Browse

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

ID PMID Title PublicationDate abstract
24932905 Application of a prediction model for the progression of rheumatoid arthritis in patients 2014 Nov INTRODUCTION: Different prediction rules have been applied to patients with undifferentiated arthritis (UA) to identify those that progress to rheumatoid arthritis (RA). The Leiden Prediction Rule (LPR) has proven useful in different UA cohorts. OBJECTIVE: To apply the LPR to a cohort of patients with UA of northeastern Mexico. METHODS: We included 47 patients with UA, LPR was applied at baseline. They were evaluated and then classified after one year of follow-up into two groups: those who progressed to RA (according to ACR 1987) and those who did not. RESULTS: 43% of the AI patients developed RA. In the RA group, 56% of patients obtained a score ≤ 6 and only 15% ≥ 8. 70% who did not progress to RA had a score between 6 and ≤ 8. There was no difference in median score of LPR between groups, p=0.940. CONCLUSION: Most patients who progressed to RA scored less than 6 points in the LPR. Unlike what was observed in other cohorts, the model in our population did not allow us to predict the progression of the disease.
25417119 Evaluation of tocilizumab therapy in patients with rheumatoid arthritis based on FDG-PET/C 2014 Nov 22 BACKGROUND: Positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (18F-FDG) can detect the presence of synovitis in rheumatoid arthritis (RA) patients. The aim of this study was to investigate whether the findings of FDG-PET matched the conventional assessments of the disease activity score (DAS) 28, DAS28-CRP, simplified disease activity index (SDAI) and clinical disease activity index (CDAI) in RA patients receiving tocilizumab (TCZ) therapy. METHODS: Seventeen RA patients treated with TCZ were assessed. FDG-PET was performed at baseline and three and six months after the initiation of TCZ therapy. The maximum SUV (SUVmax) of the bilateral shoulder, elbow, wrist, hip, knee and ankle joints were added together (total SUV) and were used to assess the degree of FDG uptake as a representative parameter. The correlations between the ΔSUV and the difference in the clinical parameters at baseline and at each observation period, and the differences in each clinical parameters, were assessed. RESULTS: The ΔSUV, the differences in the total SUV at baseline and at three/six months after starting treatment positively correlated with the ΔDAS28 (r = 0.615 p = 0.009/ r = 0.775 p < 0.001), ΔDAS28-CRP (r = 0.696, p = 0.002/ r = 0.828, p < 0.001), ΔSDAI (r = 0.652, p = 0.005/ r = 0.686, p = 0.002) and ΔCDAI (r = 0.662, p = 0.004/ r = 0.711, p = 0.001) for each period. The total SUV was significantly decreased at three and six months after the initiation of TCZ (p < 0.05). CONCLUSIONS: A reduction in the FDG uptake was observed at three and six months after the initiation of TCZ therapy. The disease activity estimated on FDG-PET/CT matched the conventional parameters following the TCZ therapy in RA patients.
23457377 Agreement between the DAS28-CRP assessed with 3 and 4 variables in patients with rheumatoi 2013 Apr OBJECTIVE: The Disease Activity Score-28-C-reactive Protein 4 [DAS28-CRP(4)] composite measure for rheumatoid arthritis (RA) is based on 4 variables: tender and swollen joint counts, CRP, and patient global assessment. DAS28-CRP(3) includes only 3 variables, because patient global assessment has been omitted. Thresholds for low and high disease activity are the same for the 2 scores. The objective of our study was to compare the 2 DAS scores and their responses on the individual patient level. METHODS: Baseline and 12-week disease activity data from 239 patients with RA treated with a biological agent were extracted from the Danish registry for biological treatment (DANBIO). Cohen's effect sizes (ES) and disease activity levels according to the DAS thresholds were assessed. The Bland-Altman method was used to examine the bias between the DAS scores and the 95% limits of agreement (LoA). RESULTS: Baseline values for DAS28-CRP(4) and DAS28-CRP(3) were 4.8 ± 1.2 and 4.6 ± 1.1, respectively. At 12 weeks, DAS28-CRP(4) had improved by -1.39 ± 1.34 (p < 0.0001). At that timepoint the bias of DAS28-CRP(3) was -0.07 (LoA -0.69, 0.55) (p < 0.0001). The bias of the DAS28-CRP(3) response was +0.21 (LoA -0.49, 0.91) (p < 0.0001). ES for DAS28-CRP(4) was 1.2 ± 1.1 versus 1.1 ± 1.1 for DAS28-CRP(3) (p < 0.0001). Compared to DAS28-CRP(4), DAS28-CRP(3) categorized 33% fewer patients as having a high level of disease activity, 8% fewer patients as good responders, and 12% more patients as nonresponders. CONCLUSION: Mean values of DAS28-CRP(4) and DAS28-CRP(3) agreed well, but in the individual patient the difference between the scores and their responses may be substantial.
24183243 [Physical therapy, orthosis and occupational therapy in medical and surgical rheumatologic 2013 Dec Hand pathology can cause functional disability and deterioration in the quality of life by altering the grip and therefore, it requires a complex approach by a multidisciplinary team, including physiotherapists and occupational therapists. Orthoses are an important part of the treatment of these pathologies. A thorough understanding of the pathogenesis of lesions and their risk of progression to deformities is required for an appropriate use. Their fabrication by a specialized therapist and also their monitoring assure a good compliance. Their effectiveness depends on the patient adherence, for which information and education are essential. The role of physiotherapist is to establish a personalised rehabilitation program, including passive and active exercises and also the prevention of joint stiffness. The main goal after surgery is to initiate an early active motion in order to decrease the risk of adhesions without compromising the suture by the use of a splint. The role of occupational therapist is important all along the treatment period, from the early rehabilitation to the moment of return to home environment. The literature search shows that there is a lack of good methodological clinical studies in order to assess the effectiveness and the costs of this medical treatment.
24788619 Randomised comparison of initial triple DMARD therapy with methotrexate monotherapy in com 2014 Jul OBJECTIVES: To compare 1-year clinical efficacy of (1) initial triple disease-modifying antirheumatic drug therapy (iTDT) with initial methotrexate (MTX) monotherapy (iMM) and (2) different glucocorticoid (GC) bridging therapies: oral versus a single intramuscular injection in early rheumatoid arthritis. METHODS: In a single-blinded randomised clinical trial patients were randomised into three arms: (A) iTDT (methotrexate+sulfasalazine+hydroxychloroquine) with GCs intramuscularly; (B) iTDT with an oral GC tapering scheme and (C) MTX with oral GCs similar to B. Primary outcomes were (1) area under the curve (AUC) of Health Assessment Questionnaire (HAQ) and Disease Activity Score (DAS) and (2) the proportion of patients with radiographic progression. RESULTS: 281 patients were randomly assigned to arms A (n=91), B (n=93) or C (n=97). The AUC DAS and HAQ were respectively -2.39 (95% CI -4.77 to -0.00) and -1.67 (95% CI -3.35 to 0.02) lower in patients receiving iTDT than in those receiving iMM. After 3 months, treatment failure occurred less often in the iTDT group, resulting in 40% fewer treatment intensifications. The difference in treatment intensifications between the arms required to maintain the predefined treatment goal remained over time. No differences were seen between the two GC bridging therapies. Respectively 21%, 24% and 23% of patients in arms A, B and C had radiographic progression after 1 year. Patients receiving iTDT had more adjustments of their medication owing to adverse events than those receiving iMM. CONCLUSIONS: Treatment goals are attained more quickly and maintained with fewer treatment intensifications with iTDT than with iMM. However, no difference in radiographic progression is seen. Both GC bridging therapies are equally effective and, therefore, both can be used. TRIAL REGISTRATION NUMBER: ISRCTN26791028.
25019052 Circulating microRNAs as biomarkers for inflammatory diseases. 2013 MicroRNAs (miRNAs), a class of small, non-coding RNA molecules with gene regulatory functions, have emerged to play a critical role in the pathogenesis of a variety of diseases. Current technological advances allow accurate, high throughput profiling of miRNA abundance in different tissues. More recently, extracellular, circulating miRNAs have begun to be demonstrated as highly stable, blood-based biomarkers for diseases. Understanding the interactions between circulating miRNAs and clinical phenotypes can enhance our knowledge of complex diseases and traits. On the other hand, given the advantages of utilizing blood-based biomarkers (e.g., convenience in collecting samples), circulating miRNAs as biomarkers may improve both disease diagnosis and management. Particularly, we reviewed recent progress in identifying circulating miRNAs as biomarkers for several common inflammatory diseases including asthma, inflammatory bowel disease, and rheumatoid arthritis. Current studies showed a promising future of using circulating miRNAs in the care of inflammatory diseases.
24912006 Associations of killer cell immunoglobulin like receptors with rheumatoid arthritis among 2014 Aug INTRODUCTION: Rheumatoid arthritis (RA) is an autoimmune and chronic inflammatory disease of unknown etiology. Killer cell immunoglobulin-like receptors (KIR) expressed on surface of natural killer cells and CD28 null T-cells which are present in synovial membrane of RA. The present study has evaluated associations of KIR genes with RA among North Indian population from Uttar Pradesh. MATERIALS AND METHODS: KIR genotypes were determined in 100 RA cases and 100 healthy controls using sequence specific primer polymerase chain reaction (PCR-SSP) method. RESULTS: RA cases positive for KIR3DS1 (OR = 1.17, p-value = 0.0498) and KIR2DS2 (OR = 2.21, p-value = 0.0120) showed risk associations. While, KIR2DL2 (OR = 0.40, p-value = 0.0026), KIR2DL3 (OR = 0.44, p-value = 0.0283) and KIR3DL1 (OR=0.32, p-value = 0.0012) showed protective associations. Increased incidence of BB genotype (45%) was revealed among cases. Risk association was noted against telomeric region (OR = 2.12, p = 0.0120) genes for RA. Pair-wise linkage disequilibrium (LD) analysis among RA cases revealed KIR2DS1-2DL1 (D' = 0.83, r(2) = 0.36), KIR3DL1-3DS1 (D' = 1, r(2) = 0.58) and KIR2DL1-2DL2 (D' = 1, r(2)=0.61) to be in significant LD. KIR3DS1 and KIR2DS3 genes showed significant risk associations among RA patients with extra-articular manifestations (OR = 5.14, p-value = 0.0018; OR = 3.79, p-value = 0.0106) and in limited range of motion in affected joints (OR = 14.91, p-value = 0.0001; OR = 2.95, p-value=0.0126). CONCLUSION: The KIR activating genes have risk association with RA in the present study.
23838082 Does stress affect the joints? Daily stressors, stress vulnerability, immune and HPA axis 2014 Sep OBJECTIVES: Both stressors and stress vulnerability factors together with immune and hypothalamus-pituitary-adrenal (HPA) axis activity components have been considered to contribute to disease fluctuations of chronic inflammatory diseases, such as rheumatoid arthritis (RA). The aim of the present study was to investigate whether daily stressors and worrying as stress vulnerability factor as well as immune and HPA axis activity markers predict short-term disease activity and symptom fluctuations in patients with RA. METHODS: In a prospective design, daily stressors, worrying, HPA axis (cortisol) and immune system (interleukin (IL)-1β, IL-6, IL-8, interferon (IFN)-γ, tumour necrosis factor α) markers, clinical and self-reported disease activity (disease activity score in 28 joints, RA disease activity index), and physical symptoms of pain and fatigue were monitored monthly during 6 months in 80 RA patients. RESULTS: Multilevel modelling indicated that daily stressors predicted increased fatigue in the next month and that worrying predicted increased self-reported disease activity, swollen joint count and pain in the next month. In addition, specific cytokines of IL-1β and IFN-γ predicted increased fatigue 1 month later. Overall, relationships remained relatively unchanged after controlling for medication use, disease duration and demographic variables. No evidence was found for immune and HPA axis activity markers as mediators of the stress-disease relationship. CONCLUSIONS: Daily stressors and the stress-vulnerability factor worrying predict indicators of the short-term course of RA disease activity and fatigue and pain, while specific cytokines predict short-term fluctuations of fatigue. These stress-related variables and immune markers seem to affect different aspects of disease activity or symptom fluctuations independently in RA.
23343931 MMP expression in rheumatoid inflammation: the rs11568818 polymorphism is associated with 2013 Apr Matrix metalloproteinases (MMPs) contribute to the joint damage in rheumatoid arthritis (RA). Less is known of the involvement of MMPs at extra-articular sites of rheumatoid inflammation. We assessed the relative contribution from MMP-1, MMP-3, MMP-7 and MMP-12 to joint and extra-articular tissue destruction and inflammation by comparing gene expression in joint synovia and subcutaneous rheumatoid nodules from RA patients. Expression of MMP-1 and MMP-3 predominated in synovia, whereas MMP-12 expression was significantly higher in rheumatoid nodules. Markedly higher MMP-7 expression distinguished a subgroup of nodules that featured infiltrating monocyte/macrophage-producing MMP-7 protein. The high MMP-7 expression in nodules was associated with the single-nucleotide polymorphism (SNP) rs11568818 (-181A>G, MMP-7 promoter) and more active inflammation within the nodule lesions. Patients with such nodules had significantly earlier age of RA onset. Our findings indicate that the expression of MMP-1 and MMP-3 occurs relatively independent of the tissue microenvironment with substantial expression also at extra-articular sites. MMP-12 expression reflects the involvement of monocyte/macrophages in rheumatoid inflammation. Evidence for the association between the rs11568818 SNP and increased MMP-7 expression is restricted to nodules, which indicates that consequences of the MMP-7 polymorphism are likely to manifest within aspects of immune/inflammatory activity that are monocyte/macrophage-mediated.
24261758 Abatacept inhibits radiographic progression in patients with rheumatoid arthritis: a retro 2014 Jan OBJECTIVES: Our objectives in this study were to determine the inhibitory effects of abatacept on joint damage and its clinical efficacy and safety in patients with rheumatoid arthritis (RA). METHODS: Fifty Japanese patients with RA were treated with abatacept for 24 weeks in routine clinical practice. RESULTS: At week 24, 20 % of patients achieved clinical remission [Simplified Disease Activity Index (SDAI) ≤3.3], whereas 50 % were in remission or had a low disease activity. Structural remission [progression of modified total Sharp score (ΔmTSS) ≤0.5] was achieved in 76 % of patients. The ΔmTSS decreased significantly from 7.1 ± 7.3 at baseline to 1.8 ± 5.7 at week 24. C-reactive protein (CRP) was the only independent prognostic factor for joint damage progression at week 24, whereas SDAI and matrix metalloproteinase-3 levels were not. A very high proportion of patients with CRP levels <1.5 mg/dl (88 %) achieved structural remission. In terms of safety, the retention rate for all patients was favorable (80 %), and stomatitis was the only adverse event observed. No patient withdrew from the study because of infections. CONCLUSIONS: Abatacept has favorable clinical and structural effects, inhibits radiographic progression, and has a good safety profile in routine clinical practice.
23420357 Meta-analysis demonstrates association between TLR polymorphisms and rheumatoid arthritis. 2013 Feb 7 We investigated whether Toll-like receptor (TLR) polymorphisms confer susceptibility to rheumatoid arthritis and whether they influence clinical characteristics of rheumatoid arthritis. Studies were considered relevant for our meta-analysis if at least two comparisons of an issue were available. Eleven studies with 2078 patients with rheumatoid arthritis and 2581 controls were included, encompassing European and Asian studies. Meta-analysis of three European studies showed no significant association between the TLR4 Asp299Gly (rs4986790) polymorphism and rheumatoid arthritis (odds ratio = 0.897, 95% confidence interval = 0.734-1.096, P = 0.289). One Turkish study showed a significant difference between TLR9 rs187084 allele frequencies and rheumatoid arthritis patients and controls, while another study revealed a significant association between rheumatoid factor and TLR8 rs5741883. A Korean study on the numbers of guanine-thymine [(GT)(n)] repeats in intron II of the TLR2 gene found a significantly higher S-allele frequency in rheumatoid arthritis patients than in controls (30.3 vs 23.0%). Overall findings for the meta-analysis including all the studies conclude that TLR polymorphism is associated with development and clinical characteristics of rheumatoid arthritis in Asian and Middle East populations.
23463689 Low-avidity anticitrullinated protein antibodies (ACPA) are associated with a higher rate 2014 Jan OBJECTIVES: Anticitrullinated protein antibodies (ACPA) are specific for rheumatoid arthritis (RA) and have been implicated in disease pathogenesis. Previously we have shown that ACPA display a considerably lower avidity as compared with antibodies against recall antigens. Nonetheless, ACPA-avidity did vary between patients. As antibody mediated effects are influenced by antibody-avidity, we now investigated ACPA-avidity in relation to biological activity and clinical outcome. METHODS: We determined the avidity of ACPA and related this with severity of joint damage in two Dutch early-RA cohorts containing 199 and 132 patients respectively. Differences in effector functions of low- and high-avidity ACPA were studied. RESULTS: Extensive variation in ACPA-avidity between patients was observed. This allowed the analysis of the relationship between avidity and severity. The presence of low-avidity ACPA is associated with a higher rate of joint destruction. This finding was replicated in an independent cohort. Analysis of the properties of low-versus high-avidity ACPA revealed that low-avidity ACPA are less hampered in their ability to bind 'new' citrullinated antigens. Although no differences could be observed regarding cellular activation via Fc-γ receptors, low-avidity ACPA were more potent in activating the complement system. CONCLUSIONS: Patients with low-avidity ACPA display a higher rate of joint destruction. Low-avidity ACPA display a higher potency to interact with more citrullinated antigens in time and show that low-avidity ACPA are more potent in complement activation. These data indicate that (low) avidity impacts on the biological activity of ACPA and associates with a worse radiological outcome.
22971639 A single nucleotide polymorphism of reduced folate carrier 1 predicts methotrexate efficac 2013   Methotrexate (MTX) exhibits large inter-individual and inter-ethnic differences in the dose required for its anti-rheumatic effect. To maintain low disease activity, patients may require increased MTX doses or co-administration of biologic disease-modifying anti-rheumatic drugs (bDMARDs). The availability of a marker predicting the effect of MTX will make it possible to increase the MTX dose and prescribe bDMARDs to patients at an early stage. To establish individualized medication for rheumatoid arthritis (RA), we investigated genetic polymorphisms of the folate pathway in Japanese RA patients. Eighty-nine patients were treated with MTX alone (MTX group). MTX and bDMARDs were co-administered to 81 patients because of insufficient MTX efficacy (MTX + bDMARDs group); an equally stable therapeutic effect was achieved in both groups. Polymorphism analyses using bDMARD co-treatment as the objective variable revealed a significant association between age and the G80A polymorphism of the reduced folate carrier 1 gene (RFC1) as an explanatory variable. Compared to patients with the A allele, patients with the G allele may have less intracellular MTX uptake and, therefore, poor efficacy; a greater number of them were found to be bDMARD concomitant cases. The results of this study suggest that the RFC1 G80A polymorphism may be a useful marker for predicting MTX efficacy in Japanese patients with RA.
25181002 [Comorbidity in rheumatoid arthritis]. 2014 Sep Patients with rheumatoid arthritis (RA) often have one or more comorbid conditions. The prevalence of comorbidities increases with age and disease duration. Comorbidities influence the outcome of RA and limit therapeutic options. Besides suppressing disease activity of RA, screening and tight control of existing comorbidities is essential to avoid further damage. A close cooperation between general practitioners, rheumatologists and attending specialists is important for a successful treatment, taking into account the complex interaction of RA and its comorbidities.
24647977 The effect of leflunomide on the eye dryness in secondary Sjögren's syndrome associated w 2014 Jul The aim of this work was to clarify the effect of leflunomide (LEF) on the eye dryness in patients with secondary Sjögren's syndrome associated with rheumatoid arthritis (RA-sSS) and in patients with rheumatoid arthritis (RA). Seventy-five female patients, 45 with RA-sSS (group A) and 30 with RA (group B), taking methotrexate at a dose of 20 mg/week for more than 6 months were enrolled in this study. They all had a loading dose of leflunomide then were maintained at a dose of 20 mg/day in addition to methotrexate for another 3 months. The modified disease activity score (DAS28) was calculated and modified Schirmer's-I test was performed. Assessment of disease parameters was done to all patients before and after 3 months of taking LEF. The mean modified Schirmer's-I test showed a significant decrease after 3 months of taking LEF in group A (3 ± 1.6 before versus 1.9 ± 1.6 after 3 months, P < 0.001), while this difference was non-significant in group B (21.3 ± 10 versus 19.9 ± 11). One patient (group A) developed peripheral ulcerative keratitis (PUK) with exacerbation of disease activity (DAS-28 = 6.9) that improved by taking corticosteroids. Three patients (group A) had aggravation of punctate keratocojunctivitis sicca with punctate erosions without PUK. The condition improved dramatically by stopping LEF and using topical lubricants. We report in this study a significant deterioration of the eye dryness in patients with sSS-RA after 3 months of receiving LEF inspite of the significant improvement of their DAS28. This finding was not clearly detected in RA patients. Close monitoring of eye dryness changes by special tests in patients using LEF is recommended, especially in cases with sSS-RA having very low baseline values.
23359233 High rate of preterm birth in pregnancies complicated by rheumatoid arthritis. 2014 Jan OBJECTIVE: To describe the outcomes of pregnancies complicated by rheumatoid arthritis (RA) and to estimate potential associations between disease characteristics and pregnancy outcomes. STUDY DESIGN: We reviewed all pregnancies complicated by RA delivered at our institution from June 2001 through June 2009. Fisher exact tests were used to calculate odds ratios. Univariable regression was performed using STATA 10.1 (StataCorp, College Station, TX). A p value of ≤ 0.05 was considered statistically significant. RESULTS: Forty-six pregnancies in 40 women were reviewed. Sixty percent of pregnancies had evidence of disease flare and 28% delivered prior to 37 weeks. We did not identify associations between preterm birth and active disease at conception or during pregnancy. In univariate analysis, discontinuation of medication because of pregnancy was associated with a significantly earlier gestational age at delivery (362/7 versus 383/7 weeks, p = 0.022). CONCLUSION: Women with RA may be at higher risk for preterm delivery.
22704786 Acute- or subacute-onset lung complications in treating patients with rheumatoid arthritis 2013 Aug Rheumatoid arthritis (RA) is a common systemic disease that manifests as inflammatory arthritis of multiple joints and produces a wide variety of intrathoracic lesions, including pleural diseases, diffuse interstitial pneumonia, rheumatoid nodules, and airway disease. Patients treated for RA can have associated lung disease that commonly manifests as diffuse interstitial pneumonia, drug-induced lung injury, and infection. The purpose of this pictorial review is to illustrate the radiographic and clinical features of lung complications of acute or subacute onset in patients treated for RA and to show the computed tomography features of these complications.
23341582 Rituximab seems to be a safer alternative in patients with active rheumatoid arthritis wit 2013 Jan 21 Demonstrating the efficiency and safety of rituximab (Rtx) in the treatment of active rheumatoid arthritis (RA) and tuberculosis (TB). Two cases of RA with active TB were followed up to 3 years following the initiation of Rtx. The former case presented with a history of concomitant diagnosis of both RA and TB and the latest one, also diagnosed with RA and reactivation of TB developed during the anti-tumour necrosis factor treatment. After a sufficient time of follow-up, we have observed that Rtx seems to be safer and efficient in the treatment of active RA and TB.
24336336 Ultrasound-guided synovial biopsy: a safe, well-tolerated and reliable technique for obtai 2015 Mar OBJECTIVE: To determine the tolerability, safety and yield of synovial tissue in an early arthritis cohort using a minimally invasive, ultrasound (US)-guided, synovial biopsy technique in small, medium and large joints. METHODS: 93 sequential biopsy procedures were assessed from a total of 57 patients (baseline and 36 repeat biopsies at 6 months) recruited as part of the 'Pathobiology of Early Arthritis Cohort' study. Patients completed a tolerability questionnaire prior to and following the synovial biopsy procedure. The synovial biopsy was performed under US guidance with US images of the joint recorded prior to each procedure. Synovial tissue was harvested for immunohistochemistry and RNA extraction. RESULTS: Five different joint sites were biopsied (knee, elbow, wrist, metacarpal phalangeal and proximal interphalangeal). No significant complications were reported following the procedure. No difference in pain, swelling and stiffness of the biopsied joint from before and after the procedure was demonstrated. A median of 14 biopsy samples was retrieved from each procedure with 93% of biopsy procedures yielding good quality tissue. RNA yield was good in all joints and in repeat biopsies. Multivariant analysis demonstrated a significantly greater yield of RNA and graded tissue in relation to a high prebiopsy, grey-scale synovitis score (0-3, semiquantitative). CONCLUSIONS: A minimally invasive approach to synovial tissue harvesting, using US guidance, is both safe and well-tolerated by patients. Tissue quality/RNA yield is preserved in subsequent biopsies following therapeutic intervention. A high US grey-scale synovitis score is a predictor of good quality/quantity of tissue and RNA.
24878859 Periodontitis exposure within one year before anti-diabetic treatment and the risk of rheu 2014 Mar OBJECTIVE: To examine whether a history of periodontitis (PD) before anti-diabetic treatment is associated with risk of rheumatoid arthritis (RA) development in newly-treated diabetes mellitus (DM) patients. METHODS: We conducted a population-based retrospective cohort study using the 1997-2009 National Health Insurance (NHI) claims data of one million representative individuals from all NHI enrollees. Adults with DM (aged ≥ 20 years) starting anti-diabetic treatment during 2001-2009 were classified as newly-treated DM patients. We identified 7097 DM subjects with PD history within one year before initiating anti-diabetes treatment (index date). By matching these 7097 subjects for age on the index date, sex, and year of the index date, we randomly extracted 14,194 DM subjects without PD history within one year before antidiabetic treatment. Adjusted hazard ratios (aHRs) with a 95% confidence interval (CI) were calculated by applying Cox proportional hazards models to quantify the association between PD history and RA risk. RESULTS: Compared with DM patients without PD exposure within one year before anti-diabetic treatment, crude HR and adjusted HR of RA among DM patients with PD exposure within one year before anti-diabetic treatment were 4.51 (95% CI, 1.39-14.64) and 3.77 (95% CI, 1.48-9.60). CONCLUSION: PD exposure within one year before anti-diabetic treatment was associated with increased RA risk in newly treated DM patients. The lack of knowledge about individual smoking status is a major limitation of this study.