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ID PMID Title PublicationDate abstract
25359523 Validation of power Doppler versus contrast-enhanced magnetic resonance imaging quantifica 2015 Apr Contrast-enhancement magnetic resonance imaging (CE-MRI) of synovial volume is the radiographic gold standard to quantify joint inflammation; however, cost limits its use. Therefore, we examined if power Doppler-ultrasound (PD-US) outcomes of synovitis in tumor necrosis factor transgenic (TNF-Tg) mice correlate with CE-MRI. TNF-Tg mice underwent PD-US of their knees to measure the joint space volume (JSV) and power Doppler volume (PDV), and the results were correlated with synovial volume determined by CE-MRI. Immunohistochemistry for CD31 was performed to corroborate the PD signal. Synovial volume strongly correlated with both JSV and PDV (p < 0.01). CD31(+) blood vessels were observed in inflamed synovium proximal to the joint surface, which corresponded to areas of intense PD signals. JSV and PDV are valid measures of joint inflammation that correlate with synovial volume determined by CE-MRI and are associated with vascularity. Given the emergence of PD-US as a nonquantitative outcome of joint inflammation, we find JSV and PDV to be feasible and highly cost-effective for longitudinal studies in animal models. Furthermore, given the increasing use of PD-US in standard clinical practice, JSV and PDV could be translated to better quantify joint flare and response to therapy in patients with rheumatoid arthritis (RA).
26645595 Can Mean Platelet Volume Be a Surrogate Marker of Inflammation in Rheumatic Diseases? 2015 May 6 BACKGROUND: In humans, it has been suggested that low-level mean platelet volume (MPV) may be related to secondary thrombosis due to inflammation. For this reason, MPV can be used as a marker showing inflammation in the body. OBJECTIVES: To evaluate the association of MPV with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Disease Activity Score-28 (DAS-28), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in patients with rheumatic diseases. METHODS: The study consisted of 261 patients with rheumatoid arthritis (203 females, 77.8%; 58 males, 22.2%), 85 patients with ankylosing spondylitis (57 males, 67.1%; 28 females, 32.9%), 56 patients with familial Mediterranean fever (32 females, 57.1%; 24 males, 42.9%) and 194 patients (139 females, 71.6%; 55 males, 28.4%) with other rheumatic diseases (Behçet's disease, psoriatic arthritis, spondyloarthropathy, systemic lupus erythematosus, systemic sclerosis, or undifferentiated connective tissue disease). RESULTS: There was an inversely significant correlation between MPV and ESR and CRP in patients with rheumatoid arthritis (r = -0.164, p = 0.008). Mean platelet volume was negatively correlated with DAS-28-ESR/CRP (r = -0.393, p < 0.001) in rheumatoid arthritis. Mean platelet volume was inversely correlated with BASDAI (r = -0.580, p < 0.001) in ankylosing spondylitis. In the group with familial Mediterranean fever (especially M694V homozygous), there was a negative correlation between MPV and ESR and CRP (p < 0.001). Mean platelet volume and CRP were negatively correlated in psoriatic arthritis (r = -0.599, p = 0.011). Mean platelet volume and ESR were inversely related in patients with systemic lupus erythematosus (r = -0.421, p = 0.045). There was a negative correlation between MPV and ESR (r = -0.219, p = 0.002), and between MPV and CRP (r = -0.208, p = 0.004) in other rheumatic diseases. CONCLUSIONS: The lower MPV level surrogates active and/or chronic inflammatory state in the body. Thus, MPV may be used as a negative acute-phase reactant in rheumatic diseases.
30603389 STX0119 ameliorates arthritis in SKG mice via inhibiting T helper 17. 2016 Feb Rheumatoid arthritis (RA) is an autoimmune disease with chronic and excessive inflammation. Upregulation of interleukin (IL)-17 is involved in the pathogenesis of RA. STX0119 is a specific inhibitor of signal transducer and activator of transcription 3 (STAT3) as a potential target for the treatment of RA. STAT3 is a member of DNA-binding molecules that regulates the expression of proinflammatory cytokines involved in the pathogenesis of RA. The objective of this study was to determine whether STX0119 could inhibit STAT3 and IL-17. We demonstrated that STX0119 decreased T helper (Th) 17 differentiation and IL-17 expression in vitro. STX0119 also improved the severity of zymosan induced arthritis and reduced joint inflammation. STX0119 reduced the proliferation of Th17 and phosphorylated STAT3 expression while increasing Treg differentiation and phosphorylated STAT5 expression. Moreover, STX0119 decreased the expression of IL-6 and -17 but not IL-10. These findings suggest that STX0119 can be used to treat autoimmune RA through inhibiting the activation of STAT3.
26835987 A pure polysaccharide from Ephedra sinica treating on arthritis and inhibiting cytokines e 2016 May In our previous study, we found that the acidic polysaccharides of Ephedra sinica had immunosuppressive effect to treat rheumatoid arthritis and the pure polysaccharide ESP-B4 was the main composition of the acidic polysaccharides. At present, the exact molecular mechanism of ESP-B4 on treating arthritis is unclear. We are thus evaluating the properties of ESP-B4 on LPS-induced THP-1 pro-monocytic cells and adjuvant-induced arthritis in Wistar rats via TLR4. In vitro, ESP-B4 decreased the production of cytokines induced by LPS. In addition, ESP-B4 reduced the LPS-stimulated nuclear translocation of p65 subunit of NF-κB. Pretreatment with ESP-B4 significantly down-regulated the phosphorylation of MAPKs induced by LPS. Furthermore, in vivo, after 12 days of disease induced by adjuvant, rats were treated with ESP-B4 for 16 days. ESP-B4 significantly improved all parameters of inflammation. ESP-B4 reduced the release of inflammatory factors and cytokines by inhibiting the TLR4 signaling pathway to treat rheumatoid arthritis.
26472605 Radiographic scoring methods in psoriatic arthritis. 2015 Sep Psoriatic arthritis (PsA) leads to structural damage that can be an important driver for disability and handicap associated with the disease. Serial radiographs, usually of hands and feet, facilitate follow-up documentation of development of these changes. Semi-quantitative scoring methods are designed to measure the degree of radiographically detectable joint damage, and of changes over time. Several radiographic scoring methods that had been developed originally for rheumatoid arthritis have been adopted for the use in PsA. Four different scoring methods used in PsA are presented with instructions on how to use them: modified Steinbrocker global scoring method; PsA scoring method based on Sharp method for RA; Sharp van der Heijde modified method; and PsA Ratingen score (PARS). Available data on the reliability, sensitivity to change, and use in clinical trials, of these four methods are presented.
26904347 Rheumatoid Arthritis, Kartagener's Syndrome, and Hyperprolactinemia: Who Started It? 2016 We report a case of an 18-year-old girl who presented to our hospital with history of recurrent respiratory infections, amenorrhea, and symmetric polyarthritis. She was diagnosed with rheumatoid arthritis (RA), Kartagener's syndrome (KS), and hyperprolactinemia. There have been very few case reports in the literature of RA occurring in the setting of KS, theoretically proposed to be due to chronic stimulation of the immune system by recurrent infections. Furthermore, hyperprolactinemia has been hypothesized to mirror RA disease activity and case reports of treatment with dopamine agonists have led to the speculation of whether or not they represent a new line of experimental treatment in the future. Our patient was found to have both KS and hyperprolactinemia together in the setting of RA, and based on our literature search, this is the first reported case of such a combination. This strikes a very intriguing question: are these three conditions interlinked by a yet to be defined association? And treatment of which condition leads to the resolution of the other?
27471707 Antigen-based immunotherapy for autoimmune disease: current status. 2015 Autoimmune diseases are common chronic disorders that not only have a major impact on the quality of life but are also potentially life-threatening. Treatment modalities that are currently favored have conferred significant clinical benefits, but they may have considerable side effects. An optimal treatment strategy for autoimmune disease would specifically target disease-associated antigens and limit systemic side effects. Similar to allergen-specific immunotherapy for allergic rhinitis, antigen-specific immunotherapy for autoimmune disease aims to induce immune deviation and promote tolerance to specific antigens. In this review, we present the current status of studies and clinical trials in both human and animal hosts that use antigen-based immunotherapy for autoimmune disease.
27358094 Painful knees and hearing-loss: a rare presentation of meningococcal disease. 2016 Jun 29 A 49-year-old woman with a medical history of rheumatoid arthritis presented to the emergency room, with high fever and painful knees. In addition, she had had a mild headache for several days and some hearing loss over several months. We saw an ill patient with arthritis of both knees, from which purulent fluid was aspirated. Antibiotics were started for septic arthritis of both knees and her condition improved rapidly. However, the headache persisted and the hearing loss worsened. At the time, meningitis was suspected. Initial knee aspiration culture was positive for Neisseria meningitidis PCR of the cerebrospinal fluid sample also was positive for N. meningitidis The patient was finally diagnosed with bilateral septic gonarthritis secondary to a bacterial meningitis caused by N. meningitidis.
27738754 Multimorbidity in rheumatic conditions. 2016 Nov In recent years, multimorbidity in rheumatic conditions has gained increasing attention. Rheumatologist care for an aging patient population with multiple diseases, therefore multimorbidity is the rule, not the exception. Owing to the high prevalence and the potential interaction of coexisting diseases, multimorbidity needs to be taken into account when treating patients with chronic inflammatory conditions. In this review we address the most prevalent comorbidities in patients with rheumatic conditions and their impact on important outcomes, such as physical function, quality of life, and mortality.
27302499 A case of surgically treated peristomal pyoderma gangrenosum in a patient with rheumatoid 2016 Jun 14 Peristomal pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum that is difficult to diagnose and treat. It is characterized by the rapid progression of painful necrotic ulcer surrounding an area of abdominal stoma. It is almost exclusively associated with inflammatory bowel disease even after bowel surgery and is associated with significant morbidity. Diagnosis of pyoderma gangrenosum is based on exclusion of other disorders replicating some of its clinical features and histopathological evidence.This is a case report of a 56-year-old lady with rheumatoid arthritis who presented with rapidly progressing abdominal ulcer 8 months after a Hartmanns procedure for perforated diverticulitis. The ulcer had formed a large cavity causing faecal filling in the dependent defect. The other causes of ulcer were excluded with negative histopathology, negative polymerase chain reaction for Mycobacterium ulcerans and negative acid fast bacillus (AFB) test. She was diagnosed with PPG which is routinely treated medically due to risk of setting off a second focus of pyoderma if surgically intervened. However due to increased risk of faecal peritonitis, it was decided to proceed with surgical debridement. This article will discuss the case in more detail and briefly discuss diagnosis and treatment options for PPG.
27088031 Successful Treatment of Focal Segmental Glomerulosclerosis after Kidney Transplantation wi 2016 Recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation is difficult to treat. Recently a series of four patients unresponsive to plasma exchange (PE) and rituximab, who were successfully treated with abatacept, has been reported. We present a 26-year-old Caucasian patient who suffered from juvenile rheumatoid arthritis and developed severe proteinuria eleven days after transplantation. An allograft biopsy was suggestive of recurrent focal segmental glomerulosclerosis. He did not respond to PE therapy. A first dose of abatacept produced partial remission. Four weeks later proteinuria again increased and a second biopsy showed progression of disease. After another ineffective course of PE he was given a second dose of abatacept, which was followed by rapid, complete, and sustained resolution of proteinuria. This treatment caused a significant increase in BK and JC viremia. Whether abatacept ameliorated proteinuria via an effect on podocytes or on the patient's primary disease remains speculative.
26793469 Delayed diagnosis of Q fever endocarditis in a rheumatoid arthritis patient. 2015 Chronic Q fever caused by Coxiella burnetii is uncommon in the United States and is most often associated with infective endocarditis. We present a 52-year-old woman with a history of aortic valve replacement and rheumatoid arthritis treated with Etanercept with chronic Q fever manifesting as prosthetic valve infective endocarditis. Explanted valve tissue showed organisms confirmed to be C. burnetii by PCR (polymerase chain reaction) sequencing. She subsequently reported consumption of unpasteurized cow milk which was the likely source of C. burnetii. She continues to do well 6 months after valve replacement on oral doxycycline and hydroxychloroquine.
26495246 Cystic lesion around the hip joint. 2015 Oct 18 This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.
26275790 Association Between the Use of Oral Contraceptives and Patient-Reported Outcomes in an Ear 2016 Mar OBJECTIVE: To evaluate the association between exposure to oral contraceptives (OCs) and clinical outcomes in an early arthritis cohort. METHODS: Female patients with early inflammatory arthritis, ages 18-60 years, who were enrolled in an early arthritis cohort and had no exposure to hormone replacement were studied (n = 273). Associations between OC exposure (current/past/never) and disease activity, treatment, and patient-reported outcomes, including the Rheumatoid Arthritis Impact of Disease Score (RAID), the Rheumatoid Arthritis Disease Activity Index (RADAI), the Profile of Mood and Discomfort (PROFAD), and the Hannover Functional Assessment (FFbH), were studied over 2 years. Linear mixed models adjusted for age, body mass index, parity, smoking, and education were used. RESULTS: Eighteen percent of patients had never used OCs, 63% had used OCs in the past, and 19% currently used OCs. After adjustment, the current/past OC use was associated with better RAID, PROFAD, RADAI, and FFbH scores at 12 months (P < 0.05 for all) compared to never use. Longitudinally over 2 years, the mean RAID scores were significantly better in women with current/past OC use (P < 0.001). Actual inflammatory markers were not associated with OC use. Glucocorticoids were used by a higher percentage of OC never users than by current/past users (P = 0.08), especially in patients with impaired function (FFbH <70: odds ratio 4.2 [95% confidence interval 1.6-11]). CONCLUSION: For past as well as current use, OCs seem to moderate patient-reported outcomes in inflammatory arthritis. Protective effects may be induced via central nervous pathways rather than through the suppression of peripheral inflammation.
27559311 Disentangling Rheumatoid Arthritis Patients' Implicit and Explicit Attitudes toward Methot 2016 Medication non-adherence is a major public health problem that has been termed an 'invisible epidemic.' Non-adherence is not only associated with negative clinical consequences but can also result in substantial healthcare costs. Up to now, effective adherence interventions are scarce and a more comprehensive model of adherence determinants is required to target the determinants for not taking the medication as prescribed. Current approaches only included explicit attitudes such as self-reported evaluations of medication as determinants, neglecting the role of associative processes that shape implicit attitudes. Implicit processes can predict daily behavior more accurately than explicit attitudes. Our aim is to assess explicit and implicit attitudes toward medication and explore the relation with beliefs, adherence and clinical (laboratory) outcomes in chronically ill patients. Fifty two Rheumatic Arthritis (RA) patients' attitudes toward Methotrexate (MTX) were explicitly (self-reported) and implicitly (Single-Category Implicit Association Test) assessed and related to the Beliefs about Medicine Questionnaire, the Compliance Questionnaire on Rheumatology and laboratory parameters [Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP)]. Results show that explicit attitudes were positive and health-related. Implicit attitudes were, however, negative and sickness-related. Half of the patients displayed explicitly positive but implicitly negative attitudes. Explicit attitudes were positively related to ESR. A positive relationship between implicit attitudes and disease duration was observed. In this study, we have obtained evidence suggesting that the measurement of implicit attitudes and associations provides different information than explicit, self-reported attitudes toward medication. Since patients' implicit attitudes deviated from explicit attitudes, we can conclude that the relationship between implicit attitudes and medication adherence is worthwhile to be further explored. With this information we can improve our understanding of the subconscious, automatic processes underlying adherence and we can develop interventions that target these implicit attitudes.
26633974 Improving the Measurement of Disease Activity for Patients with Rheumatoid Arthritis: Vali 2015 Introduction. An electronic Routine Assessment of Patient Index Data 3 (RAPID 3) was incorporated into our electronic health records (EHRs) which did not replicate the visual presentation of the paper version. This study validated the electronic RAPID 3 compared to the paper version. Methods. Rheumatoid arthritis (RA) patients (n = 50) completed both the electronic RAPID 3 online in the week prior to and a paper version on the day of their clinic visit. Results. Paired t-test showed no significant difference (p value = 0.46) between versions. Conclusion. The electronic version of RAPID 3 is valid and can be easily integrated in care of RA patients.
27540360 Patients with Rheumatoid Arthritis and Chronic Pain Display Enhanced Alpha Power Density a 2016 Patients with chronic pain due to neuropathy or musculoskeletal injury frequently exhibit reduced alpha and increased theta power densities. However, little is known about electrical brain activity and chronic pain in patients with rheumatoid arthritis (RA). For this purpose, we evaluated power densities of spontaneous electroencephalogram (EEG) band frequencies (delta, theta, alpha, and beta) in females with persistent pain due to RA. This was a cross-sectional study of 21 participants with RA and 21 healthy controls (mean age = 47.20; SD = 10.40). EEG was recorded at rest over 5 min with participant's eyes closed. Twenty electrodes were placed over five brain regions (frontal, central, parietal, temporal, and occipital). Significant differences were observed in depression and anxiety with higher scores in RA participants than healthy controls (p = 0.002). Participants with RA exhibited increased average absolute alpha power density in all brain regions when compared to controls [F (1.39) = 6.39, p = 0.016], as well as increased average relative alpha power density [F (1.39) = 5.82, p = 0.021] in all regions, except the frontal region, controlling for depression/anxiety. Absolute theta power density also increased in the frontal, central, and parietal regions for participants with RA when compared to controls [F (1, 39) = 4.51, p = 0.040], controlling for depression/anxiety. Differences were not exhibited on beta and delta absolute and relative power densities. The diffuse increased alpha may suggest a possible neurogenic mechanism for chronic pain in individuals with RA.
26381221 A Mobile Internet Service for Self-Management of Physical Activity in People With Rheumato 2015 Sep 17 BACKGROUND: User involvement in the development of health care services is important for the viability, usability, and effectiveness of services. This study reports on the second step of the co-design process. OBJECTIVE: The aim was to explore the significant challenges in advancing the co-design process during the requirements specification phase of a mobile Internet service for the self-management of physical activity (PA) in rheumatoid arthritis (RA). METHODS: A participatory action research design was used to involve lead users and stakeholders as co-designers. Lead users (n=5), a clinical physiotherapist (n=1), researchers (n=2) with knowledge in PA in RA and behavioral learning theories, an eHealth strategist (n=1), and an officer from the patient organization (n=1) collaborated in 4 workshops. Data-collection methods included video recordings and naturalistic observations. RESULTS: The inductive qualitative video-based analysis resulted in 1 overarching theme, merging perspectives, and 2 subthemes reflecting different aspects of merging: (1) finding a common starting point and (2) deciding on design solutions. Seven categories illustrated the specific challenges: reaching shared understanding of goals, clarifying and handling the complexity of participants' roles, clarifying terminology related to system development, establishing the rationale for features, negotiating features, transforming ideas into concrete features, and participants' alignment with the agreed goal and task. CONCLUSIONS: Co-designing the system requirements of a mobile Internet service including multiple stakeholders was a complex and extensive collaborative decision-making process. Considering, valuing, counterbalancing, and integrating different perspectives into agreements and solutions (ie, the merging of participants' perspectives) were crucial for moving the process forward and were considered the core challenges of co-design. Further research is needed to replicate the results and to increase knowledge on key factors for a successful co-design of health care services.
26312105 Effect of Adalimumab on Work Ability Assessed in Rheumatoid Arthritis Disease Patients in 2015 OBJECTIVES: Rheumatoid arthritis (RA) is a chronic disabling disease that can jeopardize the ability of affected individuals to participate in paid work. Our objective was to evaluate the effectiveness of a 6-month course of tumor necrosis factor (TNF) antagonist (adalimumab) on work ability, overall health, and fatigue in RA patients. METHODS: Between October 2012 and February 2014, this prospective, observational study enrolled 63 consecutive patients with established adult RA at outpatient clinics in Makkah, Jeddah, Riyadh and Abha (Saudi Arabia). Patients received subcutaneous injections of adalimumab (40 mg every 2 weeks). Outcomes were measured at baseline and 6 months using the following tools: Work Productivity and Activity Impairment (WPAI), Health Assessment Questionnaire Disability Index (HAQ-DI), Fatigue Severity Scale (FSS), Visual Analog Scale for Fatigue (VAS-F), and work disability self-assessment. RESULTS: All outcomes showed improvements after 6 months of adalimumab therapy. Significant improvements from baseline were observed in absenteeism (64% ± 11.62 to 11.60% ± 11.17 [p<0.0001]), presenteeism (62.15% ± 20.11 to 34.92% ± 20.61 [p<0.0001]), overall work impairment (69.08% ± 18.86 to 40.73% ± 22.29 [p<0.0001]), overall activity impairment (68.46% ± 18.58 to 36.46% ± 20.79 [p<0.0001]), HAQ score (1.69 ± 0.57 to 0.81 ± 0.61 [p<0.0001]), and FSS score (47.08 ± 9.55 to 27.86 ± 13.43 [p<0.0001]). CONCLUSION: A 6-month course of adalimumab improved work ability, fatigue, and overall health assessments in patients with established RA. Our findings encourage randomized controlled trials investigating the cost-effectiveness and long-term effects of TNF inhibitors on work disability.
27747494 Characteristics Associated with Biologic Monotherapy Use in Biologic-Naive Patients with R 2015 Jun INTRODUCTION: The aim of this study was to describe factors associated with initiating a biologic as monotherapy vs in combination with a conventional disease-modifying antirheumatic drug (DMARD) in biologic-naive patients with rheumatoid arthritis (RA) enrolled in the Corrona registry. METHODS: First biologic initiations were classified as monotherapy (Bio MT) or combination therapy (Bio CMB). Baseline demographic and clinical characteristics were evaluated. Odds ratios (OR) based on mixed effects regression models estimated the association of covariates and use of monotherapy. Median odds ratios (MOR) based on estimated physician random effects quantified variation in individual physician use of monotherapy. RESULTS: Between October 2001 and April 2012, 3,923 previously biologic-naive patients initiated biologic therapy, of which 19.1 % initiated as monotherapy. Baseline characteristics of patients initiating Bio MT and Bio CMB were similar for age, sex, duration of RA, and clinical disease activity index. Significantly higher proportions of Bio CMB initiators had prior conventional DMARD (97.23 vs 85.60 %; P < 0.01) and methotrexate (MTX) use (91.68 vs 71.87 %; P < 0.01) compared with Bio MT initiators. Variation in individual physician use of monotherapy [MOR 1.89; 95 % confidence interval (CI), 1.66-2.23] and use of biologics approved by the United States Food and Drug Administration for monotherapy (OR 1.47; 95 % CI, 1.20-1.81) significantly influenced the odds of initiating Bio MT. Patient history of hepatic disease, neutropenia, and malignancy were associated with increased odds of being prescribed Bio MT. CONCLUSION: In addition to regulatory approval for monotherapy and specific pre-existing comorbidities, significant variation in physician use of monotherapy was associated with increased likelihood of initiating Bio MT, independent of patient factors.