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ID PMID Title PublicationDate abstract
22516986 [Significance of the detection of anti-v-raf murine sarcoma viral oncogene homologue B1 an 2012 Apr 18 OBJECTIVE: To clarify the clinical significance of the antibody against v-raf murine sarcoma viral oncogene homologue B1 (BRAF) in the diagnostic practice of rheumatoid arthritis (RA). METHODS: In the study, 112 patients with RA, 112 patients with other rheumatic diseases,and 73 healthy individuals were recruited . With recombinant human BRAF protein as antigen, we examined the level of anti-BRAF antibody in all the patients by enzyme-linked immunosorbent assay(ELISA), The clinical data of the RA patients were collected simultaneously, and analysed statistically by using SPSS 13.0. RESULTS: The positive rate of anti-BRAF antibody was 53.6% in the RA patients, which was significantly higher than that of the normal control group (4.1%,P<0.01)and other rheumatic diseases groups (P all<0.01)except osteoarthritis group. The titer of anti-BRAF antibody was also notably higher in the patients with RA than in other rheumatic diseases and normal control groups(P all <0.01).The diagnostic sensitivity and specificity of anti-BRAF antibody for RA were 53.6% and 84.3% respectively. The positive rate of anti-BRAF antibody in rheumatoid factor, anti-cyclic citrullinated peptide antibody, antikeratin antibody,antiperinuclear factor negative groups were 52.6%,38.2%, 30.3% and 31.0%respectively. It showed significant negative correlation between the titer of anti-BRAF antibody and patient's age, disease duration and the level of CRP. CONCLUSION: The anti-BRAF antibody contributes to the diagnosis of RA, and may act as a supplement of other autoantibodies.
22790578 [Anti-atherosclerotic effects of etanercept in rheumatoid arthritis patients]. 2012 Epidemic studies have shown that rheumatoid arthritis (RA) patients have shorter life expectancy than healthy persons, primarily due to cardiovascular events. The aim of our study was to explore inhibitory effects on atherosclerosis of RA patients by TNF-inhibitor etanercept (ETN). We studied six RA patients with moderate or high disease activity as defined by the European League Against Rheumatism (EULAR) disease activity score (DAS28-ESR) in spite of treatment with methotrexate (MTX) 8 mg/week. We measured their pulse wave velocity (PWV) before and after treatment with ETN 25 mg/week for one year. There were no additional medications other than ETN that might influence on atherosclerosis. Their PWV decreased in five of six patients and the average decreased from 1474.8 cm/sec to 1432.5 cm/sec. The average of DAS28-ESR score was significantly decreased from 5.56 to 2.87 and they achieved good response by the EULAR criteria. There were no significant changes in the blood pressure, serum lipid (total cholesterol and triglyceride) and HbA1c ; all values were within normal limits before and after ETN treatment. It is suggested that the improvement of PWV is due to anti-inflammatory effects, leading inhibition of atherosclerosis, of ETN in RA patients.
22235646 [Anxiety level and its determinants in rheumatoid arthritis patients]. 2011 Jul Rheumatoid arthritis (RA) is a chronic disease with many somatic, psychological and social consequences. Somatic consequences are connected mainly with increasing levels of negative emotions such as depression, anxiety and a tendency to react with anger to many daily life situations. Additionally, loss of hope has been reported as another effect of rheumatoid arthritis. The goal of the study was to describe anxiety levels and its determinants in RA patients. The study was carried out on 31 RA patients, 22 (71%) of whom were females and 9 (29%) of whom were males. The respondents were assessed with a set of questionnaires such as Spielberger's State-Trait Anxiety Inventory (STAI), Multidimensional Health Locus of Control Scale (MHLC), The Coping Inventory for Stressful Situations (CISS) and Eysenck's Personality Questionnaire - Revised (EPQ-R). We have found the relationship between anxiety as (1) a state and external locus of control - powerful others (tau-b = 0.23, p = 0.09), task - oriented style of coping (tau-b = -0.34, p = 0.01), emotion-oriented style of coping (tau-b = 0.33, p = 0.02) and neuroticism levels (tau-b = 0.29, p = 0.03) and (2) anxiety as a trait and external locus of control - powerful others (tau-b = 0.40, p = 0.01), task - oriented style of coping (tau-b = 0.36, p = 0.01), emotion-oriented style of coping (tau-b = 0.33, p = 0.02) and neuroticism levels (tau-b = 0.47, p = 0,01).
21618398 The recognition and assessment of cardiovascular risk in people with rheumatoid arthritis 2011 Jun OBJECTIVES: To investigate how well recognized the association between rheumatoid arthritis (RA) and excess cardiovascular (CV) risk is within primary care and the current assessment strategies being employed by general practitioners (GPs). METHODS: Questionnaires were sent to all 376 GPs in the Worcestershire Primary Care Trust. RESULTS: Thirty-two per cent of GPs identified RA as an independent risk factor for CV disease. Fifteen per cent and 34%, respectively, assessed their RA patients for primary and secondary prevention of their CV risks. Of those GPs who made an assessment, 18.4% adjusted the calculated risk derived from standard charts. The frequency of assessment was greater among GPs who had received a form of education about the association between CV disease and RA. However, of the GPs identifying this susceptibility, only 40% performed any form of primary prevention risk assessment. CONCLUSIONS: At present, the excess risk of CV disease conferred by RA is under-recognized and under-assessed in primary care. Currently, educational resources on this topic targeted at GPs are lacking and may in part account for our findings. However, even when GPs did identify the risk of CV disease in RA or had received education about it, this did not consistently change their clinical management. Further work to promote knowledge and management strategies for CV disease in RA is therefore needed to improve the care of patients with this condition.
23124087 [A case of calcinomatous polyarthritis presenting rheumatoid arthritis-like polyarthritis 2012 We report a case of calcinomatous polyarthritis presenting rheumatoid arthritis-like polyarthritis as the initial symptom of gastric cancer. A 79-year-old male visited to our hospital with complaint of pain and swelling of multiple joints including bilateral hands, bilateral knees, elbows and small joints of fingers. He also complained of neck and back stiffness. Both of rheumatoid factor test and anti-cyclic citrullinated peptide antibody were negative. Non-steroidal anti-inflammatory drug did not relieve his arthritic pain. He showed anorexia, body weight loss and was anemic. Upper gastrointestinal endoscopic evaluation demonstrated a gastric cancer. The patient underwent subtotal gastrectomy. Within 1 week after the subtotal gastrectomy, both polyarthritis and stiffness started to improve. The polyarthritis in this case was diagnosed as calcinomatous plyarthritis for its features. Paraneoplastic rheumatism remains a rare event, but knowledge of it is essential for early diagnosis of underlying cancer.
22513146 Optimal use of non-biologic therapy in the treatment of rheumatoid arthritis. 2012 Jun With the evolution of therapies for RA, new treatment strategies and goals of therapy have evolved. Recent European League Against Rheumatism (EULAR) guidelines on the treatment of RA proposed three phases of therapy: phase I comprising first-line synthetic DMARD with or without glucocorticoid; phase II comprising second-line synthetic DMARD with or without glucocorticoid, or combination synthetic DMARD therapy, or (if prognostic factors are poor) first-line biologic DMARD; and phase III comprising alternative biologic DMARDs. In all phases, the key principle is tight control: striving to achieve a predefined goal of remission or low disease activity (treat to target) with frequent dose and medication adjustments tailored to the individual patient, preferably within the window of opportunity during early RA. In all phases, MTX is recognized as an anchor drug; it is characterized by proven efficacy in combination DMARD strategies, relatively low cost, relatively rapid onset of action, proven beneficial impact on radiological progression and mortality and a wide dose range that facilitates dose adjustments. Prednisone and its active metabolite, prednisolone, have similar characteristics, making them ideal anchor drugs too. The EULAR guidelines reserve a place for MTX and glucocorticoids in all phases of treatment. The second CAMERA (Computer Assisted Management in Early Rheumatoid Arthritis) study in early RA has demonstrated that including prednisone from the start in an MTX-based tight control strategy aimed at remission improves disease activity variables, time to remission, functional disability and radiological joint damage compared with the same strategy without prednisone. In conclusion, both MTX and prednisone play key roles in modern RA treatment strategies.
21670767 The epidemiology of early inflammatory arthritis. 2011 Jun 14 Various early arthritis clinics have provided extensive data on presentation, disease course and outcomes of early inflammatory arthritis (EIA). The present Review summarizes the epidemiological data from these early arthritis cohorts (EACs), which provide information about the frequency of, risk factors for, and outcomes of EIA and undifferentiated arthritis (UA). The studies demonstrate the large variation in selection criteria and outcome definitions in EACs, which demands careful interpretation of the results. The annual incidence of EIA ranges from 115 to 271 per 100,000 adults, and the incidence of UA ranges from 41 to 149 per 100,000 adults. Depending on the selection criteria used by the specific EACs, 13-54% of patients with UA will develop rheumatoid arthritis (RA) and in 21-87% UA will persist. Epidemiological data from the various EACs has enabled the development of prediction models for persistent and erosive arthritis. These data formed the basis of new classification criteria developed in 2010, which could enable earlier diagnosis and treatment. Future clinical research should focus on the role of imaging techniques in the early detection of synovitis and on the effect of early treatment on the outcomes of EIA.
22723432 A qualitative study of barriers to the implementation of a rheumatoid arthritis guideline 2012 Oct BACKGROUND: Although the increasing complexity and expansion of the body of knowledge in physical therapy have led to specialized practice areas to provide better patient care, the impact of specialization on guideline implementation has been scarcely studied. Objectives The objective of this study was to identify the similarities and differences in barriers to the implementation of a Dutch rheumatoid arthritis (RA) guideline by generalist and specialist physical therapists. Design This observational study consisted of 4 focus group interviews in which 24 physical therapists (13 generalist and 11 specialist physical therapists) participated. METHODS: Physical therapists were asked to discuss barriers to the implementation of the RA guideline. Data were analyzed qualitatively using a directed approach to content analysis. Both the interviews and the interview analysis were informed by a previously developed conceptual framework. RESULTS: Besides a number of similarities (eg, lack of time), the present study showed important, although subtle, differences in barriers to the implementation of the RA guideline between generalist physical therapists and specialist physical therapists. Generalist physical therapists more frequently reported difficulties in interpreting the guideline (cognitive barriers) and had less favorable opinions about the guideline (affective barriers) than specialist physical therapists. Specialist physical therapists were hampered by external barriers that are outside the scope of generalist physical therapists, such as a lack of agreement about the roles and responsibilities of medical professionals involved in the care of the same patient. CONCLUSIONS: The identified differences in barriers to the implementation of the RA guideline indicated that the effectiveness of implementation strategies could be improved by tailoring them to the level of specialization of physical therapists. However, it is expected that tailoring implementation strategies to barriers that hamper both generalist and specialist physical therapists will have a larger effect on the implementation of the RA guideline.
21591463 [A case of secondary pulmonary cryptococcosis presenting with multiple cystic shadows]. 2011 Apr An 80-year-old woman with a history of rheumatoid arthritis and steroid diabetes had been given a diagnosis of multiple bilateral pulmonary cystic lesions 16 months previously, and these lesions were observed to gradually increase on follow-up. She presented with a fever of 38 degrees C, cough, and sputum for 2 weeks, and the pulmonary cystic lesions had enlarged, and therefore she was admitted. A chest X-ray film revealed multiple cystic lesions 4 cm in greatest dimension in both the left upper and middle lung fields, and chest computed tomography (CT) scans revealed that the lesions of the left S1+2 had niveau formation with a partially thickened wall. However, the lesions in the left S4 and S5 areas and the right S8 area had thin, smooth walls. Transbronchial lung biopsy of the left S4 lesion yielded granuloma formation and yeast-like fungus bodies within multinucleated giant cells, while bronchial lavage fluid culture showed cryptococcus neoformans. It is known that pulmonary cryptococcosis presents various images and histopathologic findings, according to the immune interactions between the fungus body and the host. We report a rare case that presented with multiple cryptococcal cystic lesions.
22873530 Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis. 2012 Aug 9 BACKGROUND: Tofacitinib (CP-690,550) is a novel oral Janus kinase inhibitor that is being investigated as a targeted immunomodulator and disease-modifying therapy for rheumatoid arthritis. METHODS: In this phase 3, double-blind, placebo-controlled, parallel-group, 6-month study, 611 patients were randomly assigned, in a 4:4:1:1 ratio, to 5 mg of tofacitinib twice daily, 10 mg of tofacitinib twice daily, placebo for 3 months followed by 5 mg of tofacitinib twice daily, or placebo for 3 months followed by 10 mg of tofacitinib twice daily. The primary end points, assessed at month 3, were the percentage of patients with at least a 20% improvement in the American College of Rheumatology scale (ACR 20), the change from baseline in Health Assessment Questionnaire-Disability Index (HAQ-DI) scores (which range from 0 to 3, with higher scores indicating greater disability), and the percentage of patients with a Disease Activity Score for 28-joint counts based on the erythrocyte sedimentation rate (DAS28-4[ESR]) of less than 2.6 (with scores ranging from 0 to 9.4 and higher scores indicating more disease activity). RESULTS: At month 3, a higher percentage of patients in the tofacitinib groups than in the placebo groups met the criteria for an ACR 20 response (59.8% in the 5-mg tofacitinib group and 65.7% in the 10-mg tofacitinib group vs. 26.7% in the combined placebo groups, P<0.001 for both comparisons). The reductions from baseline in HAQ-DI scores were greater in the 5-mg and 10-mg tofacitinib groups than in the placebo groups (-0.50 and -0.57 points, respectively, vs. -0.19 points; P<0.001). The percentage of patients with a DAS28-4(ESR) of less than 2.6 was not significantly higher with tofacitinib than with placebo (5.6% and 8.7% in the 5-mg and 10-mg tofacitinib groups, respectively, and 4.4% with placebo; P=0.62 and P=0.10 for the two comparisons). Serious infections developed in six patients who were receiving tofacitinib. Common adverse events were headache and upper respiratory tract infection. Tofacitinib treatment was associated with elevations in low-density lipoprotein cholesterol levels and reductions in neutrophil counts. CONCLUSIONS: In patients with active rheumatoid arthritis, tofacitinib monotherapy was associated with reductions in signs and symptoms of rheumatoid arthritis and improvement in physical function. (Funded by Pfizer; ORAL Solo ClinicalTrials.gov number, NCT00814307.).
20172056 Immunosenescence and juvenile idiopathic arthritis. 2012 Mar Aging of the immune system (immunosenescence) is characterized by diminished thymus function, decreased output of recent thymic emigrants, compensatory peripheral proliferation of mature T cells and oligoclonal expansions of specific CD28(-) T cells. Clinical consequences are poor responses to new antigens or vaccinations, increased infection rates with higher morbidity and mortality, and increasing incidence of autoimmune diseases with advancing age. Premature immunosenescence is suggested to play a role in the pathogenesis of adult rheumatoid arthritis and in children with juvenile idiopathic arthritis (JIA). However, so far, there is not enough evidence for supporting one of the two theories: the first, favoring premature immunosenscence in children developing autoimmune conditions as the primary defect causing break-down of self-tolerance; the second, that premature immunosenescence in children with autoimmune disorders is secondary to chronic stimulation and activation of the immune system by inflammatory processes by the autoimmune disease itself. This contradictory view of etiology and pathogenesis of autoimmune diseases in the very young underlines the need for population-based longitudinal studies on immune-risk factors for autoimmune diseases beginning at infancy.
22119010 Collagen-induced arthritis and related animal models: how much of their pathogenesis is au 2011 Oct In this review, we discuss our studies on the pathogenesis of collagen-induced arthritis (CIA) and related mouse models for rheumatoid arthritis. Of note, these models invariably rely on the use of complete Freund's adjuvant (CFA). Our analysis has focused on explaining the dichotomous - either protective or disease-promoting - role of endogenous IFN-γ. Induction of a myelopoietic burst by CFA was identified as an important and underestimated factor in mediating the role of IFN-γ and other cytokines (IL-6, IL-17, GCP-2, RANK-L). Myelopoiesis provides an excess in precursors for joint-infiltrating neutrophils and osteoclasts. We postulate that classical CIA is primarily an auto-inflammatory disease, in part because of a strong innate immune response to the adjuvant. Superimposed on this, collagen-specific auto-immunity reinforces inflammatory reactivity in joints.
22349877 Association study of human leukocyte antigen-DRB1 alleles with rheumatoid arthritis in sou 2012 Jun The aim of this study is to explore relationship between HLA-DRB1 alleles and the susceptibility and clinical features of rheumatoid arthritis (RA) in the south Tunisian population. We studied 142 RA patients and 123 controls matched for age, sex, and ethnicity. HLA-DRB1 genotyping and HLA-DRB1*04 subtypes were performed using polymerase chain reaction/sequence-specific primers. Association was assessed based on the χ (2) test and odds ratio with 95% confidence interval. For multiple comparisons, p value was corrected (p (c)) with Bonferroni test. Two alleles, HLA-DRB1*04 (p=0.045, p(c)=NS) and HLA-DRB1*10 (p=0.021, p(c)=NS), were found to have increased frequencies in RA patients compared to controls. In contrast HLA-DRB1*08 allele was found to have a decreased frequency in patients compared to controls (p=0.044, p(c)=NS). Molecular subtyping of the most prevalent allele (DRB1*04) revealed increased frequencies of HLA-DRB1*04:05 in patients compared to controls (p=0.013, p(c)=NS) whereas HLA-DRB1*04:02 showed a protective effect (p=0.005, p(c)=0.04). Moreover, stratified analyses indicated statistically significant associations between HLA-DRB1*04 allele and anti-cyclic peptides antibodies positivity (ACPA(+)) and rheumatoid factor positivity (RF(+); p(c)=0.03, for both subgroups), HLA-DRBI*10 and ACPA(+) and the presence of another autoimmune disease (p(c)=0.05 and p(c)=0.007, respectively), and HLA-DRB1*04:05 and RF(+) and erosion (p(c)=0.005 and p(c)=0.049; respectively). A significant decrease in the frequency of the DRB1*04:02 allele was observed in patients with ACPA(+) and RF(+) subgroups (p(c)=0.04 and p(c)=0.02, respectively). Our results showed that there was a trend of positive association of HLA-DRB1*04 and HLA-DRB1*10 with RA as such and significant associations with the disease severity in the south Tunisian population.
21259413 Guidelines for the management of the foot health problems associated with rheumatoid arthr 2011 Jun BACKGROUND: Rheumatoid arthritis (RA) as a chronic systemic disease, commonly affects the feet, impacting negatively on patients' quality of life. Specialist podiatrists have a prime role to play in the assessment and management of foot and ankle problems within this patient group. However, it has been identified that in many areas there is no specialist podiatry service, with many patients being managed by non-specialist podiatrists. Therefore, the North West Clinical Effectiveness Group for the Foot in Rheumatic Diseases (NWCEG) identified the need to develop 'practitioner facing' guidelines for the management of specific foot health problems associated with RA. METHODS: Members of a guideline development group from the NWCEG each reviewed the evidence for specific aspects of the assessment and management of foot problems. Where evidence was lacking, 'expert opinion' was obtained from the members of the NWCEG and added as a consensus on current and best practice. An iterative approach was employed, with the results being reviewed and revised by all members of the group and external reviewers before the final guideline document was produced. RESULTS: The management of specific foot problems (callus, nail pathology, ulceration) and the use of specific interventions (foot orthoses, footwear, patient education, steroid injection therapy) are detailed and standards in relation to each are provided. A diagrammatic screening pathway is presented, with the aim of guiding non-specialist podiatrists through the complexity of assessing and managing those patients with problems requiring input from a specialist podiatrist and other members of the rheumatology multidisciplinary team. CONCLUSION: This pragmatic approach ensured that the guidelines were relevant and applicable to current practice as 'best practice', based on the available evidence from the literature and consensus expert opinion. These guidelines provide both specialist and non-specialist podiatrists with the essential and 'gold standard' aspects of managing people with RA-related foot problems.
22508400 Meta-analysis of genetic polymorphisms in granulomatosis with polyangiitis (Wegener's) rev 2012 Oct OBJECTIVE: To examine the association of previously identified autoimmune disease susceptibility loci with granulomatosis with polyangiitis (Wegener's) (GPA), and to determine whether the genetic susceptibility profiles of other autoimmune diseases are associated with those of GPA. METHODS: Genetic data from 2 cohorts were meta-analyzed. Genotypes for 168 previously identified single-nucleotide polymorphisms (SNPs) associated with susceptibility to different autoimmune diseases were ascertained in a total of 880 patients with GPA and 1,969 control subjects of European descent. Single-marker associations were identified using additive logistic regression models. Associations of multiple SNPs with GPA were assessed using genetic risk scores based on susceptibility loci for Crohn's disease, type 1 diabetes, systemic lupus erythematosus, rheumatoid arthritis (RA), celiac disease, and ulcerative colitis. Adjustment for population substructure was performed in all analyses, using ancestry-informative markers and principal components analysis. RESULTS: Genetic polymorphisms in CTLA4 were significantly associated with GPA in the single-marker meta-analysis (odds ratio [OR] 0.79, 95% confidence interval [95% CI] 0.70-0.89, P = 9.8 × 10(-5) ). The genetic risk score for RA susceptibility markers was significantly associated with GPA (OR 1.05 per 1-unit increase in genetic risk score, 95% CI 1.02-1.08, P = 5.1 × 10(-5) ). CONCLUSION: RA and GPA may arise from a similar genetic predisposition. Aside from CTLA4, other loci previously found to be associated with common autoimmune diseases were not statistically significantly associated with GPA in this study.
21362762 Circulating Dickkopf-1 is correlated with bone erosion and inflammation in rheumatoid arth 2011 May OBJECTIVE: To explore the potential role of Dickkopf-1 (DKK-1) in rheumatoid arthritis (RA) and to evaluate the effect of a tumor necrosis factor-α (TNF-α) inhibitor (infliximab) and an interleukin 1 receptor antagonist (IL-1Ra; anakinra) on DKK-1 secretion in patients with RA. METHODS: Serum samples were collected from 100 patients with RA, 100 patients with other rheumatic diseases (e.g., osteoarthritis and ankylosing spondylitis), and 40 healthy controls. DKK-1 and osteoprotegerin (OPG) levels in serum were detected by ELISA. Serum C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), rheumatoid factor (RF) titers, and anti-cyclic citrullinated peptide antibody were also measured in patients with RA. RESULTS: The serum level of DKK-1 was significantly higher in patients with RA than in healthy controls and those with other rheumatic diseases (p < 0.01); the serum DKK-1 level was correlated with levels of CRP (r = 0.488, p = 0.003) and ESR (r = 0.458, p = 2.4 x 10(-4)) and the Sharp score of radiologic change (r = 0.449, p = 0.001) in RA. In contrast to the increasing level of OPG, DKK-1 was significantly decreased in RA patients treated with TNF-α inhibitor (p < 0.01). DKK-1 was significantly decreased in RA patients treated with IL-1Ra (p < 0.01). CONCLUSION: DKK-1, as an important mediator, was correlated with bone erosion and inflammation in RA. The change of DKK-1 level may serve as a biomarker of disease activity and bone erosion.
23364579 Treatment with adalimumab in amyloidosis secondary to rheumatoid arthritis: two case repor 2013 Rheumatological diseases and, firstly, rheumatoid arthritis (RA) remain a major cause of secondary amyloidosis. The emergence of biological agents such as adalimumab in the early treatment of RA can be an effective alternative to stop the development and progression of secondary amyloidosis. Not all patients will respond the same way to treatment; we must consider associated comorbidity, the poor prognosis factors for predicting therapeutic response and possible adverse effects. In the adverse effects of biological therapies, there has been an increase in the rate of lethal infections and congestive heart failure. We present two cases with renal amyloidosis secondary to RA who had a different clinical course: our 1st case had a good response to Adalimumab while the 2nd case evolved unfavourably after treatment, and died from cardiovascular complications.
21708018 Antibodies toward infliximab are associated with low infliximab concentration at treatment 2011 Jun 27 INTRODUCTION: A proportion of patients receiving infliximab have antibodies toward infliximab (ATI), which are associated with increased risk of infusion reaction and reduced response to treatment. We studied the association of infliximab concentration at treatment initiation and development of ATI as well as the association of the presence of ATI and maintenance of infliximab. METHODS: All patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) receiving infliximab beginning in December 2005 were retrospectively followed until January 2009 or until infliximab discontinuation. Trough serum infliximab and ATI concentrations were measured at each visit. The patients were separated into two groups: ATI(pos) if ATI were detected at least once during the follow-up period and ATI(neg) otherwise. Repeated measures analysis of variance was used to study the association of infliximab concentration at treatment initiation and the development of ATI. Maintenance of infliximab in the two groups was studied by using Kaplan-Meier curves. RESULTS: We included 108 patients: 17 with RA and 91 with SpA. ATI were detected in 21 patients (19%). The median time to ATI detection after initiation of infliximab was 3.7 months (1.7 to 26.0 months). For both RA and SpA patients, trough infliximab concentration during the initiation period was significantly lower for ATI(pos) than ATI(neg) patients. RA patients showed maintenance of infliximab at a median of 19.5 months (5.0 to 31.0 months) and 12.0 months (2.0 to 24.0 months) for ATI(neg) and ATI(pos) groups, respectively (P = 0.08). SpA patients showed infliximab maintenance at a median of 16.0 months (3.0 to 34.0 months) and 9.5 months (3.0 to 39.0 months) for ATI(neg) and ATI(pos) groups, respectively (P = 0.20). Among SpA patients, those who were being treated concomitantly with methotrexate had a lower risk of developing ATI than patients not taking methotrexate (0 of 14 patients (0%) vs. 25 of 77 patients (32%); P = 0.03). CONCLUSIONS: High concentrations of infliximab during treatment initiation reduce the development of ATI, and the absence of ATI may be associated with prolonged maintenance of infliximab. Thus, trough serum infliximab concentration should be monitored early in patients with rheumatic diseases.
22965673 Is the prevalence of arterial hypertension in rheumatoid arthritis and osteoarthritis asso 2013 May In this study, we compare the prevalence of arterial hypertension (HT) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients, exposed to high- and low-grade chronic inflammation, respectively, to assess the possible association between chronic inflammation and HT. A total of consecutive 627 RA and 352 OA patients were enrolled in this multicentric study. HT was defined as a systolic blood pressure (BP) ≥ 140 and/or diastolic BP ≥ 90 mmHg or current use of any antihypertensive drug. Overweight/obesity was defined as body mass index (BMI) ≥ 25, and patients ≥65 years were considered elderly. The prevalence of HT was higher in the OA group than in the RA group [73.3 % (95 % CI, 68.4, 77.7) and 59.5 % (95 % CI, 55.6, 68.4) P < 0.001, respectively]. When the results were adjusted for age and BMI, the HT prevalence was similar in both groups [RA 59 % (95 % CI, 55.1, 63.8) OA 60 % (95 % CI, 58.4, 65.0)]. In both groups, the prevalence of HT was higher in the elderly and those who were overweight than in the younger patients and those with a BMI < 25. Overweight (BMI ≥ 25) and age ≥65 were independent predictors of HT in multivariate logistic regression model, which showed no association between HT and the disease (RA or OA). The results indicate a robust association of age and BMI with HT prevalence in both RA and OA. The difference in HT prevalence between RA and OA is due rather to age and BMI than to the features of the disease, putting into question specific association of HT with RA.
21569552 Prostaglandin E(2) binding peptide screened by phage displaying: a new therapeutic strateg 2011 May 14 OBJECTIVE: To investigate the therapeutic potential and mechanism of action of the mimotope of PGE(2) receptor EP4 (PBP, named by our team) screened by phage displaying technique in the treatment of adjuvant-induced arthritis (AA). METHODS: Freund's complete adjuvant-induced arthritis was induced in Wistar rats. At the first clinical sign of disease, mice were given with daily injections of PBP or saline for 21 days. Disease progression was monitored by measurement of paw swelling. Inflammation and joint destruction were assessed histologically. The IL-1β and TNF-α were studied by ELISA in the ankle steeps of arthritis model. The degree of proliferation and apoptosis of synoviocytes of RA patients were assessed by CCK-8 kit and AnnexinV-FITC/PI respectively. RESULTS: PBP-treated animals displayed significantly less cartilage and bone destruction than model controls. Tumor necrosis factor α and IL-1β expression were reduced after PBP treatment. The proliferation and apoptosis of synoviocytes of RA patients were influenced by PBP. CONCLUSIONS: The data support the view that PBP is a potential therapy for RA that may help to diminish both joint inflammation and destruction. And the activities of PBP are related with the effect on synoviocytes directly.