tumor necrosis factor inhibitor; BASDAI, Bath Ankylosing Spondylitis Disease Activity Indexf; BASFI, Bath Ankylosing Spondylitis Functional Index; ASDAS, Ankylosing Spondylitis Disease Activity Score; CRP, C-reactive protein; SJC, swollen joint count; TJC, tender joint count; VAS, visual analogue scale.ConclusionTreatment efficacy and retention rates are lower among female patients with axSpA initiating their first TNFi. Females presented with lower C-reactive protein levels and higher scores on patient reported outcomes at baseline, reflecting differences in disease expression. Recognizing these sex differences is of relevance for customized patient care and may improve patient education.References[1]van der Horst-Bruinsma et al. Ann Rheum Dis. 2013 Jul;72(7):1221-4.AcknowledgementsNovartis Pharma AG and IQVIA for supporting the EuroSpA collaboration.Disclosure of InterestsPasoon Hellamand Grant/research support from: Novartis, Marleen G.H. van de Sande Speakers bureau: UCB, Consultant of: Abbvie, Eli Lily, Novartis and UCB, Grant/research support from: Novartis, Janssen, UCB and Eli Lilly, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Thomas Klausch: None declared, Michael Nurmohamed Speakers bureau: Abbvie, Janssen and Celgene, Consultant of: Abbvie, Grant/research support from: Abbvie, Amgen, Pfizer, Galapagos, BMS, Ronald van Vollenhoven Consultant of: AbbVie, AstraZeneca, Biogen, BMS, Galapagos, Janssen, Miltenyi, Pfizer, UCB and speaker fees from Abbvie, Galapagos, GSK, Janssen, Pfizer, R-Pharma and UCB, Grant/research support from: BMS, GSK and UCB, Dan Nordström Consultant of: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Anna-Mari Hokkanen Grant/research support from: MSD, Maria Jose Santos Speakers bureau: Abbvie, AstraZeneca, Lilly, Novartis and Pfizer, Elsa Vieira-Sousa Speakers bureau: MSD, Celgene, Novartis, Janssen, Abbvie and Pfizer, Consultant of: MSD, Celgene, Novartis, Janssen, Abbvie and Pfizer, Grant/research support from: MSD, Celgene, Novartis, Janssen, Abbvie and Pfizer, Anne Gitte Loft Consultant of: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: Novartis, Bente Glintborg Grant/research support from: Pfizer, Abbvie and BMS, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, BMS, Merck, Celgene and Novartis, Ulf Lindström: None declared, Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly and Novartis, Brigitte Michelsen Grant/research support from: Novartis, Adrian Ciurea Speakers bureau: AbbVie and Novartis, Michael J. Nissen Speakers bureau: AbbVie, Eli Lilly, Janssens, Novartis and Pfizer, Consultant of: AbbVie, Eli Lilly, Janssens, Novartis and Pfizer, Catalin Codreanu Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis and Pfizer, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis and Pfizer, Corina Mogosan Speakers bureau: AbbVie, Ewopharma, Lilly, Novartis and Pfizer, Consultant of: AbbVie, Ewopharma, Lilly, Novartis and Pfizer, Gary Macfarlane Grant/research support from: GSK, Gareth T. Jones Grant/research support from: AbbVie, Pfizer, UCB, Amgen and GSK, Karin Laas Speakers bureau: Amgen, Janssen, Novartis and Abbvie, Ziga Rotar Speakers bureau: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek and Janssen, Consultant of: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek and Janssen, Matija Tomsic Speakers bureau: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi and Sandoz-Lek, Consultant of: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi and Sandoz-Lek, Isabel Castrejon Speakers bureau: Eli Lilly, BMS, Janssen, MSD and Abbvie, Consultant of: Eli Lilly, BMS, Janssen, MSD and Abbvie, Manuel Pombo-Suarez Consultant of: Abbvie, MSD and Roche, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, Consultant of: Amgen and Novartis, Arni Jon Geirsson: None declared, Eirik kristianslund: None declared, Jiří Vencovský Speakers bureau: Abbvie, Argenx, Boehringer-Ingelheim, Eli-Lilly, Gilead, MSD, Novartis, Octapharma, Pfizer, Roche, Sanofi and UCB, Consultant of: Abbvie, Argenx, Boehringer-Ingelheim, Eli-Lilly, Gilead, MSD, Novartis, Octapharma, Pfizer, Roche, Sanofi and UCB, Lucie Nekvindova: None declared, Semih Gulle: None declared, Berrin Zengin: None declared, Merete Lund Hetland Grant/research support from: Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz and Novartis, Irene van der Horst-Bruinsma Speakers bureau: BMS, AbbVie, Pfizer and MSD, Consultant of: Abbvie, UCB, MSD, Novartis and Lilly, Grant/research support from: MSD, Pfizer, AbbVie and UCB.
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Vencovský J, Pisarczyk K, Leff R, Park E, Palaniswamy K, Long L. AB1277 POOR LONG-TERM OUTCOMES AND SUBSTANTIAL BURDEN OF COMORBIDITIES IN EUROPEAN PATIENTS WITH DERMATOMYOSITIS/POLYMYOSITIS: RESULTS FROM A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundDermatomyositis (DM) and polymyositis (PM) are rare heterogenous systemic autoimmune disorders of the skin, muscles and other organs that may have a devastating impact on patients’ lives. Despite various therapies used in clinical practice, a notable proportion of patients seem not to achieve sustainable remission. There is a need to better understand long-term outcomes and comorbidities in patients with DM/PM in Europe.ObjectivesTo systematically review and summarize evidence on clinical burden of disease in patients with DM/PM in Europe.MethodsA systematic literature review (SLR) was conducted in MEDLINE and Embase databases to identify studies in children and adults with DM/PM, published in the English language between 2011 and 2021. Primary studies enrolling 10 or more patients were included, irrespective of country or region. Each eligible article was independently reviewed by two reviewers. The title and study abstracts were reviewed to assess eligibility for full-text review. The current abstract summarizes SLR results on the long-term outcomes and comorbidities in patients with DM/PM in Europe.ResultsA total of 2,967 non-duplicated publications were retrieved from medical databases and analyzed against pre-defined study selection criteria. There were 2,574 records excluded at title and abstract screening. Remaining 393 records were analyzed in the full text with 208 papers considered relevant. Additional 21 papers were identified from searching reference list of relevant studies and conference proceedings. In total, 222 studies (229 publications) were included in data abstraction. Among 43 studies conducted across 14 European countries, 23 studies evaluated long-term outcomes of disease and burden of comorbidities. There were 14 longitudinal cohort studies, 7 cross-sectional analyses and 2 case-control studies. Only 29-44% of DM/PM adults achieved remission. Between 38% and 62% of adults with DM/PM required at least 3 different medications, suggesting inadequate response to initial and subsequent regimens. During a mean follow-up of 13.9 years, 69% patients with JDM had polycyclic or chronic disease characterized by periods of remission and recurrence or by permanently active disease for more than 2 years after diagnosis. A notable proportion of children (60.4%) showed evidence of damage in at least one body organ and 13-20% of patients had complications such as calcinosis, lipodystrophy, or muscle atrophy. Adults with DM/PM often suffered from interstitial lung disease (16-66%), serious infections leading to hospitalization or death (21-26.7%), and cardiovascular disorders (CVDs) (19-71%). Compared to age and gender matched controls without DM, patients with DM had 16-times higher risk of venous thromboembolism (HR=16.44, 95% CI: 7.54-35.86). Incidence of coronary heart disease, hemorrhagic stroke, or ischemic stroke during 10-year follow-up was approximately 1.5- to 2-times higher in DM/PM adults relative to general population. Multiple studies reported high rates of any malignancy in DM adults (7.5-33%) and in PM adults (8-11.7%). During approximately 24,000 patient-years of follow-up, adults with DM/PM had more than 4-times higher incidence of lung cancer compared to general population that also was one of the highest incidences among multiple other autoimmune diseases. Long-term prognosis in DM/PM was poor with 20-year survival below 70%. The most common causes of deaths were pulmonary-related, malignancies, and cardiac complications. Mortality due to lung cancer was more than 4-times higher than in general population (standardized mortality ratio=4.17, 95% CI: 3.03-5.60).ConclusionEuropean patients with DM/PM suffer from substantial burden of comorbidities including serious infections, malignancies and CVDs that lead to poor long-term outcomes. A notable proportion of adult and juvenile patients do not achieve sustainable remission or experience relapse indicating high unmet need.Disclosure of InterestsJiří Vencovský Speakers bureau: Abbvie, Biogen, Boehringer, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Roche, Sanofi, UCB, Werfen, Consultant of: Abbvie, Argenx, Boehringer, Eli Lilly, Gilead, Octapharma, Pfizer, UCB, Grant/research support from: Abbvie, Konrad Pisarczyk Consultant of: Kezar Life Sciences, Richard Leff Shareholder of: Kezar Life Sciences, Consultant of: Kezar Life Sciences, Eunmi Park Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Kiruthi Palaniswamy Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences, Li Long Shareholder of: Kezar Life Sciences, Employee of: Kezar Life Sciences.
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Pavelcova K, Stiburkova B, Balajková V, Belickova M, Salek C, Vostry M, Mann H, Vencovský J. AB1275 SUGGESTED APPROACH TO UBA1 GENE MUTATION TESTING IN PATIENTS WITH SUSPECTED VEXAS SYNDROME. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundVEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is a recently identified autoinflammatory disease caused by de novo somatic mutations in the X-linked gene UBA1 (1). This disease is clinically characterized by inflammatory symptoms and bone marrow failure (2).ObjectivesThe aim of our study was to identify genetic variants associated with VEXAS syndrome and to design an algorithm for detection of UBA1 gene mutations in patients with suspected VEXAS syndrome, which could be used for diagnosis.MethodsWe examined the UBA1 gene in 9 patients with clinically suspected VEXAS syndrome. We first focused on variants p.Met41Val, p.Met41Thr and p.Met41Leu with a known association with this disease (1). Samples of individual blood cell populations obtained by magnetic isolation were evaluated using RFLP, tetra-primer ARMS-PCR and Sanger sequencing. Subsequently, we analyzed the remaining exons of the UBA1 gene by Sanger sequencing.ResultsUsing the above described method we have identified the previously described variants p.Met41Thr in two and p.Met41Leu in another two patients. In one patient, we discovered a new mutation p.Gly477Ala (c.1430G>C) in exon 14 that has not yet been identified. The presence of these variants and their allelic forms (heterozygous / homozygous) varied between cell populations in individual patients.ConclusionThe increasing number of reports suggests that VEXAS syndrome is not rare. In patients with clinical suspicion, typically UBA1 sequencing analysis of haematopoietic cells is performed in hot spot sites of p.Met41 in exon 3 only. Our results suggest that other variants, such as the newly identified p.Gly477Ala variant, may also be associated with clinical features of VEXAS syndrome. We propose that an extended analysis of all coding regions of the UBA1 gene may uncover other mutations with putative functional consequences.References[1]Beck DB, et al. Somatic Mutations in UBA1 and Severe Adult-Onset Autoinflammatory Disease. N Engl J Med. 2020 Dec 31;383(27):2628-2638. doi: 10.1056/NEJMoa2026834.[2]Grayson PC, et al. VEXAS syndrome. Blood. 2021 Jul 1;137(26):3591-3594. doi: 10.1182/blood.2021011455.AcknowledgementsSupported by MH CZ: DRO (Institute of Rheumatology, 00023728), RVO (VFN, 64165), DRO (IHBT, 00023736), grant NV18-03-00227, and grant NU21-05-00522.Disclosure of InterestsNone declared
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Leclair V, Galindo-Feria AS, Rothwell S, Kryštůfková O, Mann H, Pyndt Diederichsen L, Andersson H, Klein M, Tansley S, Mchugh N, Lamb J, Vencovský J, Chinoy H, Holmqvist M, Padyukov L, Lundberg IE, Diaz-Gallo LM. OP0160 HLA-DRB1 ASSOCIATIONS WITH AUTOANTIBODY-DEFINED SUBGROUPS IN IDIOPATHIC INFLAMMATORY MYOPATHIES (IIM). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThere is a gap between how IIM patients are classified in practice and current validated classification criteria1. Also, different associations with genetic variations in HLA can inform about different T-cell mechanisms involved in disease pathogenesis.ObjectivesWe aimed to systematically study associations between HLA-DRB1 alleles, clinical manifestations, and autoantibody-defined IIM subgroups.MethodsWe included 1348 IIM patients from five European countries. An unsupervised cluster analysis was performed using 14 autoantibodies: anti-Jo1, -PL7, -PL12, -EJ, -OJ, -SRP, -U1RNP, -Ro52, -Mi2, -TIF1γ, -MDA5, -PMScl, -SAE1, and -NXP2 to identify patients’ subgroups. Logistic regressions were used to estimate the associations between HLA-DRB1 alleles, clinical manifestations and the identified subgroups.ResultsEight subgroups were defined by the autoantibody status (Table 1). Three of the subgroups (1, 2 and 6) have overlapping autoantibodies, while four are almost monospecific (3,4,5 and 7), and one (8) has patients negative for tested autoantibodies. Figure 1 represents the significant associations between HLA-DRB1 alleles and the eight subgroups. Heliotrope rash and Gottron’s sign were significantly more frequent in subgroups 3 (OR:2.2 95%CI:[1.1-4.8], OR:2.6 95%CI:[1.3-5.9], respectively), 4 (OR:12 95%CI:[3.6-75], OR:7.8 95%CI:[2.8-33], respectively) and 7 (OR:22 95%CI:[4.5-385], OR:10 95%CI:[3.1-65], respectively), and Raynaud’s phenomenon was significantly more frequent in subgroup 6 (OR:3.3 95%CI:[1.2-11]).Table 1.Autoantibody-defined subgroups using an unsupervised cluster analysis.Subgroups/ MedoidsVariables1 Ro522 U1RNP3 PMScl4 Mi25 Jo16 Jo1/Ro527 TIF18 None*Alln (%)137 (10)183 (14)107 (8)65 (5)119 (9)140 (10)78 (6)519 (39)1348 (100)Female (%)93 (68)116 (63)79 (74)45 (69)76 (64)96 (69)64 (82)313 (60)882 (65)Age at diagnosis, median (IQR)56 (16)51.5 (23)51 (25)57 (22.5)47.5 (23.25)52 (19.5)53.5 (21.75)58 (22)55 (23)AutoantibodiesAnti-Jo106 (3)01 (2)119 (100)140 (100)00266 (20)Anti-PL77 (5)13 (7)00000020 (1.5)Anti-PL125 (4)3 (2)1 (1)01 (1)00010 (0.7)Anti-EJ2 (2)00000002 (0.1)Anti-OJ07 (4)0000007 (0.5)Anti-TIF110 (7)2 (1)2 (2)00078 (100)092 (7)Anti-Mi21 (1)1 (1)1 (1)65 (100)02 (1)0070 (5)Anti-SAE18 (6)23 (13)00000031 (2)Anti-NXP21 (1)23 (13)1 (1)0000025 (2)Anti-MDA59 (7)10 (6)1 (1)1 (2)01 (1)0022 (2)Anti-SRP8 (6)32 (18)00000040 (3)Anti-Ro52137 (100)16 (9)000140 (100)00293 (22)Anti-PMScl11 (8)1 (1)107 (100)00000119 (9)Anti-U1RNP079 (43)0003 (2)0082 (6)*IIM patients negative for the tested autoantibodies.Figure 1.Forest plot of significant associations of HLA. *DRB1 alleles with autoantibody-defined subgroups. Scandinavia includes patients from Denmark, Norway, and Sweden.ConclusionOur study reveals that certain subgroups of IIM patients are characterized by overlap of myositis -specific and -associated autoantibodies, which in turn are associated with different HLA-DRB1 alleles including potential novel associations. These results point to different disease mechanisms in the subgroups, as well as suggest that IIM classification could be improved by integrating broader serological and genetic data.References[1]Parker MJS, Oldroyd A, Roberts ME, et al. The performance of the European League Against Rheumatism/American College of Rheumatology idiopathic inflammatory myopathies classification criteria in an expert-defined 10 year incident cohort. Rheumatology (Oxford). 2019;58(3):468-475.AcknowledgementsWe thank all the patients who participated in the study.Disclosure of InterestsValerie Leclair: None declared, Angeles Shunashy Galindo-Feria: None declared, Simon Rothwell: None declared, Olga Kryštůfková: None declared, Heřman Mann: None declared, Louise Pyndt Diederichsen: None declared, helena andersson: None declared, Martin Klein: None declared, Sarah Tansley: None declared, Neil McHugh: None declared, Janine Lamb: None declared, Jiří Vencovský Speakers bureau: Abbvie, Biogen, Boehringer, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Roche, Sanofi, UCB, Werfen, Consultant of: Abbvie, Argenx, Boehringer, Eli Lilly, Gilead, Octapharma, Pfizer, UCB, Grant/research support from: Abbvie, Hector Chinoy: None declared, Marie Holmqvist: None declared, Leonid Padyukov: None declared, Ingrid E. Lundberg Shareholder of: Roche and Novartis, Consultant of: Corbus Pharmaceuticals Inc, Astra Zeneca, Bristol Myer´s Squibb, Corbus Pharmaceutical, EMD Serono Research & Development Institute, Argenx, Octapharma, Kezaar, Orphazyme, and Janssen, Grant/research support from: Astra Zeneca, Lina M. Diaz-Gallo: None declared
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Heřmánková B, Špiritović M, Oreska S, Štorkánová H, Pavelka K, Šenolt L, Vencovský J, Bečvář R, Tomčík M. OP0208-HPR EFFECT OF AN 8-WEEK SPECIALIZED PHYSICAL THERAPY PROGRAM ON SEXUAL HEALTH IN FEMALE PATIENTS WITH SYSTEMIC SCLEROSIS AND IDIOPATHIC INFLAMMATORY MYOPATHIES: A PILOT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSystemic rheumatic diseases like systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM) may affect all aspects of life, including sexual health However, no non-pharmacological treatment has been proposed to date.ObjectivesThis is the pilot project aiming to investigate the effect of an 8-week physical therapy program on sexual function in women with SSc and IIM.MethodsIn total, 12 women with SSc and 4 women with IIM, who fulfilled the ACR/EULAR 2013 criteria for SSc and the Bohan/Peter 1975 criteria for DM/PM, respectively, were enrolled in the study. Based on patient’s possibilities and willingness to participate in the program, they were divided into an intervention group (IG) (6 SSc/2 IIM, mean age: 46.8±3.1 years) and a control group (CG) (6 SSc/2 IIM, mean age: 46.3±3.0 years). The IG underwent the 8-week tailored physiotherapy program, including the pelvic floor exercise and physiotherapy of musculoskeletal problems subjectively limiting the patient’s sexual function (1 hour supervised physiotherapy twice weekly), whereas the control group received no specialized therapy. At weeks 0 and 8, all patients filled in questionnaires assessing sexual function: Female Sexual Function Index (FSFI), Brief Index of Sexual Functioning for Women (BISF-W); sexual quality of life: Sexual Quality of Life-Female (SQoL-F); functional ability: Health Assessment Questionnaire (HAQ); quality of life: Medical Outcomes Short Form-36 (SF-36) and depression: Beck’s Depression Inventory-II (BDI-II). At the baseline, patients in IG were assessed by a physician (medical history, mRSS, ESSG activity score, MITAX, MYOACT) and by a physiotherapist (pelvic floor function assessment–PERFECT scheme, MMT-8, Functional Index-II). Normality of data was tested, and inter-group analysis was performed with 2-way ANOVA and intra-group analysis by Friedmann’s test.ResultsCompared to observed statistically significant deterioration in CG over the period of weeks 0-8, we found statistically significant improvement in both sexual function questionnaires: FSFI (p=0.043), BISF-W (p=0.040), functional status: HAQ (p=0.018), and quality of life: SF-36 Physical Somponent score (0.050). Only numerical improvement in IG compared to numerical deterioration in CG, which has not reached statistical significance, was observed in SQoL-F, BDI-II, and SF-36 Mental Component Score.ConclusionOur physiotherapy program not only prevented the natural course of progressive deterioration of functional abilities, but also led to a significant improvement in sexual function and overall quality of life in women with SSc and IIM. Physical therapy might become one of the possible therapeutic treatments for sexual problems in women with SSc and IIM.Figure 1.AcknowledgementsSupported by MHCR 023728, SVV–260523, GAUK-1578119.Disclosure of InterestsNone declared
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Alchus Laiferová N, Nemec M, Vernerová L, Balážová M, Vokurková M, Oreská S, Klein M, Špiritović M, Tomčík M, Vencovský J, Ukropec J, Ukropcová B. MyomiRs in cultured muscle cells from patients with idiopathic inflammatory myopathy are modulated by disease but not by 6-month exercise training. Clin Exp Rheumatol 2022; 40:346-357. [DOI: 10.55563/clinexprheumatol/69z7za] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Nikoleta Alchus Laiferová
- Institute of Experimental Endocrinology, Biomedical Research Centre, Slovak Academy of Sciences, Bratislava, and Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michal Nemec
- Institute of Experimental Endocrinology, Biomedical Research Centre, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | - Mária Balážová
- Centre of Biosciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | | | - Sabína Oreská
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Klein
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maja Špiritović
- Institute of Rheumatology, Prague, and Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jozef Ukropec
- Institute of Experimental Endocrinology, Biomedical Research Centre, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Barbara Ukropcová
- Institute of Experimental Endocrinology, Biomedical Research Centre, Slovak Academy of Sciences, Bratislava, and Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
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Štorkánová H, Oreská S, Špiritović M, Heřmánková B, Bubová K, Kryštůfková O, Mann H, Komarc M, Slabý K, Pavelka K, Šenolt L, Zámečník J, Vencovský J, Tomčík M. Hsp90 Levels in Idiopathic Inflammatory Myopathies and Their Association With Muscle Involvement and Disease Activity: A Cross-Sectional and Longitudinal Study. Front Immunol 2022; 13:811045. [PMID: 35154129 PMCID: PMC8832010 DOI: 10.3389/fimmu.2022.811045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Heat shock proteins (Hsp) are chaperones playing essential roles in skeletal muscle physiology, adaptation to exercise or stress, and activation of inflammatory cells. We aimed to assess Hsp90 in patients with idiopathic inflammatory myopathies (IIM) and its association with IIM-related features. Methods Hsp90 plasma levels were analyzed in a cross-sectional cohort (277 IIM patients and 157 healthy controls [HC]) and two longitudinal cohorts to assess the effect of standard-of-care pharmacotherapy (n=39 in early disease and n=23 in established disease). Hsp90 and selected cytokines/chemokines were measured by commercially available ELISA and human Cytokine 27-plex Assay. Results Hsp90 plasma levels were increased in IIM patients compared to HC (median [IQR]: 20.2 [14.3–40.1] vs 9.8 [7.5–13.8] ng/mL, p<0.0001). Elevated Hsp90 was found in IIM patients with pulmonary, cardiac, esophageal, and skeletal muscle involvement, with higher disease activity or damage, and with elevated muscle enzymes and crucial cytokines/chemokines involved in the pathogenesis of myositis (p<0.05 for all). Plasma Hsp90 decreased upon pharmacological treatment in both patients with early and established disease. Notably, Hsp90 plasma levels were slightly superior to traditional biomarkers, such as C-reactive protein and creatine kinase, in differentiating IIM from HC, and IIM patients with cardiac involvement and interstitial lung disease from those without these manifestations. Conclusions Hsp90 is increased systemically in patients with IIM. Plasma Hsp90 could become an attractive soluble biomarker of disease activity and damage and a potential predictor of treatment response in IIM.
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Affiliation(s)
- Hana Štorkánová
- Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Sabína Oreská
- Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Maja Špiritović
- Institute of Rheumatology, Prague, Czechia
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Kristýna Bubová
- Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Olga Kryštůfková
- Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Heřman Mann
- Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Kryštof Slabý
- Department of Rehabilitation and Sports Medicine, 2 Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Ladislav Šenolt
- Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Josef Zámečník
- Department of Pathology and Molecular Medicine, 2 Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Michal Tomčík
- Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czechia
- *Correspondence: Michal Tomčík,
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Heřmánková B, Špiritović M, Šmucrová H, Oreská S, Štorkánová H, Komarc M, Pavelka K, Šenolt L, Vencovský J, Bečvář R, Tomčík M. Female Sexual Dysfunction and Pelvic Floor Muscle Function Associated with Systemic Sclerosis: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:612. [PMID: 35010872 PMCID: PMC8744868 DOI: 10.3390/ijerph19010612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023]
Abstract
Only a few studies have addressed sexual health in patients with systemic sclerosis (SSc). This study aimed to compare female sexual function and pelvic floor muscle function in SSc patients with healthy controls (HC) matched by age, and to identify the potential implications of clinical features on sexual function. Our cohort included 90 women with SSc and 90 HC aged 18-70 years that completed six well-established and validated questionnaires assessing sexual function (Brief Index of Sexual Function for Women, Female Sexual Function Index, Sexual Quality of Life Questionnaire-Female, Sexual Function Questionnaire) and pelvic floor function (Pelvic Floor Impact Questionnaire-Short Form 7 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form). Results from women with SSc and HC were contrasted and correlated with relevant clinical features. The prevalence of female sexual dysfunction was 73% in SSc patients (vs. 31% in HC). Women with SSc reported significantly worse pelvic floor function and sexual function than HC. Impaired sexual function was correlated with higher disease activity, the presence of dyspnea and interstitial lung disease, increased systemic inflammation, reduced physical activity, functional disability, more severe depression, more pronounced fatigue, and impaired quality of life. We demonstrate that sexual dysfunction is highly prevalent among women with SSc. This aspect of the disease deserves more attention both in clinical care and at the level of international research collaboration.
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Affiliation(s)
- Barbora Heřmánková
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic
| | - Maja Špiritović
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic
| | - Hana Šmucrová
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
| | - Sabína Oreská
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic;
| | - Karel Pavelka
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Radim Bečvář
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
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Heřmánková B, Špiritović M, Oreská S, Štorkánová H, Komarc M, Klein M, Mann H, Pavelka K, Šenolt L, Vencovský J, Tomčík M. Sexual function in patients with idiopathic inflammatory myopathies: a cross-sectional study. Rheumatology (Oxford) 2021; 60:5060-5072. [PMID: 33956947 PMCID: PMC8566285 DOI: 10.1093/rheumatology/keab397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To date, there is almost no information concerning the sexual health of patients with idiopathic inflammatory myopathies (IIM). This cross-sectional study aimed to compare sexual function in patients with IIM to age-/sex-matched healthy controls (HC) and determine the potential impact of clinical features on sexual function. METHODS In total, 122 women (61 with IIM, 61 age-matched HC) and 22 men (11 with IIM, 11 age-matched HC) aged 18-80 years completed gender-specific selection of 7 well-established and validated questionnaires assessing sexual health and function (Female Sexual Function Index, Brief Index of Sexual Function for Women, Sexual Function Questionnaire, Sexual Quality of Life Questionnaire-Female, International Index of Erectile Function, Male Sexual Health Questionnaire, Sexual Quality of Life Questionnaire-Male). Results were compared between patients and HC and correlated with selected disease-related features. RESULTS The prevalence of sexual dysfunction in IIM was 59% in women (vs 40% in HC), and 64% (vs 9% in HC) in men. Men and women with IIM reported significantly impaired sexual function compared with sex-/age-matched HC. Decreased sexual function was associated with muscle weakness, disability, physical inactivity, fatigue, depression and decreased quality of life. CONCLUSIONS Our results suggest that sexual dysfunction is common among IIM patients and more attention should be paid to this aspect of the disease.
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Affiliation(s)
- Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Maja Špiritović
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
- Institute of Rheumatology, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Martin Klein
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Navrátilová A, Andrés Cerezo L, Hulejová H, Bečvář V, Tomčík M, Komarc M, Veigl D, Tegzová D, Závada J, Olejárová M, Pavelka K, Vencovský J, Šenolt L. IL-40: A New B Cell-Associated Cytokine Up-Regulated in Rheumatoid Arthritis Decreases Following the Rituximab Therapy and Correlates With Disease Activity, Autoantibodies, and NETosis. Front Immunol 2021; 12:745523. [PMID: 34745117 PMCID: PMC8566875 DOI: 10.3389/fimmu.2021.745523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/24/2021] [Indexed: 01/10/2023] Open
Abstract
Background Interleukin 40 (IL-40) is a newly identified B cell-associated cytokine implicated in humoral immune responses and B cell homeostasis. As B cells play a pivotal role in autoimmunity, we investigated the function of IL-40 in rheumatoid arthritis (RA). Methods IL-40 expression was determined in the synovial tissue from RA and osteoarthritis (OA) patients. IL-40 was analysed in the serum/synovial fluid of patients with RA (n=50), systemic lupus erythematosus (SLE, n=69), OA (n=44), and healthy controls (HC, n=50). We assessed the changes of IL-40 levels in RA patients following the B cell depletion by rituximab (n=29) or after the TNF inhibition by adalimumab (n=25). We examined the relationship between IL-40, disease activity, autoantibodies, cytokines, and NETosis markers. Effect of IL-40 on synovial fibroblasts was determined. Results IL-40 was overexpressed in RA synovial tissue, particularly by synovial lining and infiltrating immune cells. The levels of IL-40 were up-regulated in the synovial fluid of RA versus OA patients (p<0.0001). Similarly, IL-40 was increased in the serum of RA patients compared to HC, OA, or SLE (p<0.0001 for all) and decreased after 16 and 24 weeks (p<0.01 and p<0.01) following rituximab treatment. No significant effect of adalimumab on IL-40 was observed. IL-40 levels in RA patients correlated with rheumatoid factor-IgM and anti-cyclic citrullinated peptides (anti-CCP) in the serum (p<0.0001 and p<0.01), as well as in the synovial fluid (p<0.0001 and p<0.001). Synovial fluid IL-40 was also associated with disease activity score DAS28 (p<0.05), synovial fluid leukocyte count (p<0.01), neutrophil attractants IL-8 (p<0.01), MIP-1α (p<0.01), and markers of neutrophil extracellular traps externalization (NETosis) such as proteinase 3 (p<0.0001) and neutrophil elastase (p<0.0001). Synovial fibroblasts exposed to IL-40 increased the secretion of IL-8 (p<0.01), MCP-1 (p<0.05), and MMP-13 (p<0.01) compared to the unstimulated cells. Conclusions We show the up-regulation of IL-40 in RA and its decrease following B cell depleting therapy. The association of IL-40 with autoantibodies, chemokines, and markers of NETosis may imply its potential involvement in RA development. Moreover, IL-40 up-regulates the secretion of chemokines and MMP-13 in synovial fibroblasts, indicating its role in the regulation of inflammation and tissue destruction in RA.
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Affiliation(s)
- Adela Navrátilová
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Lucie Andrés Cerezo
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Hana Hulejová
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
| | - Viktor Bečvář
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
| | - Michal Tomčík
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - David Veigl
- First Orthopaedic Clinic, 1 Faculty of Medicine, Charles University, Prague, Czechia
| | - Dana Tegzová
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Jakub Závada
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Marta Olejárová
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Karel Pavelka
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Jiří Vencovský
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Ladislav Šenolt
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czechia
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czechia
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Kropáčková T, Vernerová L, Štorkánová H, Horváthová V, Vokurková M, Klein M, Oreská S, Špiritović M, Heřmánková B, Kubínová K, Cerezo LA, Kryštůfková O, Mann H, Ukropec J, Ukropcová B, Zámečník J, Tomčík M, Vencovský J, Šenolt L. Clusterin is upregulated in serum and muscle tissue in idiopathic inflammatory myopathies and associates with clinical disease activity and cytokine profile. Clin Exp Rheumatol 2021; 39:1021-1032. [DOI: 10.55563/clinexprheumatol/k3vtg5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/07/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Tereza Kropáčková
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Hana Štorkánová
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Veronika Horváthová
- Institute of Rheumatology, Prague, and Faculty of Science, Charles University, Prague, Czech Republic
| | | | - Martin Klein
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maja Špiritović
- Institute of Rheumatology, Prague, and Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Barbora Heřmánková
- Institute of Rheumatology, Prague, Czech Republic 4 Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Olga Kryštůfková
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jozef Ukropec
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Barbara Ukropcová
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, and Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Josef Zámečník
- Department of Pathology and Molecular Medicine, 2nd Medical School and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Špiritović M, Šmucrová H, Heřmánková B, Oreská S, Štorkánová H, Rathouská A, Česák P, Komarc M, Růžičková O, Bunc V, Pavelka K, Vencovský J, Šenolt L, Bečvář R, Tomčík M. The effect of a 24-week physiotherapy and occupational therapy program in systemic sclerosis: a monocentric controlled study with follow-up. Clin Exp Rheumatol 2021; 40:1941-1950. [DOI: 10.55563/clinexprheumatol/0njr37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Maja Špiritović
- Institute of Rheumatology, Prague, and Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | | | - Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Petr Česák
- Department of Human Movement Laboratory, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Olga Růžičková
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Václav Bunc
- Department of Human Movement Laboratory, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radim Bečvář
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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31
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Špiritović M, Heřmánková B, Oreská S, Štorkánová H, Růžičková O, Vernerová L, Klein M, Kubínová K, Šmucrová H, Rathouská A, Česák P, Komarc M, Bunc V, Pavelka K, Šenolt L, Mann H, Vencovský J, Tomčík M. The effect of a 24-week training focused on activities of daily living, muscle strengthening, and stability in idiopathic inflammatory myopathies: a monocentric controlled study with follow-up. Arthritis Res Ther 2021; 23:173. [PMID: 34154634 PMCID: PMC8218432 DOI: 10.1186/s13075-021-02544-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The structural and functional changes of the skeletal muscles in idiopathic inflammatory myopathies (IIM) caused by inflammation and immune changes can be severely disabling. The objective of this study was to assess the effect of a 24-week program combining a supervised training of activities of daily living (ADL), resistance, and stability with home exercise for improving muscle function, compared to a daily home-based exercise representing the regular outpatient care. METHODS Fifty-seven patients with IIM were consecutively and non-selectively enrolled in an intervention (IG, n = 30) or control (CG, n = 27) group. Both groups were provided a standard-of-care pharmacological treatment and follow-up. Only the IG underwent the supervised intervention twice a week for 1 h per session. At baseline, 12, 24, and 48 weeks, all patients were assessed by an assessor blinded to the intervention for primary outcomes: muscle strength (Manual Muscle Testing of eight muscle groups [MMT-8]) and endurance (Functional Index-2 [FI-2]), and secondary outcomes: stability and body composition. Secondary outcomes also included questionnaires evaluating disability (Health Assessment Questionnaire [HAQ]), quality of life (Short Form 36 [SF-36]), depression (Beck's Depression Inventory-II [BDI-II]), and fatigue (Fatigue Impact Scale [FIS]), and analysis of the systemic and local inflammatory response and perceived exertion to assess the safety of the intervention. RESULTS Twenty-seven patients in the IG and 23 in the CG completed the entire program and follow-up. At week 24, compared to deterioration in the CG, we found a significant improvement in the IG in muscle strength (mean % improvement compared to baseline by 26%), endurance (135%), disability (39%), depression (26%), stability (11%), and basal metabolism (2%) and a stabilization of fitness for physical exercise. The improvement was clinically meaningful (a 24-week change by >20%) in most outcomes in a substantial proportion of patients. Although the improvement was still present at 48 weeks, the effect was not sustained during follow-up. No significant increase in the systemic or local expression of inflammatory markers was found throughout the intervention. CONCLUSIONS This 24-week supervised intervention focused on ADL training proved to be safe and effective. It not only prevented the progressive deterioration, but also resulted in a significant improvement in muscle strength, endurance, stability, and disability, which was clinically meaningful in a substantial proportion of patients. TRIAL REGISTRATION ISRCTN35925199 (retrospectively registered on 22 May 2020).
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Affiliation(s)
- Maja Špiritović
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Růžičková
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucia Vernerová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic
| | - Martin Klein
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Šmucrová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic
| | - Adéla Rathouská
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic
| | - Petr Česák
- Department of Human Movement Laboratory, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Václav Bunc
- Department of Human Movement Laboratory, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic. .,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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Štorkánová H, Štorkánová L, Navrátilová A, Bečvář V, Hulejová H, Oreská S, Heřmánková B, Špiritović M, Bečvář R, Pavelka K, Vencovský J, Distler JHW, Šenolt L, Tomčík M. Inhibition of Hsp90 Counteracts the Established Experimental Dermal Fibrosis Induced by Bleomycin. Biomedicines 2021; 9:650. [PMID: 34200311 PMCID: PMC8226767 DOI: 10.3390/biomedicines9060650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022] Open
Abstract
Our previous study demonstrated that heat shock protein 90 (Hsp90) is overexpressed in the involved skin of patients with systemic sclerosis (SSc) and in experimental dermal fibrosis. Pharmacological inhibition of Hsp90 prevented the stimulatory effects of transforming growth factor-beta on collagen synthesis and the development of dermal fibrosis in three preclinical models of SSc. In the next step of the preclinical analysis, herein, we aimed to evaluate the efficacy of an Hsp90 inhibitor, 17-dimethylaminoethylamino-17-demethoxygeldanamycin (17-DMAG), in the treatment of established experimental dermal fibrosis induced by bleomycin. Treatment with 17-DMAG demonstrated potent antifibrotic and anti-inflammatory properties: it decreased dermal thickening, collagen content, myofibroblast count, expression of transforming growth factor beta receptors, and pSmad3-positive cell counts, as well as leukocyte infiltration and systemic levels of crucial cytokines/chemokines involved in the pathogenesis of SSc, compared to vehicle-treated mice. 17-DMAG effectively prevented further progression and may induce regression of established bleomycin-induced dermal fibrosis to an extent comparable to nintedanib. These findings provide further evidence of the vital role of Hsp90 in the pathophysiology of SSc and characterize it as a potential target for the treatment of fibrosis with translational implications due to the availability of several Hsp90 inhibitors in clinical trials for other indications.
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Affiliation(s)
- Hana Štorkánová
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Lenka Štorkánová
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
| | - Adéla Navrátilová
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Viktor Bečvář
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
| | - Hana Hulejová
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
| | - Sabína Oreská
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 16252 Prague, Czech Republic;
| | - Maja Špiritović
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 16252 Prague, Czech Republic;
| | - Radim Bečvář
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Jörg H. W. Distler
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Ladislav Šenolt
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, 12800 Prague, Czech Republic; (H.Š.); (L.Š.); (A.N.); (V.B.); (H.H.); (S.O.); (M.Š.); (R.B.); (K.P.); (J.V.); (L.Š.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 12800 Prague, Czech Republic
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Charles-Schoeman C, Giles JT, Lane N, Choy E, Furst D, Vencovský J, Wilson AG, Burmester GR, Shaw T, Song Y, Camp H, Khan N, Yee J, Anyanwu S, Mcinnes I. OP0128 INTEGRATED LABORATORY ABNORMALITY PROFILES OF UPADACITINIB WITH UP TO 4.5 YEARS OF EXPOSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED IN THE SELECT PHASE 3 PROGRAM. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Upadacitinib (UPA) is an oral Janus kinase inhibitor approved for rheumatoid arthritis (RA). The safety and efficacy of UPA has been evaluated across a spectrum of patients (pts) with RA in the phase 3 SELECT clinical program.1,2Objectives:To describe long-term laboratory profiles (cutoff date: June 30, 2020) associated with exposure to UPA, adalimumab (ADA), and methotrexate (MTX) in pts with RA treated in the SELECT trials.Methods:Data were analyzed from 6 randomized controlled UPA RA trials.1,2 The proportions of pts experiencing potentially clinically significant laboratory changes at a single time point were summarized for the following groups: pooled UPA 15 mg once daily (QD; UPA15; 6 trials), pooled UPA 30 mg QD (UPA30; 4 trials), ADA 40 mg every other week (EOW; 1 trial), and MTX monotherapy (1 trial). Pts received UPA with/without background conventional synthetic disease-modifying antirheumatic drugs. Treatment-emergent adverse events are reported as exposure-adjusted event rates (events/100 pt-years [E/100 PY]). Toxicity was graded per OMERACT criteria, or NCI CTCAE for creatine phosphokinase (CPK) and creatinine.Results:4413 pts received ≥1 dose of UPA (UPA15, n=3209; UPA30, n=1204). Exposures were comparable between treatment groups (Table). Proportions of pts with Grade (Gr) 3 and 4 decreases in hemoglobin were highest with UPA30 and MTX (Table). Rates of anemia, as reported by the investigator, were comparable between UPA15, ADA, and MTX groups (Figure); the frequency of UPA-treated pts who discontinued due to anemia was low in all arms. Gr 3 and 4 decreases in neutrophils and lymphocytes with UPA were dose-dependent and higher vs ADA or MTX. Discontinuations due to neutropenia and lymphopenia were rare (<0.1%). Transaminase elevations were more frequent with UPA and MTX vs ADA; however, the proportion of pts who discontinued due to increases in alanine (ALT) or aspartate aminotransferase (AST) were comparable between UPA15 and ADA, and numerically higher with UPA30 and MTX. CPK elevations were more frequent with UPA (Figure). Most events were asymptomatic, and the 1 case of rhabdomyolysis in the UPA30 group was unrelated to study drug (attributed to influenza).Table 1.Pts with potentially clinically significant laboratory changesVariable, n (%)MTX monotherapy (n=314; 637.4 PY)ADA 40 mg EOW (n=579; 1051.8 PY)UPA 15 mg QD (n=3209; 7023.8 PY)UPA 30 mg QD (n=1204; 3091.6 PY)Mean (SD) exposure, weeks106 (67)95 (70)114 (64)134 (66)Median (range) exposure, weeks144 (1, 221)118 (2, 231)136 (0, 232)160 (0, 231)Hemoglobin, g/LGr 3 (70–<80 or decreased 21–<30)28a (9.0)24b (4.2)254d (7.9)169f (14.2)Gr 4 (<70 or decreased ≥30)16a (5.1)16b (2.8)101d (3.2)78f (6.5)Neutrophils, 109/LGr 3 (0.5–<1.0)3a (1.0)3b (0.5)40d (1.2)37g (3.1)Gr 4 (<0.5)1a (0.3)1b (0.2)10d (0.3)5g (0.4)Lymphocytes, 109/LGr 3 (0.5–<1.0)74a (23.7)53b (9.2)802d (25.1)423g (35.5)Gr 4 (<0.5)5a (1.6)3b (0.5)75d (2.3)47g (3.9)ALT, U/LGr 3 (3.0–8.0 × ULN)26a (8.3)13c (2.3)152e (4.8)71h (5.9)Gr 4 (>8.0 × ULN)5a (1.6)4c (0.7)26e (0.8)10h (0.8)AST, U/LGr 3 (3.0–8.0 × ULN)15a (4.8)9c (1.6)101e (3.2)36h (3.0)Gr 4 (>8.0 × ULN)1a (0.3)5c (0.9)18e (0.6)8h (0.7)CPK, U/LGr 3 (>5.0–10.0 × ULN)2a (0.6)3c (0.5)65e (2.0)36i (3.0)Gr 4 (>10.0 × ULN)0a (0)3c (0.5)27e (0.8)15i (1.3)Creatinine, μmol/LGr 3 (>3.0–6.0 × ULN)0a (0)1c (0.2)3e (<0.1)2j (0.2)Gr 4 (>6.0 × ULN)0a (0)4c (0.7)8e (0.3)1j (<0.1)an=312. bn=576. cn=577. dn=3201. en=3199. fn=1193. gn=1192. hn=1195. in=1196. jn=1197ULN, upper limit of normalConclusion:This long-term analysis of UPA-treated pts with RA showed dose-dependent relationships for several laboratory abnormalities. Incidences of these with UPA15 were typically higher than with ADA but similar to MTX, except for increased CPK elevations. Treatment discontinuations due to laboratory abnormalities were infrequent and similar across all treatment groups.References:[1]Tanaka Y. Mod Rheumatol 2020;30:779–87; 2. Rubbert-Roth A, et al. N Engl J Med 2020;383:1511–21.Acknowledgements:AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Russell Craddock, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of Interests:Christina Charles-Schoeman Consultant of: AbbVie, Gilead, Pfizer, and Sanofi/Regeneron, Grant/research support from: AbbVie, Bristol-Myers Squibb, and Pfizer, Jon T Giles Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, Pfizer, and UCB, Grant/research support from: Pfizer, Nancy Lane Consultant of: Amgen, Mallinckrodt, Pfizer, and Roche, Ernest Choy Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Chugai, Eli Lilly, Galapagos, Gilead, Janssen, Novartis, Pfizer, Regeneron, Roche, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Biocon, Biogen, Chugai, Eli Lilly, Gilead, Janssen, Merck Serono, Novartis, Pfizer, Regeneron, Roche, R-Pharm, and Sanofi, Grant/research support from: Bio-Cancer, Biogen, Novartis, Pfizer, Roche, Sanofi, and UCB, Daniel Furst Speakers bureau: AbbVie, Continuing Medical Education, and Novartis, Consultant of: Actelion, Amgen, Bristol-Myers Squibb, Corbus, Galapagos, Novartis, and Pfizer, Grant/research support from: Actelion, Amgen, Bristol-Myers Squibb, Corbus, Galapagos, GSK, NIH, Novartis, Pfizer, Roche/Genentech, and Sanofi, Jiří Vencovský Speakers bureau: AbbVie, Biogen, MSD, Pfizer, Roche, Sanofi, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Eli Lilly, Gilead, and Octapharma, Anthony G Wilson: None declared, Gerd Rüdiger Burmester Speakers bureau: AbbVie, Eli Lilly, Gilead, Janssen, MSD, Pfizer, Roche, and UCB, Consultant of: AbbVie, Eli Lilly, Gilead, Janssen, MSD, Pfizer, Roche, and UCB, Tim Shaw Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Heidi Camp Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Nasser Khan Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Jillian Yee Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Samuel Anyanwu Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Iain McInnes Consultant of: AbbVie, Celgene, Janssen, Novartis, and UCB, Grant/research support from: Celgene, Janssen, Novartis, Pfizer, Roche, and UCB
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Aggarwal R, Charles-Schoeman C, Schessl J, Bata-Csorgo Z, Dimachkie M, Griger Z, Moiseev S, Oddis CV, Schiopu E, Vencovský J, Beckmann I, Levine T, Clodi E, Proderm Investigators AT. OP0008 A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED PHASE III TRIAL OF IVIG 10% IN PATIENTS WITH DERMATOMYOSITIS. THE PRODERM STUDY: RESULTS ON EFFICACY AND SAFETY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Dermatomyositis (DM) is a rare chronic systemic autoimmune disease with characteristic skin rash and progressive proximal muscle weakness. Current therapies encompass corticosteroids and other immunosuppressants and intravenous immunoglobulins (IVIg), however, none of these therapies are proven by randomized controlled phase 3 studies. There have been no large randomized clinical trials supporting the efficacy and safety of IVIg in DM.Objectives:The ProDERM study aimed to evaluate the efficacy and safety/tolerability of IVIg in DM patients in a double-blind, randomized, placebo-controlled, international multi-center, phase III clinical trial.Methods:The trial consisted of a double-blind, placebo-controlled First Period (16 weeks), in which adult patients with definite or probable DM (according to Bohan and Peter criteria) were randomized 1:1 to either high dose IVIg (2g/kg every 4 weeks) or placebo. Patients on placebo and patients without clinical worsening while on IVIg treatment entered the open label Extension Period (24 weeks) and received 2g/kg IVIg infusions every 4 weeks. To be included, subjects must have active disease with a manual muscle testing-8 (MMT-8) score < 142/150. Patients who showed clinical worsening (defined according to Oddis et al, 2013 - with slight adaptation) at 2 consecutive visits between week 8 and week 16 were switched to the alternate treatment arm.Primary endpoint was the proportion of responders in the IVIg vs. placebo arm at week 16, where response was defined per 2016 ACR/EULAR Myositis response criteria of at least minimal improvement [Total Improvement Score (TIS) ≥ 20 points)] and without clinical worsening at 2 consecutive visits up to week 16.Results:A total of 95 adult DM patients (mean age: 53 years; 75% females; 92% Caucasian) were enrolled, with 47 and 48 randomized to IVIg and placebo, respectively. Baseline clinical characteristics (including medical history and prior DM medication) were balanced between the 2 arms.The study met the primary endpoint at week 16, with the proportion of responders being significantly higher in the IVIg group (37/47; 78.7%) as compared to the placebo group (21/48; 43.8%; p-value 0.0008; Table 1).Table 1.Total Improvement Score – Analysis of Proportion of Responders at Week 16 (Full Analysis Set, N=95)TIS Responseoctagam 10%N=47PlaceboN=48Difference octagam 10% – placeboNumber (%) of responders37 (78.72%)21 (43.75%)Difference in response rates34.97[95% CI] p-valuea[16.70, 53.24] 0.0008aCochran-Mantel-Haenszel TestCI=confidence interval; N=number of patients; TIS=total improvement scoreIn the analysis of responders per improvement category at Week 16, a 45.2% higher response rate for at least moderate improvement (TIS ≥n40 points; p < 0.0001) and a 23.6% higher response rate for at least major improvement (TIS ≥060 points; p < 0.0062) was observed in the IVIG group as compared to the placebo group.The mean (SD) TIS was significantly higher in IVIg group [48.4 (24.4)] than in placebo arm [21.6 (20.2)] at week 16 (Fig 1).Figure 1.After switching to IVIG in the Extension Period the placebo group attained a similar response rate at Week 40 as did the IVIg treated patients at Week 16, i.e approx. 70% for minimal improvement.In line with the overall primary endpoint, secondary end points including all of the sub-components of TIS except muscle enzyme (MMT-8, MD global, Extramuscular global, patient global, HAQ,) as well as CDASI (Cutaneous Dermatomyositis Disease Area and Severity Index), also showed statistically significant improvement under IVIg treatment compared to placebo treatment.The safety and tolerability profile of IVIg was consistent with previously reported safety outcomes for IVIg administration.Conclusion:This is the first large international phase III randomized, placebo-controlled trial demonstrating the efficacy and safety of IVIg as a treatment for patients with DM.References:[1]Oddis, C. V. et al. Arthritis Rheum (2013), 65, 314–324Acknowledgements:Acknowledgments to all participating investigators, centers and patients and their familiesDisclosure of Interests:Rohit Aggarwal Consultant of: Q32, Alexion, Argenx, AstraZeneca, BMS, Boehringer Ingelheim, Corbus, Csl Behring, EMD Serono, Janssen, Kezar, Mallinckrodt, Kyverna, Octapharma, Orphazyme, Pfizer., Grant/research support from: BMS, Mallinckrodt, Pfizer, EMD Serono, Christina Charles-Schoeman Consultant of: Pfizer, Abbvie, Octapharma, Gilead, Regeneron-Sanofi, Grant/research support from: Bristol Myers Squibb, Pfizer, Abbvie, Octapharma, Joachim Schessl Speakers bureau: Octapharma, Grifols, CSL Behring, Consultant of: Octapharma, Zsuzsanna Bata-Csorgo Speakers bureau: Novartis, Sanofi-Genzyme, Ewopharma, Consultant of: Sanofi-Genzyme, Novartis, Ewopharma, Mazen Dimachkie Consultant of: ArgenX, Catalyst, Cello, CSL-Behring, EcoR1, Kezar, Momenta, NuFactor, Octapharma, RaPharma/UCB, RMS Medical, Sanofi Genzyme, Shire Takeda, Spark Therapeutics and UCB Biopharma., Grant/research support from: Alexion, Alnylam Pharmaceuticals, Amicus, Biomarin, Bristol-Myers Squibb, Catalyst, Corbus, CSL-Behring, GlaxoSmithKline, Genentech, Grifols, Kezar, Mitsubishi Tanabe Pharma, Novartis, Octapharma, Orphazyme, Ra Pharma/UCB, Sanofi Genzyme, Sarepta Therapeutics, Shire Takeda, Spark Therapeutics, UCB Biopharma, Viromed/Healixmith., Zoltán Griger Speakers bureau: Abbvie, CSL-Behring, Eli-Lilly, Roche, Boehringer Ingelheim, Consultant of: Octapharma, Sergey Moiseev: None declared, Chester V Oddis Consultant of: EMD Serono; Alexion Pharmaceuticals, Inc, Grant/research support from: Genentech (Clinical trial support); Bristol Myers Squibb (Clinical trial support), Elena Schiopu Consultant of: Octapharma, Grant/research support from: Octapharma, Janssen (Johnson & Johnson), BMS, Pfizer, Abbvie, Jirˇí Vencovský Speakers bureau: Abbvie, Biogen, MSD, Pfizer, Roche, Sanofi, UCB, Consultant of: Abbvie, Boehringer, Eli Lilly, Octapharma, Gilead, Irene Beckmann Employee of: Octapharma, Todd Levine Shareholder of: Corinthian Reference Labs, CND Life Sciences, Consultant of: Grifols, Octapharma, Alexion, Elisabeth Clodi Employee of: Octapharma PPG, Vienna Austria, and the ProDERM Investigators: None declared
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Navrátilová A, Andres Cerezo L, Hulejova H, Becvar V, Tegzová D, Olejárova M, Veigl D, Pavelka K, Vencovský J, Šenolt L. POS0388 INTERLEUKIN 40 (IL-40) IS UP-REGULATED IN RHEUMATOID ARTHRITIS (RA) AND ASSOCIATED WITH DISEASE ACTIVITY, LEVELS OF AUTOANTIBODIES AND CHEMOKINES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Interleukin 40 (IL-40) is newly identified B cell - associated cytokine implicated in humoral immune responses and in B cell development. As B cells play a pivotal role in autoimmunity, we aimed to investigate the function of IL-40 in rheumatoid arthritis (RA).Objectives:The aim of our study was to determine the function of IL-40 in RA.Methods:IL-40 expression in the synovial tissue was determined by immunohistochemistry and immunofluorescence (n=4-5). IL-40 was analysed in the serum/synovial fluid of patients with RA (n=69), systemic lupus erythematosus (SLE; n=69), osteoarthritis (OA; n=44), and in healthy controls (HC; n=25). Given the association of IL-40 with B cells, we analysed the effect of rituximab therapy on the serum IL-40 in 19 patients with RA after 16 and 24 weeks of the therapy. The clinical activity of patients with RA was assessed according to the 28 joint count Disease Activity Score (DAS28). Levels of C-reactive protein (CRP) and autoantibodies were measured by routine laboratory techniques. In vitro experiments were performed in RA synovial fibroblasts (n=9). Levels of cytokines and inflammatory mediators were determined in serum, synovial fluid and supernatants using ELISA or multiplex immunoassay.Results:IL-40 was overexpressed in RA synovial tissue compared to OA, particularly by synovial fibroblasts and immune cells such as B and T lymphocytes, macrophages and neutrophils. The levels of IL-40 were significantly higher in the synovial fluid of RA patients compared to OA (33.2 (6.6-68.9) vs. 0.7 (0.1-2.4) ng/ml; p<0.0001). In addition, IL-40 was increased in the serum of RA patients compared to SLE, OA or HC (4.8 (1.7-24.9) vs. 1.4 (1.0-1.9), 1.6 (0.6-3.1) or 1.5 (0.7-2.7) ng/ml; p<0.0001 for all) and decreased after 16 (p<0.01) and 24 weeks (p<0.001) in a subgroup of rituximab treated patients with RA. IL-40 levels in RA patients correlated with autoantibodies rheumatoid factor (IgM) and anti-citrullinated protein antibody (ACPA) in the serum (p<0.0001 and p<0.01) as well as in the synovial fluid (p<0.0001 and p<0.001). IL-40 in RA synovial fluid was also significantly associated with DAS28 (p<0.05), synovial fluid leukocyte count (p<0.01), number of swollen joints (p<0.05) and neutrophil attractants IL-8 (p<0.01) and MIP-1α (p<0.01). RA synovial fibroblasts exposed to recombinant IL-40 increased secretion of IL-8 (p<0.01), MCP-1 (p<0.05) and MMP-13 (p<0.01) compared to unstimulated cells in in vitro conditions.Conclusion:Our results show for the first time that IL-40 is elevated in RA and decreases following B-cell depletion therapy. The association of IL-40 with autoantibodies and chemokines may imply its potential involvement in RA development. Moreover, IL-40 up-regulates the secretion of chemokines and MMP-13 by synovial fibroblasts, indicating its role in the regulation of inflammation and tissue destruction in RA.Acknowledgements:Supported by MHCR 023728 a SVV 260 523Disclosure of Interests:None declared
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Oreska S, Štorkánová H, Špiritović M, Heřmánková B, Vrablik M, Pavelka K, Šenolt L, Mann H, Vencovský J, Tomčík M. AB0412 LIPID PROFILE IN IIM PATIENTS AND ITS ASSOCIATION WITH DISEASE ACTIVITY, DURATION, AND GLUCOCORTICOID TREATMENT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic inflammation, limited mobility, and glucocorticoid treatment in idiopathic inflammatory myopathies (IIM) can have a negative impact on intermediate metabolic pathways, especially on lipid metabolism.Objectives:The aim of this study was to assess the differences in the lipid profile of IIM patients and healthy controls (HC) and the association with disease-specific features.Methods:133 patients with IIM (106 females; mean age 60.3; disease duration 2.2 years; DM 47 / PM 41 / IMNM 45) and 133 age-/sex-matched HC (106 females, mean age 60.2) were included. Patients with DM and PM fulfilled the Bohan/Peter criteria for PM/DM; patients with IMNM fulfilled the ENMC criteria. Levels of selected parameters of lipid metabolism were measured in sera. In IIM patients, disease activity, damage, and muscle involvement were evaluated (MITAX, MDI, MMT-8); comorbidities and current treatment were recorded. Data are presented as median.Results:Several differences in disease activity, the dose of glucocorticoids, prevalence of comorbidities, and serum lipid levels were observed in IIM compared to HC, and among the three subtypes of IIM; the most significant changes were observed in IMNM. All the differences in lipid profile between IIM and HC, as well as the correlations of lipid profile parameters with disease-specific features in IIM patients, are demonstrated in the table 1.Conclusion:We have observed significant alterations in serum lipid parameters in our IIM patients compared to healthy age-/sex-matched individuals. Differences were also found among the three subtypes of IIM. These alterations were associated with laboratory parameters of disease activity and the current dose of corticosteroids.Table 1.Lipidogram in IIM patients compared to healthy controlsParameter of lipidogram, medianIIM(n = 133)DM(n = 47)PM(n = 41)IMNM(n = 45)HC(n = 133)p-valueIM-HC; DM-HC;PM-HC; IMNM-HCTC (mmol/L);5.795.365.656.35.14<0.001; 0.135; 0.040; <0.001TG (mmol/L);2.021.911.882.271.28<0.001; <0.001; 0.002; <0.001LDL-C (mmol/L);3.132.953.123.582.820.005; 0.436; 0.131; <0.001Apo-B (g/L);1.061.020.981.260.91<0.001; 0.160; 0.017; <0.001Non-HDL-C (mmol/L);4.44.254.155.13.9<0.001; 0.262; 0.040; <0.001Lp(a) (g/L);0.10.10.10.120.150.098; 0.733; 0.242; 0.032HDL-C (mmol/L);1.1221.131.181.361.20.913; 0.917; 0.503; 0.928Apo-A (g/L);1.71.761.751.681.80.073; 0.782; 0.267; 0.025AI (log(TG/ HDL-C);3.853.93.853.73.150.003; 0.425; 0.071; 0.002Significant correlations of lipid profile parameters and disease-specific features in all IIM patients (n=133)Correlated parametersSpear-man’s rp-valueCorrelated parametersSpearman’s rp-valueTC: Disease duration; LD; PED; Age; CK; Myoglobin-0.322; 0.343; 0.292; 0.193; 0.198; 0.249<0.001; <0.001; <0.001; 0.027; 0.025; 0.007non-HDL-C: Disease duration; LD; BMI; CK; Myoglobin; PED-0.303; 0.322; 0.202; 0.214;0.270; 0.275<0.001; <0.001; 0.027; 0.015;0.003; 0.002TG: Disease duration; PED; BMI-0.326; 0.316; 0.271<0.001; <0.001; 0.003HDL-C: CRP-0.2300.010LDL-: Disease duration; LD; Age; CK; Myoglobin;-0.310; 0.359; 0.212; 0.257; 0.289<0.001; <0.001; 0.015; 0.003; 0.002Apo-A: CRP; CK; Myoglobin-0.293; -0.214; -0,258<0.001; 0.016; 0.005Apo-B: Disease duration; LD; PED; Age; BMI; MMT-8; CK; Myoglobin; Glycemia-0.311; 0.348; 0.307; 0.220; 0.239; -0.214; 0.256; 0.307; 0.201<0.001; <0.001; <0.001; 0.012; 0.009; 0.017; 0.004; <0.001; 0.031AI: BMI0.2090.021Acronyms: TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein; Apo-B, apolipoprotein B; non-HDL-C, non-high-density lipoprotein (TC minus measured HDL-C); Lp(a), lipoprotein A; HDL-C, high-density lipoprotein; Apo-A, apolipoprotein A; AI, atherogenic index of plasma = log(TG/ HDL-C); LD, lactate dehydrogenase; PED, current prednisolone equivalent dose; CK, creatine kinase; BMI, body mass index; MMT-8, manual muscle testing-8; CRP, C-reactive proteinAcknowledgements:AZV NV18-01-00161A, MHCR-00023728, GAUK-312218Disclosure of Interests:None declared
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Abstract
Background:microRNAs (miRNAs) are small non-coding RNAs that can ignite the degradation of mRNAs or inhibit the protein translation and are therefore essential for several physiological and pathological functions. miRNAs can regulate up to 60 % of human mRNA, including genes related to cartilage development, homeostasis, and OA pathology. For example, miR-9 inhibits matrix metalloproteinase 13 or miR-140 expression level correlates with the disease progression of knee OA (Zhang et al.; Chao et al.). Under certain circumstances, miRNAs can be released into the body fluids and easily be detected in the blood samples. Therefore, miRNAs are hot candidates as biomarkers for early diagnosis or structural progression of OA.Objectives:The aim of this study was to evaluate circulating miRNAs in patients with hand osteoarthritis (HOA) and healthy individuals. Simultaneously, we studied specific miRNAs in order to differentiate between erosive and non-erosive subsets of the disease.Methods:Eight patients with HOA (erosive: n=4, 3 females, mean age=63.7±7 yrs; non-erosive: n=4, 3 females, mean age= 62.4±6 yrs) and 4 healthy controls (3 females, mean age=63.5±7 yrs) were included in this study. Firstly, Advance TaqMan low-density assay (TLDA) was performed for the purpose of miRNA high-throughput screening. Differently expressed miRNAs were further verified by real-time qPCR on the validation cohort in 31 patients with hand OA (19 females, mean age=66.2±7 yrs, erosive: n=9, non-erosive: n=10, healthy controls: n=12).Results:TLDA profiling displayed 346 circulating miRNAs in plasma of patients with HOA and healthy controls. We demonstrated 40 differently expressed circulating miRNAs in patients with HOA compared with healthy controls. Using a real-time qPCR, we verified increased expression levels of 10 circulating miRNAs in patients with HOA compared with healthy controls, e.g. miR-191-5p (3.4 fold), miR-151a-3p (3.4 fold) or miR-222-3p (2.4 fold). We did not find any specific miRNA, which could distinct erosive from a non-erosive subset of the disease.Conclusion:Extensive profiling of circulating miRNAs revealed several miRNAs that can be associated with HOA and can help to better understand OA pathogenesis.References:[1]Chao, Yu, et al. “Expression of MiR-140 and MiR-199 in Synovia and Its Correlation with the Progression of Knee Osteoarthritis.” Medical Science Monitor, vol. 26, 2020, pp. 1–6, doi:10.12659/MSM.918174.[2]Zhang, Hongxin, et al. “Downregulation of MicroRNA-9 Increases Matrix Metalloproteinase-13 Expression Levels and Facilitates Osteoarthritis Onset.” Molecular Medicine Reports, vol. 17, no. 3, 2018, pp. 3708–14, doi:10.3892/mmr.2017.8340.Acknowledgements:Supported by AZV NV18-01-00542, MHCR No. 023728Disclosure of Interests:None declared
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Baloun J, Pekacova A, Mann H, Vencovský J, Pavelka K, Šenolt L. AB0063 DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS: A BIOMARKER SCREENING PILOT STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Despite modern therapeutic approaches, many patients with rheumatoid arthritis (RA) remain symptomatic after several cycles of treatment and may become so called Difficult-To-Treat (D2T)1. D2T RA is a multifactorial condition in which different factors may be major determinants of the persistence of signs and symptoms, which is seldom caused by drug resistance only2. Discovering new biomarkers is necessary to develop tailored therapies that will be effective in an individual patient at each stage of the disease.Objectives:The primary aim of this pilot study was to validate a target proteomic technique for the proteome profiling of the two cohorts of RA patients and controls. Moreover, we searched for potential plasma biomarker(s) predicting D2T RA.Methods:Seven RA patients with persistent remission on biological therapy in two consecutive examinations 12 wks apart (mean age 59.6±14 yrs), seven D2T RA patients fulfilling proposed EULAR definition of D2T RA1 (mean age 59.3±13 yrs), and six healthy controls (mean age 58.8±15 yrs) were included in this study. All subjects were females and their samples were collected before starting biological therapy. We employed Thermo Orbitrap Fusion paired with nano-flow UHPLC Dionex Ultimate 3000. Prior to quantification, 125 plasma proteins were modified by Peptiquant Plus Human kit to increase the sensitivity. Data were analysed by ANOVA and Tukey`s posthoc test with false-discovery-rate adjustment.Results:The target proteome profiling reliably quantified 92 from 125 labelled proteins. Our follow-up statistical analysis revealed ten plasma proteins, which significantly differed among groups. Notably, we found significantly different plasma levels of paraoxonase/arylesterase 1 (PON1), an esterase with an antioxidant characteristic preventing lipid peroxidation3, between RA patients and controls and between RA patients with persistent remission and D2T RA patients.Conclusion:Using target proteome profiling technique, we demonstrated PON1 as a potential biomarker of D2T RA. However, these results have to be validated on a larger cohort.References:[1]Nagy G, Roodenrijs NMT, Welsing PMJ, et al. EULAR definition of difficult-To-Treat rheumatoid arthritis. Annals of the Rheumatic Diseases 2021;80:31-5.[2]de Hair MJH, Jacobs JWG, Schoneveld JLM, van Laar JM. Difficult-to-treat rheumatoid arthritis: an area of unmet clinical need. Rheumatology (Oxford, England) 2018 Jul 1;57(7):1135-1144.[3]Isik A, Koca SS, Ustundag B, Celik H, Yildirim A. Paraoxonase and arylesterase levels in rheumatoid arthritis. Clinical Rheumatology 2007;26:342-8.Acknowledgements:This research was supported by MHCR No. 023728 and authors thank Proteomics Service Laboratory, Faculty of Science, Charles University for performing the LC–MS/MS analysis.Disclosure of Interests:None declared
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Heřmánková B, Špiritović M, Oreska S, Štorkánová H, Smucrova H, Komarc M, Klein M, Pavelka K, Šenolt L, Mann H, Vencovský J, Tomčík M. POS0849 SEXUAL FUNCTION IS IMPAIRED IN WOMEN WITH IDIOPATHIC INFLAMMATORY MYOPATHIES COMPARED TO HEALTHY CONTROLS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Idiopathic inflammatory myopathies (IIM) are rare diseases characterized by chronic muscle inflammation and multiple organ involvement. These serious clinical manifestations can be associated with significant impairment of quality of life, including sexual life.Objectives:This study aimed to compare sexual function in patients with IIM to age-/sex-matched healthy controls (HC) and determine the potential impact of clinical features on sexual function.Methods:In total, 62 women with IIM [mean age: 53.1, disease duration: 5.2 years, dermatomyositis (DM, 29)/ polymyositis (PM, 27)/ necrotizing myopathy (IMNM, 5)/ inclusion body myositis (IBM, 1)], who fulfilled the Bohan/Peter 1975 criteria for DM/PM, or ENMC criteria for IMNM or IBM, and 62 healthy controls (HC) (mean age: 53.1) without rheumatic diseases filled in 11 well-established and validated questionnaires assessing sexual function (FSFI, SFQ28, BISF-W, SQoL-F), pelvic floor function (PFIQ-7, PISQ-12), fatigue (FIS, Fatigue Impact Scale), physical activity (HAP, Human Activity Profile), disability (HAQ, Health Assessment Questionnaire), depression (BDI-II, Beck’s Depression Inventory-II), and quality of life (SF-36, Medical outcomes study Short Form 36 – PCS, Physical Component Summary; MCS, Mental Component Summary). A routine laboratory testing was performed. Data are presented as median (IQR).Results:Patients with IIM reported significantly greater prevalence and severity of sexual dysfunction (FSFI, BISF-W, SFQ28, SQoL-F) and pelvic floor dysfunction (PISQ-12, PFIQ-7) compared to HC (Table 1). The prevalence of sexual dysfunction in patients with IIM according to the FSFI cut-off score was 59%. Worse scores in IIM patients were associated with greater muscle weakness of m. gluteus maximus [MMT: FSFI (r=0.289, p=0.035), PFIQ-7 (r=-0.407, p=0.003)], m. gluteus medius [MMT: PFIQ-7 (r=-0.381, p=0.005)], more pronounced fatigue [FIF: SQoL-F (r=-0.412, p=0.003)], severer depression [BDI-II: SQoL-F (r=-0.459, p=0.0007)], worse functional disability [HAQ: FSFI (r=-0.436, p=0.005)], reduced physical activity [HAP: FSFI (r=0.403, p=0.001), SQoL-F (r=0.368, p=0.007)], and decreased quality of life [SF-36 PCS: FSFI-total (r=0.381,p=0.002), SF-36 MCS: SQoL-F (r=0.407, p=0.002)]. We did not observe any associations with disease duration, the current prednisone dose, or serum levels of muscle enzymes.Conclusion:Women with IIM reported significantly impaired sexual function and pelvic floor function compared to age-/sex-matched healthy controls. Worse scores in IIM were associated with disease-related features.Table 1.Sexual function and pelvic floor function in women with IIM and healthy controlsQuestionnaire: score range (meaning)IIM (n=62)HC (n=62)p-valueFSFI: Female Sexual Function Index: 2 (worst) - 36 (best)18.2 (3.2-28.5)28.4 (14.4-32.1)p=0.006BISF-W: Brief Index of Sexual Function forWomen: -16 (worst) - 75 (best)18.6 (2.7-32.3)34.0 (8.0-44.7)p=0.004SQoL-F: Sexual Quality of Life Questionnaire – Female: 0 (worst) - 100 (best)60.0 (41.4-83.6)86.7 (70.8-95.6)p<0.0001PISQ–12: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form: 0 (best) - 48 (worst)14.5 (9.0-18.0)8.0 (5.0-12.0)p<0.0001PFIQ7: Pelvic Floor Impact Questionnaire – short form 7: 0 (best) - 300 (worst)4.8 (0.0-23.8)0.0 (0.0-4.8)p=0.052SFQ-28: Sexual Functioning Questionnaire-28 desire: 5 (worst) - 31 (best)18.0 (13.3-20.0)19.0 (17.0-22.0)p=0.042SFQ-28 arousal sensation: 4 (worst) - 20 (best)9.5 (7.0-11.0)12.0 (9.0-14.3)p=0.082SFQ-28 arousal lubrication: 2 (worst) - 10 (best)6.0 (4.0-8.0)7.0 (5.0-9.0)p=0.112SFQ-28 arousal cognitive: 2 (worst) - 10 (best)6.0 (4.3-7.0)6.0 (5.0-7.3)p=0.235SFQ-28 orgasm: 1 (worst) - 15 (best)11.0 (8.0-13.0)12.0 (9.8-13.0)p=0.279SFQ-28 pain: 2 (worst) - 15 (best)12.0 (10.0-15.0)15.0 (13.0-15.0)p=0.004SFQ-28 enjoyment: 6 (worst) - 30 (best)19.0 (14.3-24.3)23.0 (19.0-25.0)p=0.027SFQ-28 partner: 2 (worst) - 10 (best)9.0 (8.0-10.0)10.0 (9.0-10.0)p=0.012Acknowledgements:Supported by MHCR 023728, GA UK 1578119, and SVV 260373Disclosure of Interests:None declared
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Štorkánová H, Andres Cerezo L, Oreska S, Špiritović M, Heřmánková B, Komarc M, Pavelka K, Vencovský J, Distler JHW, Šenolt L, Bečvář R, Tomcik M. AB0410 S100A4 PLASMA LEVELS CORRELATE WITH DISEASE ACTIVITY, SKIN FIBROSIS AND INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In our previous study we demonstrated that S100A4 is overexpressed in scleroderma (SSc) skin, SSc fibroblasts and preclinical models of SSc in a TGF-β dependent manner. We showed that S100A4 is a new regulator of TGF-β signalling and its inhibition prevents the pro-fibrotic effects of TGF-β. Inactivation of S100A4 prevented dermal fibrosis induced by bleomycin and in Tsk-1 miceObjectives:The aim of this study was to evaluate S100A4 in the peripheral blood of SSc patients and characterize its potential association with SSc-related features.Methods:A total of 33 patients (29 females; mean age 52.8; disease duration 4.2 years; dcSSc/lcSSc = 8/25) who met the 2013 EULAR/ACR classification criteria for SSc and 20 healthy age- and sex-matched individuals were included in this study. Plasma levels of S100A4 were measured using ELISA (CUSABIO, Houston, USA). Data are presented as median (IQR).Results:S100A4 plasma levels were significantly increased in SSc patients compared to healthy controls (78.6(32.3-146.5) vs. 43.4(32.3-53.4)ng/mL,p=0.011). Patients with diffuse cutaneous (dc)SSc had significantly higher levels of S100A4 than patients with limited cutaneous (lc)SSc or healthy controls (168.5(81.5-347.5) vs. 63.4(30.9-130.6),p=0.017,p=0.001, respectively). Plasma levels of S100A4 positively correlated with mRSS (r=0.556,p=0.001). Furthermore, S100A4 negatively correlated with forced vital capacity (FVC) and peripheral oxygen saturation (SpO2) (r=- 0.362,p=0.038;r=-0.414,p=0.029, respectively). S100A4 levels positively correlated with ESSG activity score (r=0.750,p<0.001). However, only correlations between S100A4 and mRSS, and ESSG activity score were approved at corrected level of statistical significance after Bonferroni’s correction (p<0.01). In a prospective analysis of patients (n=40) with progressive SSc-ILD treated with 6 (n=24) or 12 (n=16) monthly i.v. pulses of cyclophosphamide (CPA, 500 mg/m2), we observed a significant decrease in plasma S100A4 levels between the baseline samples (month 0) and blood drawn after 6 months of CPA treatment (76.3(52.9–98.6) vs. 73.2(44.4–98.6)ng/mL,p=0.013). Furthermore, baseline S100A4 levels predicted the change (m0-m6) in CRP and ESR levels after 6 months of CPA therapy (r=0.472,p=0.004;r=0.528,p=0.003, respectively).Conclusion:We demonstrate that plasma S100A4 levels are significantly increased in SSc patients compared with healthy controls. Increased S100A4 is associated with the dcSSc subset, skin involvement, deteriorated parameters of interstitial lung disease and higher disease activity. In patients with progressive SSc-ILD, S100A4 declines after 6 months of cyclophosphamide therapy and predicts the systemic inflammatory response. These data further support our previous findings on the role of S100A4 as a regulator of TGF-β induced fibrosis in SSc.Acknowledgements:Supported by MHCR023728, SVV–260373.Disclosure of Interests:None declared
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Heřmánková B, Špiritović M, Oreska S, Štorkánová H, Smucrova H, Pavelka K, Vencovský J, Šenolt L, Bečvář R, Tomčík M. POS0846 SEXUAL FUNCTION IS IMPAIRED IN WOMEN WITH SYSTEMIC SCLEROSIS COMPARED TO HEALTHY CONTROLS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic sclerosis (SSc) is a multisystem, connective tissue disorder characterized by fibrosis of the skin and internal organ involvement, which can influence all aspects of life, including sexual life.Objectives:This study aimed to compare sexual function in patients with SSc to age-/sex-matched healthy controls (HC) and determine the potential impact of clinical features on sexual function.Methods:In total, 90 women with SSc (mean age: 49.1, disease duration: 6.1 years, lcSSc/dcSSc: 62/28, mRSS: 9.3, ESSG activity index: 2.1), who fulfilled the ACR/EULAR 2013 criteria, and 90 healthy controls (mean age: 49.1) without rheumatic diseases filled in 12 well-established and validated questionnaires assessing sexual function (FSFI, BISF-W, SFQ-28, SQoL-F), pelvic floor function (PISQ-12, PFIQ-7), fatigue (FIS, Fatigue Impact Scale), physical activity (HAP, Human Activity Profile), disability (HAQ, Health Assessment Questionnaire), depression (BDI-II, Beck’s Depression Inventory-II) and quality of life (SF-36, Medical outcomes study Short Form 36 – PCS, Physical Component Summary; MCS, Mental Component Summary). A routine laboratory testing was performed. Data are presented as median (IQR).Results:Patients with SSc reported significantly greater prevalence and severity of sexual dysfunction (FSFI, BISF-W, SFQ28 – in all subscales as well as total scores), worse sexual quality of life (SQoL-F) and pelvic floor dysfunction (PISQ-12, PFIQ-7) compared to HC (table 1). The prevalence of sexual dysfunction in patients with SSc according to the FSFI cut-off score was 77%. Worse scores in SSc patients were associated with longer disease duration [BISF-W-total (r=-0.243,p=0.026), FSFI-lubrication (r=-0.229,p=0.035)], higher disease activity [ESSG activity index: BISF-W-total (r=-0.291,p=0.010), FSFI-arousal (r=-0.299,p=0.007)], increased inflammation [CRP: BISF-W-receptivity/initiation (r=-0.301,p=0.007)], more pronounced fatigue [FIS-total: BISF-W-total (r=-0.412,p<0.0001)], more severe depression [BDI-II: FSFI-total (r=-0.506,p<0.0001), SQoL-F (r=-0.369, p<0.0001)], worse functional disability [HAQ: FSFI-total (r=-0.394,p<0.0001)], reduced physical activity [HAP: FSFI-total (r=0.535,p<0.0001)], and decreased overall quality of life [SF-36 PCS: FSFI-total (r=0.428,p<0.0001), SF-36 MCS: SQoL-F (r=0.472, p<0.0001)].Conclusion:Women with SSc reported significantly impaired sexual function and pelvic floor function compared to age-/sex-matched healthy controls. Worse scores in SSc were associated with disease-related features.Table 1.Sexual function and pelvic floor function in women with SSc and healthy controlsQuestionnaire: score range (meaning)SSc (n=90)HC (n=90)p-valueFSFI: Female sexual function index: 2 (worst) - 36 (best)19.4 (3.9-26.8)30.1 (23.1-32.9)p<0.0001BISF-W: Brief Index of Sexual Function for Women: -16 (worst) - 75 (best)14.3 (2.1-35.1)38.2 (19.3-46.2)p<0.0001SQoL-F: Sexual Quality of Life Questionnaire-Female: 0 (worst) - 100 (best)61.1 (34.4-81.1)91.1 (70.0-96.7)p<0.0001PISQ-12: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form: 0 (best) - 48 (worst)13.0 (9.0-17.0)7.0 (5.0-12.0)p<0.0001PFIQ-7: Pelvic Floor Distress Inventory Questionnaire: 0 (best) - 300 (worst)9.5 (0.0-48.8)0.0 (0.0-8.3)p<0.0001SFQ-28: Sexual Functioning Questionnaire-28 desire: 5 (worst) - 31 (best)17.0 (12.0-20.0)21.0 (17.0-23.0)p<0.0001SFQ-28 arousal sensation: 4 (worst) - 20 (best)10.0 (8.0-13.0)12.0 (9.0-15.0)p=0.0031SFQ-28 arousal lubrication: 2 (worst) - 10 (best)5.0 (4.0-7.0)8.0 (5.2-9.0)p<0.0001SFQ-28 arousal cognitive: 2 (worst) - 10 (best)5.0 (4.0-6.0)7.0 (5.0-8.0)p<0.0001SFQ-28 orgasm: 1 (worst) - 15 (best)10.0 (6.5-12.0)12.0 (10.0-13.0)p<0.0001SFQ-28 pain: 2 (worst) - 15 (best)12.0 (9.5-15.0)15.0 (13.0-15.0)p<0.0001SFQ-28 enjoyment: 6 (worst) - 30 (best)19.0 (12.5-24.0)24.0 (20.0-25.8)p<0.0001SFQ-28 partner: 2 (worst) - 10 (best)9.0 (8.0-10.0)10. (9.0-10.0)p=0.0182Acknowledgements:Supported by MHCR 023728, GA UK 1578119, and SVV 260373.Disclosure of Interests:None declared
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Kropáčková T, Mann H, Růžičková O, Šléglová O, Vernerová L, Horváthová V, Tomčík M, Pavelka K, Vencovský J, Šenolt L. Clusterin serum levels are elevated in patients with early rheumatoid arthritis and predict disease activity and treatment response. Sci Rep 2021; 11:11525. [PMID: 34075162 PMCID: PMC8169772 DOI: 10.1038/s41598-021-90973-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/23/2021] [Indexed: 12/29/2022] Open
Abstract
Clusterin (CLU) is a molecular chaperone that participates in a variety of biological processes. Recent studies indicate its possible involvement in the development of bone erosions and autoimmunity. The aim of this study was to investigate its serum concentrations in patients with early rheumatoid arthritis (RA) and to explore their potential relationship with disease activity and treatment response. Serum levels of CLU were measured in 52 patients before and 3 months after the initiation of treatment and in 52 healthy individuals. CLU levels at baseline were significantly increased in patients with early RA compared with healthy subjects (p < 0.0001). After 3 months of treatment, the levels of CLU decreased and reached concentrations comparable to those in controls. Even though there was no relationship between CLU levels and disease activity at baseline, CLU levels positively correlated with disease activity at months 3, 6 and 12 after treatment initiation. Using ROC analysis, lower CLU baseline levels predicted achieving the therapeutic target of low disease activity and remission at months 3, 6 and 12. In summary, we found increased serum concentrations of clusterin in treatment-naïve patients with early rheumatoid arthritis, and we suggest clusterin as a predictive biomarker of disease activity and treatment response.
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Affiliation(s)
- Tereza Kropáčková
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Růžičková
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Šléglová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucia Vernerová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic
| | - Veronika Horváthová
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Faculty of Science, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague 2, Czech Republic. .,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
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Laiferová N, Nemec M, Vernerová L, Balážová M, Vokurková M, Klein M, Špiritović M, Tomčík M, Vencovský J, Ukropec J, Ukropcová B. Lower serum vitamin D in patients with idiopathic inflammatory myopathies is related to altered lipid metabolism in patients’ muscle cells. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.05191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nikoleta Laiferová
- Biomedical Research Center, Slovak Acad of Sci, Bratislava, SlovakiaBratislava
| | - Michal Nemec
- Biomedical Research Center, Slovak Acad of Sci, Bratislava, SlovakiaBratislava
| | | | - Mária Balážová
- Centre of Biosciences, Slovak Acad of Sci, Bratislava, SlovakiaBratislava
| | | | - Martin Klein
- Institute of Rheumatology, Prague, CzechiaPrague
| | | | | | | | - Jozef Ukropec
- Biomedical Research Center, Slovak Acad of Sci, Bratislava, SlovakiaBratislava
| | - Barbara Ukropcová
- Biomedical Research Center, Slovak Acad of Sci, Bratislava, SlovakiaBratislava
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Prajzlerová K, Kryštůfková O, Komarc M, Mann H, Hulejová H, Petrovská N, Gregová M, Hánová P, Pavelka K, Vencovský J, Šenolt L, Filková M. The dysregulation of monocyte subpopulations in individuals at risk of developing rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:1823-1831. [PMID: 33119082 DOI: 10.1093/rheumatology/keaa518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/13/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Individuals carrying antibodies against citrullinated proteins (ACPA) are at high risk of developing RA. EULAR provided a clinical definition of individuals with arthralgia suspicious for progression to RA (clinically suspect arthralgia, CSA). The alteration of monocyte subpopulations in patients with established RA has been previously described. We analysed peripheral blood monocyte subpopulations in individuals with arthralgia at risk of RA. METHODS We included 70 at-risk individuals, defined as having arthralgia without arthritis and being either ACPA+ or meeting the clinical CSA definition, 23 patients with early RA (ERA) and 19 healthy controls (HCs). Monocytes classified as classical (CD14++CD16-), intermediate (CD14++CD16+/++) and nonclassical (CD14-/+CD16++) were analysed by flow cytometry. RESULTS Of the 70 at-risk individuals, 46 were ACPA+ and 45 met the CSA definition. The at-risk individuals and, especially, ERA patients had a lower percentage of classical monocytes and a higher percentage of nonclassical monocytes than the HCs. ACPA positivity had no effect on the difference in the distribution of the monocyte subsets between at-risk individuals and ERA patients, but a difference was determined in those reaching the ERA phase. However, when compared with HCs, the shift of monocyte subsets was more significant in ACPA+ than in ACPA- individuals with arthralgia. This trend was observed in individuals who did not meet the CSA definition. This finding was, however, determined by a selection bias, as these individuals were solely ACPA+. CONCLUSION The shift from classical to nonclassical monocyte subpopulations was observed already in individuals at risk of developing RA.
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Affiliation(s)
- Klára Prajzlerová
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Kryštůfková
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Hulejová
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Nora Petrovská
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Monika Gregová
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petra Hánová
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Karel Pavelka
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mária Filková
- Department of Experimental Rheumatology, Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Navrátilová A, Bečvář V, Baloun J, Damgaard D, Nielsen CH, Veigl D, Pavelka K, Vencovský J, Šenolt L, Andrés Cerezo L. S100A11 (calgizzarin) is released via NETosis in rheumatoid arthritis (RA) and stimulates IL-6 and TNF secretion by neutrophils. Sci Rep 2021; 11:6063. [PMID: 33727634 PMCID: PMC7966750 DOI: 10.1038/s41598-021-85561-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 02/24/2021] [Indexed: 02/07/2023] Open
Abstract
S100A11 (calgizzarin), a member of S100 family, is associated with several autoimmune diseases, including rheumatoid arthritis (RA). Neutrophil extracellular traps (NETs) are implicated in the pathogenesis of RA and in the externalization of some S100 family members. Therefore, we aimed to determine the association between S100A11 and NETs in RA. For this purpose, the levels of S100A11 and NETosis markers were detected in the RA synovial fluid by immunoassays. The expression of S100A11 by neutrophils in the RA synovial tissue was assessed. Neutrophils isolated from peripheral blood were exposed to S100A11 or stimulated to release NETs. The levels of NETosis- and inflammation-associated proteins were analysed by immunoassays. NETs were visualized by immunofluorescence. We showed that S100A11 was expressed by the neutrophils in the RA synovial tissue. Moreover, S100A11 in the RA synovial fluid correlated with several NETosis markers. In vitro, S100A11 was abundantly released by neutrophils undergoing NETosis compared to untreated cells (p < 0.001). Extracellular S100A11 increased the secretion of IL-6 (p < 0.05) and TNF (p < 0.05) by neutrophils but did not induce NETosis. This study demonstrates, for the first time, that the release of S100A11 is dependent on NETosis and that extracellular S100A11 augments the inflammatory response by inducing pro-inflammatory cytokines in neutrophils.
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Affiliation(s)
- Adéla Navrátilová
- Institute of Rheumatology, Na Slupi 4, 12850, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Viktor Bečvář
- Institute of Rheumatology, Na Slupi 4, 12850, Prague, Czech Republic
| | - Jiří Baloun
- Institute of Rheumatology, Na Slupi 4, 12850, Prague, Czech Republic
| | - Dres Damgaard
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus Henrik Nielsen
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David Veigl
- First Orthopaedic Clinic, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Na Slupi 4, 12850, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Na Slupi 4, 12850, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Na Slupi 4, 12850, Prague, Czech Republic
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Andrés Cerezo
- Institute of Rheumatology, Na Slupi 4, 12850, Prague, Czech Republic.
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
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Prajzlerová K, Komarc M, Forejtová Š, Pavelka K, Vencovský J, Šenolt L, Filková M. Circulating miR-145 as a marker of therapeutic response to anti-TNF therapy in patients with ankylosing spondylitis. Physiol Res 2021; 70:255-264. [PMID: 33676382 DOI: 10.33549/physiolres.934542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Circulating miRNAs appear promising therapeutic and prognostic biomarkers. We aimed to investigate the predictive value of circulating miRNAs on the disease outcome following anti-TNF therapy in patients with ankylosing spondylitis (AS). Our study included 19 AS patients assessed at baseline (M0), after three (M3) and twelve months (M12) of therapy. Total RNA was isolated from plasma. A comprehensive analysis of 380 miRNAs using TaqMan Low Density Array (TLDA) was followed by a single assay validation of selected miRNAs. All AS patients had high baseline disease activity and an excellent response to anti-TNF therapy at M3 and M12. TLDA analysis revealed the dysregulation of 17 circulating miRNAs, including miR-145. Single assay validation confirmed that miR-145 is significantly downregulated at M3 compared to baseline. The decrease in the levels of miR-145 from M0 to M3 negatively correlated with the change in BASDAI from M0 to M3; and positively correlated with disease activity improvement from M3 to M12 as per BASDAI and ASDAS. The predictive value of the early change in miR-145 and levels of miR-145 at M3 were further validated by Receiver operating curves analysis. We show thatthe early change in circulating miR-145 may be a predictor for the future outcome ofAS patients treated with TNF inhibitors. Patients with a more significant decrease in miR-145 levels may show further significant improvement of disease activity after 12 months. Monitoring the expression of miR-145 in plasma in AS patients may, therefore, influence our therapeutic decision-making.
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Vernerová L, Horváthová V, Kropáčková T, Vokurková M, Klein M, Tomčík M, Oreská S, Špiritović M, Štorkánová H, Heřmánková B, Kubínová K, Kryštůfková O, Mann H, Ukropec J, Ukropcová B, Vencovský J. Alterations in activin A-myostatin-follistatin system associate with disease activity in inflammatory myopathies. Rheumatology (Oxford) 2021; 59:2491-2501. [PMID: 31990347 DOI: 10.1093/rheumatology/kez651] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/22/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the systemic and skeletal muscle levels of atrophy-associated myokines in patients with idiopathic inflammatory myopathies (IIM) and their association with clinical characteristics of myositis. METHODS A total of 94 IIM patients and 162 healthy controls were recruited. Of those, 20 IIM patients and 28 healthy controls underwent a muscle biopsy. Circulating concentrations of myostatin, follistatin, activin A and TGF-β1 were assessed by ELISA. The expression of myokines and associated genes involved in the myostatin signalling pathway in muscle tissue was determined by real-time PCR. RESULTS We report decreased levels of circulating myostatin (median 1817 vs 2659 pg/ml; P = 0.003) and increased follistatin (1319 vs 1055 pg/ml; P = 0.028) in IIM compared with healthy controls. Activin A levels were also higher in IIM (414 vs 309 pg/ml; P = 0.0005) compared with controls. Myostatin was negatively correlated to muscle disease activity assessed by physician on visual analogue scale (MDA) (r = -0.289, P = 0.015) and positively to manual muscle testing of eight muscles (r = 0.366, P = 0.002). On the other hand, follistatin correlated positively with MDA (r = 0.235, P = 0.047). Gene expression analysis showed higher follistatin (P = 0.003) and myostatin inhibitor follistatin-like 3 protein (FSTL3) (P = 0.008) and lower expression of activin receptor type 1B (ALK4) (P = 0.034), signal transducer SMAD3 (P = 0.023) and atrophy marker atrogin-1 (P = 0.0009) in IIM muscle tissue compared with controls. CONCLUSION This study shows lower myostatin and higher follistatin levels in circulation and attenuated expression of myostatin pathway signalling components in skeletal muscle of patients with myositis, a newly emerging pattern of the activin A-myostatin-follistatin system in muscle wasting diseases.
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Affiliation(s)
- Lucia Vernerová
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague
| | - Veronika Horváthová
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
| | - Tereza Kropáčková
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
| | - Martina Vokurková
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague
| | - Martin Klein
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
| | - Michal Tomčík
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
| | - Sabína Oreská
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
| | - Maja Špiritović
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
| | - Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Kateřina Kubínová
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
| | - Olga Kryštůfková
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
| | - Heřman Mann
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
| | - Jozef Ukropec
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava
| | - Barbara Ukropcová
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava.,Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Jiří Vencovský
- Division of Experimental Rheumatology, Institute of Rheumatology, Prague.,Department of Rheumatology, First Faculty of Medicine
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Štorkánová H, Oreská S, Špiritović M, Heřmánková B, Bubová K, Komarc M, Pavelka K, Vencovský J, Distler JHW, Šenolt L, Bečvář R, Tomčík M. Plasma Hsp90 levels in patients with systemic sclerosis and relation to lung and skin involvement: a cross-sectional and longitudinal study. Sci Rep 2021; 11:1. [PMID: 33414495 PMCID: PMC7791137 DOI: 10.1038/s41598-020-79139-8] [Citation(s) in RCA: 3242] [Impact Index Per Article: 1080.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/03/2020] [Indexed: 11/11/2022] Open
Abstract
Our previous study demonstrated increased expression of Heat shock protein (Hsp) 90 in the skin of patients with systemic sclerosis (SSc). We aimed to evaluate plasma Hsp90 in SSc and characterize its association with SSc-related features. Ninety-two SSc patients and 92 age-/sex-matched healthy controls were recruited for the cross-sectional analysis. The longitudinal analysis comprised 30 patients with SSc associated interstitial lung disease (ILD) routinely treated with cyclophosphamide. Hsp90 was increased in SSc compared to healthy controls. Hsp90 correlated positively with C-reactive protein and negatively with pulmonary function tests: forced vital capacity and diffusing capacity for carbon monoxide (DLCO). In patients with diffuse cutaneous (dc) SSc, Hsp90 positively correlated with the modified Rodnan skin score. In SSc-ILD patients treated with cyclophosphamide, no differences in Hsp90 were found between baseline and after 1, 6, or 12 months of therapy. However, baseline Hsp90 predicts the 12-month change in DLCO. This study shows that Hsp90 plasma levels are increased in SSc patients compared to age-/sex-matched healthy controls. Elevated Hsp90 in SSc is associated with increased inflammatory activity, worse lung functions, and in dcSSc, with the extent of skin involvement. Baseline plasma Hsp90 predicts the 12-month change in DLCO in SSc-ILD patients treated with cyclophosphamide.
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Affiliation(s)
- Hana Štorkánová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maja Špiritović
- Institute of Rheumatology, Prague, Czech Republic
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Kristýna Bubová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jörg H W Distler
- Department of Internal Medicine III and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ladislav Šenolt
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radim Bečvář
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Prague, Czech Republic.
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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Nekvindová L, Vencovský J, Pavelka K, Horák P, Křístková Z, Závada J. Switching first-line targeted therapy after not reaching low disease activity within 6 months is superior to conservative approach: a propensity score-matched analysis from the ATTRA registry. Arthritis Res Ther 2021; 23:11. [PMID: 33407803 PMCID: PMC7789592 DOI: 10.1186/s13075-020-02393-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/13/2020] [Indexed: 01/23/2023] Open
Abstract
Background Treat-to-target (T2T) is a widely accepted strategy for patients with rheumatoid arthritis (RA). It recommends attaining a goal of at least low disease activity (LDA) within 6 months; otherwise, the current therapy should be modified. We aimed to investigate whether switching a first-line targeted therapy (TT) in patients not reaching LDA within 6 months leads to a higher probability of meeting LDA at the 12-month visit in daily clinical practice using data from Czech registry ATTRA. Methods We included patients with RA starting the first-line TT from 1 January 2012 to 31 January 2017 with at least 1-year follow-up. We created four mutually exclusive cohorts based on (1) switching to another TT within the first year and (2) reaching a treatment target (DAS28-ESR ≤ 3.2) at the 6-month visit. The primary outcome was the comparison of odds for reaching remission (REM) or LDA at the 12-month visit between patients switching and not switching TT after not reaching treatment target at 6 months. Before using logistic regression to estimate the odds ratio, we employed the propensity score to match patients at the 6-month visit. Results A total of 1275 patients were eligible for the analysis. Sixty-two patients switched within the first 5 months of the treatment before evaluating treatment response at the 6-month visit (C1); 598 patients reached the treatment target within 6 months of therapy (C2); 124 patients did not reach treatment response at 6-month visit and switched to another therapy (C3), and 491 patients continued with the same treatment despite not reaching LDA at the 6-month visit (C4). We matched 75 patients from cohort C3 and 75 patients from C4 using the propensity score. Patients following the T2T principle (C3) showed 2.8 (95% CI 1.4–5.8; p = 0.005) times increased likelihood of achieving REM/LDA at the 12-month visit compared to patients not following the T2T strategy (C4). Conclusions In daily clinical practice, the application of the T2T strategy is underused. Switching TT after not reaching REM/LDA within the first 6 months leads to a higher probability of achieving REM/LDA in RA patients at the 12-month visit.
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Affiliation(s)
- Lucie Nekvindová
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic.,Institute of Rheumatology, Na Slupi 4, 128 00, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Prague, Czech Republic
| | - Pavel Horák
- Department of Internal Medicine III - Nephrology, Rheumatology, Endocrinology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic.,University Hospital, Olomouc, Czech Republic
| | | | - Jakub Závada
- Institute of Rheumatology, Na Slupi 4, 128 00, Prague, Czech Republic. .,Department of Rheumatology, First Faculty of Medicine, Prague, Czech Republic.
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50
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Baloun J, Kropáčková T, Hulejová H, Tomčík M, Růžičková O, Šléglová O, Gatterová J, Vencovský J, Pavelka K, Šenolt L. Chemokine and Cytokine Profiles in Patients with Hand Osteoarthritis. Biomolecules 2020; 11:biom11010004. [PMID: 33375165 PMCID: PMC7822191 DOI: 10.3390/biom11010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The development of hand osteoarthritis (HOA) and its progression into the erosive subset are unclear, but inflammation is suspected to be the main source. To verify the involvement of inflammation in HOA pathogenesis, we evaluate serum inflammatory mediators and their association with HOA-related clinical features in patients. Methods: 153 participants (50 non-erosive HOA patients, 54 erosive HOA patients, and 49 healthy control subjects) were included in this study. All patients underwent clinical examination, which included assessment of tender and swollen small hand joints, ultrasound (US) examination, and self-reported measures (e.g., AUSCAN or algofunctional indexes). Serum inflammatory mediators were quantified using human cytokine 27-plex immunoassay. We employed linear modelling, correlation analysis, and resampling statistics to evaluate the association of these mediators to HOA. Results: We identified increased levels of nine inflammatory mediators (e.g., eotaxin, monocyte chemoattractant protein 1, interleukin-8, and tumour necrosis factor) in HOA patients compared to healthy controls. Increased mediators correlated with ultrasound findings as well as with clinically tender and swollen joint counts in patients with erosive HOA. However, none of the mediators distinguished between erosive and non-erosive HOA subtypes. Conclusion: Our findings support the hypothesis on the involvement of inflammation in HOA.
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Affiliation(s)
- Jiří Baloun
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
| | - Tereza Kropáčková
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
| | - Hana Hulejová
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
| | - Michal Tomčík
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
| | - Olga Růžičková
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
| | - Olga Šléglová
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
| | - Jindřiška Gatterová
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (J.B.); (T.K.); (H.H.); (M.T.); (O.R.); (O.Š.); (J.G.); (J.V.); (K.P.)
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic
- Correspondence: ; Tel.: +420-234-075-232
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