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Search for: rheumatoid arthritis    methotrexate    autoimmune disease    biomarker    gene expression    GWAS    HLA genes    non-HLA genes   

ID PMID Title PublicationDate abstract
23931459 Investigation of tear osmolarity in early rheumatoid arthritis: relation to disease activi 2013 Aug OBJECTIVE: To investigate the frequency of dry eye (DE) by measuring tear osmolarity (TO) with the recently introduced TearLab system (TearLab Corp, San Diego, Calif.) in patients with early rheumatoid arthritis (ERA) and the relationship between the severity of DE and ERA disease activity. DESIGN: Prospective study PARTICIPANTS: Sixty-four eyes of 64 newly diagnosed and untreated patients with ERA were enrolled in this study. METHODS: TO measurements, tear break-up time (TBUT), and Schirmer tests were performed. ERA disease activity was evaluated according to the disease activity score 28 (DAS28). The patients were divided into 3 groups according to DAS28 scores as follows: mild (DAS28 ≤ 3.2), moderate (3.2 < DAS28 ≤ 5.1), and severe (DAS28 > 5.1). RESULTS: DE was identified in 46 (71.8%) patients with ERA according to the TO values. There were significant differences among these groups concerning TO (p = 0.001) and TBUT (p = 0.005) scores, whereas there was no significant difference between these groups regarding Schirmer scores (p = 0.200). In addition, DAS28 values were positively correlated with TO values (r = 0.710, p < 0.001), negatively correlated with Schirmer scores, (r = -0.251, p = 0.045), and negatively correlated with TBUT scores (r = -0.335, p = 0.007) among all patients. CONCLUSIONS: Our study demonstrated a relationship between the ERA disease activity and severity of DE by using TO measurements with the TearLab system. Therefore, TO measurement could be added to other classical DE tests for diagnosing DE and for assessing the degree of disease activity of ERA.
22609344 Pannus regression after posterior decompression and occipito-cervical fixation in occipito 2013 Feb OBJECTIVES: Several techniques have been proposed for treating cervical spine instability due to rheumatoid arthritis. The aim of this study was to screen the different treatment options used in this pathology to evaluate the best form of treatment when the progression of rheumatoid disease affected the cranio-vertebral junction (CVJ) stability. The most important purpose of this study was to achieve both the efficacy of occipito-cervical fusion (OCF) to stabilize the occipitocervical junction and stop pannus progression. The authors describe their case example and stress, in the light of a literature review, the hypothesis that a stable biomechanical system extended to all the spaces involved, has both direct and indirect effects on RA pannus progression and the condition responsible for its formation, such as inflammation and articular hypermobility. Hence, the aim of this study is to advance this thesis, which may be extended to a wider statistical sample, with the same characteristics. METHOD: A systematic literature research of case report articles, review articles, original articles, and prospective cohort studies, published from 1978 to 2011, was performed using PUBMED to analyze the different surgical strategies of RA involving CVJ and the role of OCF in these conditions. The key words used for the search the were: "inflammatory cervical pannus regression", "rheumatoid arthritis of the cranio-cervical junction", "occipito-cervical fusion", "treatment option in rheumatoid cervical instability", "altanto-axial dislocation", "craniovertebral junction" and "surgical technique". In addition, the authors reported their experience in a patient affected by erosive rheumatoid arthritis (ERA) with an anterior and posterior pannus involving C0-C1-C2. They decided to report this exemplative case to emphasize their own assumptions concerning the association between a posterior bony fusion, the arrest of anterior pannus progression and the improvement of functional outcome, without, however, a direct intervention on the anterior pannus. RESULT: Thirty-seven different studies were identified that reflected search criteria, five of which were literature reviews. The different surgical treatment options in cervical RA disease are described in relation to neurological outcome according to the Ranawat grading system, functional outcome or quality of life according to the Steinbrocker classification, and progression of cervical instability and radiographic index of cranial settling, focusing on the role of OCF.
25005131 Prevalence of lipid phenotypes, serum lipid behaviour over follow-up and predictors of ser 2014 Jul OBJECTIVES: Our aim was to describe the prevalence of dyslipidaemia, serum lipid behaviour and predictors of serum lipid levels in a cohort of early rheumatoid arthritis (RA) patients. METHODS: Charts from 146 patients who were lipid-lowering therapy (LLT) free at inclusion and had baseline complete serum fasting lipid profile and ≥1 lipid profile/patient/year of follow-up were reviewed. Patient's prevalence of dyslipidemia was compared to matched controls. Linear regression analysis was applied in 101 patients who achieved remission to define predictors of lipid levels according to disease activity status. RESULTS: At baseline, the 146 patients were most frequently female (89.7%), middle aged (37.6±12.5 years) and had high disease activity; 37 of them (25.3%) had normal lipid profile. When compared to controls, patients had lower prevalence of hypercholesterolaemia (19.8% vs. 33.5%) and raised LDL cholesterol (22.6% vs. 33.5%), and higher prevalence of hypoaphalipoproteinemia (54.8% vs. 18.4%) and of hypertriglycediremia (28.1% vs. 4.8%), p≤0.05. During follow-up (45.6±26.3 months), 108 patients did not receive LLT; lipid levels increased up to last follow-up meanwhile DAS28, C-reactive protein and COL/HDL ratio decreased, especially during the first 2 years when RA treatment was intensive. Age, gender and body mass index predicted individual lipid levels in 101 patients who achieved remission. LLT was a strong predictor of triglycerides levels and of COL/HDL ratio only during remission. CONCLUSIONS: The prevalence of dyslipidaemia in early RA patients differed from the matched controls. During follow-up and parallel to disease activity, the COL/HDL ratio decreased. Demographic and anthropometric variables and LLT predicted individual serum lipid levels.
24684777 Rheumatoid forefoot reconstruction: outcome of 1st metatarsophalangeal joint fusion and th 2014 Jun BACKGROUND: Rheumatoid arthritis is a chronic inflammatory disease involving connective tissue and joints. The most common rheumatoid forefoot deformities are hallux valgus and clawed lesser toes. There are a number of surgical procedures that have been described offering symptomatic relief and anatomical correction. OBJECTIVES: This prospective case series aims to assess outcome in patients with rheumatoid forefoot deformities who underwent a novel combination of 1st metatarsophalangeal joint fusions and Stainsby procedures. METHODS: Thirteen procedures were performed on 12 consecutive patients with an age range of 55-71 (mean=62) between 02/2009 and 05/2011. AOFAS scoring was performed preoperatively and again six and 12 months post-surgery. Hallux valgus (HVA) and intermetatarsal angles (IMA) were measured preoperatively and six weeks and six months postoperatively. RESULTS: The mean AOFAS score increased from 46 to 72, 12 months postoperatively. The mean HVA reduced from 48° preoperatively to 14° six months postoperatively. The IMA decreased from 15° to 10° six months postoperatively. CONCLUSIONS: The novel approach of 1st metatarsophalangeal fusion combined with lesser toe metatarsal head sparing is an effective procedure that reduces forefoot deformity and pain.
23553120 Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the asse 2013 Jul OBJECTIVE: To investigate the clinical relevance of grade 1 findings on gray-scale ultrasound (GSUS) of the joints in patients with rheumatoid arthritis (RA). METHODS: We examined the wrists and small joints of 100 patients with early or established RA and 30 healthy controls, using GSUS and power Doppler ultrasound (PDUS). Independent clinical assessment of all joints for tenderness and swelling according to the European League Against Rheumatism examination technique was performed. Joints with grade 1 findings on GSUS were identified, and associations with swelling, pain, and findings on PDUS were assessed. Grade 1 findings on GSUS in patients with early RA were reassessed after 6 months of antirheumatic treatment. RESULTS: Grade 1 results represented the majority of all GSUS findings in patients with RA and were also frequently recorded in healthy controls. Grade 1 GSUS findings were not associated with tenderness, swelling, or positive results on PDUS. In comparison to joints with grade 2 and grade 3 findings on GSUS, joints with grade 1 findings were less likely to respond to treatment. CONCLUSION: The present results indicate that grade 1 findings on GSUS have limited clinical relevance.
23829886 Anxiety, depression and suicidal ideation in patients with rheumatoid arthritis in use of 2013 Nov OBJECTIVE: This paper aims to investigate the prevalence of anxiety, depression and suicidal ideation in patients with rheumatoid arthritis taking different drugs to control the disease. METHODS: The study included 105 patients with rheumatoid arthritis who were treated with methotrexate, leflunomide, hydroxychloroquine and biological drugs. All patients were assessed using the Mini International Neuropsychiatric Interview, the Beck Scale for Suicide Ideation and the Hospital Anxiety and Depression Scale. RESULTS: Difference was statistically significant (p < 0.001) for both depression and anxiety as to suicidal ideation among groups of patients according to the medication used. Furthermore, the value reached by those patients taking biological drugs was alarming with higher scores for all measures, including suicide ideation. The patients using methotrexate and leflunomide reported lower scores on suicidal ideation than those using hydroxychloroquine and biological drugs. Patients using leflunomide showed less mental health impairment than other groups. CONCLUSION: Greater scores for depression, as a comorbidity of rheumatoid arthritis, increase the rate of suicidal ideation and depression also can worsen general pain, hardships, treatment denial, and prognosis, as well as cause a faster reduction in quality of life. Patients taking biologic DMARDs (drugs known as disease-modifying drugs) had the highest rates of depression, anxiety and suicidal ideation among all patients studied. The current analysis showed that psychiatric aspects such as depression, anxiety and even suicide ideation, may differ between groups of patients with arthritis according to the drug used, serving as an alert to the importance of considering also this factors in therapeutic decisions.
24704577 Regulatory roles of tumor necrosis factor alpha-induced proteins (TNFAIPs) 3 and 9 in arth 2014 Jul Tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6) have proved to be important in rheumatoid arthritis (RA) because the outcome of RA has greatly improved with the recent availability of biologics targeting them. It is well accepted that these cytokines are involved in the activation of the nuclear factor-κB (NF-κB) signaling pathway, but our understanding of the dependency of these pro-inflammatory cytokines and the link between them in RA is currently limited. Recently, we and others proved the importance of TNFα-induced protein (TNFAIP), due to the spontaneous development of arthritis in deficient animals that are dependent on IL-6. To date, nine TNFAIPs have been identified, and TNFAIP3 and TNFAIP9 were found to be clearly associated with mouse and human arthritis. In this review, we compare and discuss recent TNFAIP topics, especially focusing on TNFAIP3 and TNFAIP9 in autoimmune arthritis in mice and humans.
25381729 Delayed wound healing after forefoot surgery in patients with rheumatoid arthritis. 2015 May OBJECTIVE: To elucidate the systemic and local risk factors and the effect of surgical procedures for delayed wound healing after forefoot surgery in patients with rheumatoid arthritis (RA). METHODS: Fifty forefoot surgeries were performed in 39 patients using resection arthroplasty or a joint-preserving procedure (25 feet for each procedure). The associations between the occurrence of delayed wound healing and clinical variables, radiological assessment, or surgical procedures were analyzed. RESULTS: Delayed wound healing was recorded in nine feet of eight patients. The duration of RA was significantly longer in the delayed healing group than that in the healed group. Age, sex, smoking history, concomitant diabetes, and RA medication did not differ between the groups. Radiological evaluation showed significant differences between groups in metatarsophalangeal dorsal flexion angle. The shortened length of the fourth and the fifth metatarsal bones affected the occurrence of the complication. The joint-preserving procedure had significantly less delayed wound healing compared with resection arthroplasty. CONCLUSIONS: Preoperative dorsoplantar deformity and perioperative tissue damage can cause delayed wound healing after forefoot surgery in RA patients.
24961712 The rise of biosimilars: potential benefits and drawbacks in rheumatoid arthritis. 2014 Aug Although biologic agents are effective in the treatment of rheumatoid arthritis, the high price of drugs and restricted health care budgets have restricted easy access to biologics. Eventually, the use of biologic disease-modifying antirheumatic drugs might be inversely associated with disease activity in countries with low gross domestic product. The EMA approved an infliximab biosimilar for the first time in September 2013. The first approval of a biosimilar monoclonal antibody by a major regulatory authority provided a global standard for subsequent biosimilars and for biopharmaceutical companies developing biosimilars. Biosimilars with a highly similar quality and efficacy profile at an acceptable lower cost would significantly increase affordability of biologic disease-modifying antirheumatic drugs in the treatment of rheumatoid arthritis. Here, we will review the current status of first biosimilar antibody agent and the potential discussion points raised against biosimilars. In addition, the importance of awareness on biosimilars for stakeholders is discussed.
24142191 [Recovery of knee function after total knee arthroplasty: different outcomes in patients w 2014 Aug INTRODUCTION: Following total knee arthroplasty (TKA), no investigations have been published to assess possible differences between rheumatoid arthritic (RA) and osteoarthritic (OA) patients with respect to patient-reported outcome measures of knee function. PATIENTS AND METHODS: A cohort of 128 consecutively operated patients (OA: n = 92, RA: n = 36) treated with bicondylar TKA was included in this prospective, clinical study. Knee function was assessed preoperatively and at 6 and 12 months after TKA, using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS). RESULTS: Both OKS and KOOS revealed a statistically significant improvement for OA and RA patients at 6 and 12 months after surgery, as compared to the preoperative status. The results of the OKS at 6 and 12 months did not show a further improvement for either group. The KOOS, however, revealed an additional improvement between 6 and 12 months for the osteoarthritis group, regarding the total score and all subscores, but not for the RA subgroup. CONCLUSION: Functional recovery after TKA improves in the second 6 months after surgery in OA patients, but not in RA patients, when knee function is exclusively assessed with patient-reported outcome measures.
25182207 Anti-citrullinated peptides as autoantigens in rheumatoid arthritis-relevance to treatment 2014 Nov Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by the presence of rheumatoid factor (RF) and anti-citrullinated protein/peptide autoantibodies (ACPAs). Citrulline derives from arginine by peptidyl arginine deiminases, and ACPAs are directed against different citrullinated antigens, including fibrinogen, fibronectin, α-enolase, collagen type II, histones. ACPAs are present in two thirds of RA patients have higher specificity than RF for RA, and are associated with joint radiographic damage and extra-articular manifestations and they are detected years before the onset clinical arthritis. Recent studies suggest that citrullinated antigens are most likely arthritogenic autoantigens in RA. ACPA production is associated with the HLA-DRB1 shared epitope (HLA-DRB1 SE) and accounts for the well-known RA-HLA-DRB1 SE association, as T cells recognize citrullinated peptides. Smoking and periodontitis, known environmental risk factors for RA promote protein citrullination and ACPA production. Cirullinated proteins are capable of inducing arthritis in transgenic mice carrying HLA-DRB1 SE genes, and ACPAs induce macrophage TNF-α production, osteoclastogenesis and complement activation. They also induce the formation of neutrophil extracellular traps (NETs). NETs, increased in RA, are a source of citrullinated autoantigens in RA and induce fibroblast interleukin-8 production. This knowledge is likely to have therapeutic implications, as there is a need of matching therapy with patient profile. Abatacept, a T cell activation modulator, is the best therapy for ACPA(+) RA patients, although clinical data are sparse at present. Rituximab, a monoclonal antibody that depletes B cells, is also the best therapy for ACPA(+) RA patients, and clinical data support this view.
24760805 Correlation between receptor activator of nuclear factor-κβ ligand (RANKL), and osteopro 2014 Jan AIM: to analyze the correlation between Receptor activator of nuclear factor-κβ ligand (RANKL), Osteoprotegrin (OPG) serum level with cartilage oligomeric matrix protein (COMP) serum level as a marker of cartilage degradation in rheumatoid arthritis patients. METHODS: a cross-sectional study was conducted on the subjects who came to the outpatient clinic of rheumatology in Cipto Mangunkusumo Hospital. Patients were diagnosed based on the American College of Rheumatology (ACR) 1987 revised criteria. All numerical data, both primary data and data transformation were not normally distributed, so we did bivariate analysis with Spearman correlation test. RESULTS: we collected the data of 60 RA patients with majority of the subject had active disease activity (78.3%). Methotrexate was the most widely disease modifying anti-rheumatoid drug (DMARD) used, either as a single drug (51.7%) or in combination with another DMARD (25.1%). Bivariate analysis was revealed that RANKL, OPG, and OPG/RANKL serum level have no significantly correlation with COMP serum level (p=0.52; p=0.25; p=0.2, respectively). CONCLUSION: RANKL and OPG serum level, had no correlation with cartilage degradation in rheumatoid arthritis patients.
24525910 The effects of tocilizumab on osteitis, synovitis and erosion progression in rheumatoid ar 2014 May OBJECTIVE: To examine the imaging-detected mechanism of reduction of structural joint damage progression by tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) using MRI. METHODS: In a substudy of a randomised, double-blind, phase 3b study (ACT-RAY) of biologic-naïve patients with RA who were methotrexate (MTX)-inadequate responders, 63 patients were randomised to continue MTX or receive placebo (PBO), both in combination with TCZ 8 mg/kg every 4 weeks, with optional additional disease-modifying antirheumatic drugs at week 24 if Disease Activity Score of 28 joints < 3.2. The most symptomatic hand was imaged with 0.2 Tesla extremity MRI at weeks 0, 2, 12 and 52. MR images were scored using Outcome Measures in Rheumatology-Rheumatoid Arthritis Magnetic Resonance Imaging Score. Predictors of week 52 erosion progression were determined by logistic regression analysis. RESULTS: TCZ + PBO (n=32) demonstrated mean improvements in synovitis from baseline to weeks 2 (-0.92; p=0.0011), 12 (-1.86; p<0.0001) and 52 (-3.35; p<0.0001), while TCZ + MTX (n=31) had mean improvements in synovitis at week 12 (-0.88; p=0.0074), but not week 52 (-1.00; p=0.0711). TCZ+PBO demonstrated mean reductions in osteitis at weeks 12 (-5.10; p=0.0022) and 52 (-8.56; p=0.0006), while TCZ+MTX had mean reductions at weeks 2 (-0.21; p<0.05) and 12 (-3.63; p=0.0008), but not week 52 (-2.31; p=0.9749). Mean erosion scores did not worsen in either group. MRI erosion scores at weeks 12 and 52 correlated strongly with radiography erosion scores at week 52 (r>0.80). Baseline synovitis and worsening of osteitis predicted erosion progression. CONCLUSIONS: Rapid suppression of synovitis and osteitis with reduction in structural joint damage progression occurred with TCZ, as monotherapy or in combination with MTX, through week 52.
25392118 Arthritis patients' motives for (not) wanting to be involved in medical decision-making an 2016 May The aim of this study is to gain insight into arthritis patients' motives for (not) wanting to be involved in medical decision-making (MDM) and the factors that hinder or promote patient involvement. In-depth semi-structured interviews were conducted with 29 patients suffering from Rheumatoid Arthritis (RA). Many patients perceived the questions about involvement in MDM as difficult, mostly because they were unaware of having a choice. Shared decision-making (SDM) was generally preferred, but the preferred level of involvement varied between and within individuals. Preference regarding involvement may vary according to the type of treatment and the severity of the complaints. A considerable group of respondents would have liked more participation than they had experienced in the past. Perceived barriers could be divided into doctor-related (e.g. a paternalistic attitude), patient-related (e.g. lack of knowledge) and context-related (e.g. too little time to decide) factors. This study demonstrates the complexity of predicting patients' preferences regarding involvement in MDM: most RA patients prefer SDM, but their preference may vary according to the situation they are in and the extent to which they experience barriers in getting more involved. Unawareness of having a choice is still a major barrier for patient participation. The attending physician seems to have an important role as facilitator in enhancing patient participation by raising awareness and offering options, but implementing SDM is a shared responsibility; all parties need to be involved and educated.
24130265 Health status has improved more in women than in men with rheumatoid arthritis from 1994 t 2015 Jan OBJECTIVE: To examine changes in patient reported outcome measures (PROs) over 15 years in a representative population of patients with rheumatoid arthritis (RA), with a particular focus on gender differences. PATIENTS AND METHODS: Patients in the Oslo RA register filled in questionnaires including the Modified Health Assessment Questionnaire (MHAQ), the Short-Form 36 (SF-36) with physical (PCS) and mental component summaries and derived utility (SF-6D), visual analogue scales (VAS) for pain, patient global assessment of disease (PtGA) and fatigue, and checklists of medication commonly used in the treatment of RA. Data were collected at five time points during a 15-year period from 1994. Mixed model analyses were used to analyse longitudinal changes in PROs from 1994 to 1996, 2001, 2004 and 2009. RESULTS: Data were available from 829-1025 RA patients at each time point. PROs were statistically significantly improved from 1994 to 2009 (MHAQ, SF-36 PCS, SF-6D, pain VAS, PtGA VAS and fatigue VAS; all p<0.001), and also with clinically important improvement. Men reported significantly better health status than women in 1994, but women improved significantly more than men over 15 years with a reduction of the gender gap in 2009. Antirheumatic medication was increasingly used over 15 years with no gender differences. CONCLUSIONS: RA patients reported statistically significantly improved health status for most PROs from 1994 to 2009. Women improved most, and although they still reported higher disease impact than men, the gender differences were small at the final data collection in 2009.
22948540 SKG arthritis as a model for evaluating therapies in rheumatoid arthritis with special foc 2013 May The aim was to further characterize the SKG model of rheumatoid arthritis (RA) and its potential for studying intervention treatments, with special focus on bone targeting therapies. Three individual studies were conducted, using a total of 71 SKG mice, comparing arthritis induction with mannan versus zymosan A, female versus male mice, and the effect of dexamethasone intervention treatment initiated at different time points after arthritis induction. Hind paws were embedded undecalcified in methyl methacrylate, and sections were stained with Masson-Goldner trichrome. Areal Bone Mineral Density (aBMD) of the femora was determined with pDXA. RNA was extracted from the hind paws followed by the quantification by reverse transcriptase PCR. SKG mice stimulated with mannan presented a higher arthritis score than mice stimulated with zymosan A. Female SKG mice developed a more severe arthritis than male SKG mice. Dexamethasone inhibited arthritis clinically as well as histologically when the treatment was initiated prophylactically or within the first week of arthritis. Femoral aBMD was lower in animals with arthritis than in control animals. The RANKL RNA expression was elevated in arthritic mice, whereas OPG RNA expression was unchanged. The results suggest mannan as arthritis inductor and female instead of male mice in experiments as well as an optimal time window for the initiation of treatment. Systemic bone loss as well as local up regulation of RANKL was present early in SKG arthritis. These results demonstrate that SKG arthritis is a suitable new model for evaluating therapies in RA.
24612835 Lymphoma of the hands in a patient with rheumatoid arthritis: case report. 2014 Apr The correlation of rheumatoid arthritis and lymphoma-and more generally, autoimmune disease and malignancy-has long been observed. Here, we present the case of a woman with rheumatoid arthritis who developed lymphoma limited to her hands.
25427395 [The treatment of rheumatoid arthritis]. 2014 Today, the goal of the treatment of rheumatoid arthritis is remission of disease activity which should be achieved through the first 6 months of treatment with conventional disease modifying antirheumatic drugs and tight control principle. The treatment must be adjusted to the state of disease on each visit. In the absence of remission or low disease activity biological drugs are indicated. Tapering or withdrawal of any treatment depends on the judgment of the physician and the patient, and should be considered only after at least 6 months of stable remission.
24471997 Neutrophil CD64 for monitoring the activity of nontuberculous mycobacteria infection in pa 2014 Sep OBJECTIVE: To evaluate the utility of neutrophil CD64 as a marker for monitoring the activity of nontuberculous mycobacteria (NTM) infection in patients with rheumatoid arthritis (RA). METHODS: We compared neutrophil CD64 expression in nine RA patients with NTM infection in the active and inactive phase of NTM disease chronologically. "Active phase" was here defined as present in patients admitted to hospital to receive intensive treatment for NTM, as well as outpatients with an infectious episode showing positive acid- and alcohol-fast bacillus (AFB) staining of sputa (Grade 2-3) who needed to start treatment for NTM with a multiple antibiotics regimen. The cut-off value for CD64 positivity was 2000 molecules/cell. RESULTS: Neutrophils from patients with active-phase NTM infection expressed high levels of CD64 with a mean ± SEM of 7335 ± 784 molecules/cell. However, during the inactive phase of disease, this was significantly lower (1481 ± 103 molecules/cell, p < 0.001). The sensitivity and specificity of neutrophil CD64 to detect active-phase NTM infection was 96.3% and 84.6%, respectively. Expression of neutrophil CD64 was not affected by disease activity of the RA itself. CONCLUSIONS: Neutrophil CD64 is useful for monitoring disease activity in NTM infection of patients with RA.
23958186 The phenotype and genotype of rheumatoid arthritis in the Democratic Republic of Congo. 2013 Aug 19 INTRODUCTION: Little is known about rheumatoid arthritis in the black, particularly in Congolese, populations. Our objective was to describe the phenotype and genotype of rheumatoid arthritis (RA) in Congolese. METHODS: All consecutive rheumatoid arthritis (RA) patients attending Kinshasa University Hospital in a three-year time period were included. Demographics, clinical features and tobacco consumption were noted. Disease Activity Score (DAS)-28 based on the erythrocyte sedimentation rate (ESR), Health Assessment Questionnaire (HAQ), anti-citrullinated peptide antibodies (CCP) antibodies and rheumatoid factor (RF) were determined. Radiographs were scored according to Sharp-van der Heijde. On a subset of patients and controls HLA-DRB1 typing was performed. RESULTS: A total of 114 females and 14 males aged 51.2 ± 14.9 were included. Mean duration of symptoms was four years. Moderate tobacco consumption was reported in a minority of patients. DAS-28 at first visit was >5.1 and HAQ ≥0.5 in all patients. X-rays showed joint erosions and/or joint space narrowing, mostly of a moderate grade in 55.8% of patients. Anti-CCP and/or RF were present in 48.6% of patients with available data (n = 72) and in 3.0% of controls (n = 67). Radiographic changes and nodules were more frequent in RF or anti-CCP positive patients. One copy of the shared epitope was found in 13 patients (35.1%) and 3 controls (12.5%). Two copies were found in one patient (2.7%) and in one control (4.2%). CONCLUSION: Congolese patients with RA consult long after disease onset. Despite this delay, the majority presents without major damage and is RF, anti-CCP and SE negative. We put forward the hypothesis that besides different environmental factors there is probably also a particular genetic risk profile in Congolese patients, different from the HLA-DRB1 shared epitope.