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ID PMID Title PublicationDate abstract
28507640 Histopathological Features of Methotrexate Induced Pulmonary Lesions in Rheumatoid Arthrit 2017 Apr 15 BACKGROUND: Methotrexate (MTX) is the most commonly used disease-modifying drug in the treatment of rheumatoid arthritis (RA); however, it causes many side effects, including pulmonary lesions. In this review, we characterised the histopathological features of MTX-induced pulmonary lesions in RA patients. AIM: We carried out an electronic search of the relevant literature published during the period from 1990 to 2016. We included only the cases with definitive histo-pathological findings caused by MTX therapy. MATERIAL AND METHODS: The total number of cases is 27. Male: female ratio was 1:3, and ages ranged from 48 to 87 years old, with a mean (SD) = 65.7 (1.0). The cases were originally from Asia (55%), Europe (41%), and America (4%). The major complications of methotrexate therapy were lymphoproliferative disorders (42%) followed by interstitial fibrosis (33), and infections (25%). The incidence of these complications significantly increases with the duration of MTX treatment (p = 0.044). Among the infections, the most common causative organism was pneumocystis jiroveci. The majority of patients who developed infections following methotrexate therapy were from Europe whereas the majority of those who developed lymphoproliferative disorders were from Asia (p = 0.003). CONCLUSION: In conclusion, methotrexate therapy in rheumatoid arthritis patients causes different types pulmonary complications.
30207564 Bee Venom and Hesperidin Effectively Mitigate Complete Freund's Adjuvant-Induced Arthritis 2018 Jun OBJECTIVES: This study aims to assess the antirheumatic activity of bee venom (BV) and/or hesperidin as natural products in complete Freund's adjuvant (CFA)-induced arthritis in male Wistar rats. MATERIAL AND METHODS: Rheumatoid arthritis was induced in 30 male Wistar rats (weight 130 g to 150 g; age 10 to 12 weeks) by subcutaneous injection of CFA into the right hind paw of the rats. The rats were divided into five groups of six rats in each and administered the following regimens for 21 days: Normal group (given the equivalent volume of saline and carboxymethylcellulose), arthritic group (given the equivalent volume of saline and carboxymethylcellulose), arthritic group treated with BV (treated with BV along with carboxymethylcellulose), arthritic group treated with hesperidin (treated with hesperidin along with saline), and arthritic group treated with BV and hesperidin (treated with BV and hesperidin concurrently). RESULTS: Bee venom and/or hesperidin successfully reversed the CFA-arthritis-induced increases in right hind leg paw swelling, leukocytes' count, liver lipid peroxidation, serum inflammatory cytokine interleukin (IL-2 and IL-12) levels and spleen tumor necrosis factor-alpha messenger ribonucleic acid expression. Moreover, the CFA-induced down-regulation in serum IL-10 level and spleen IL-4 messenger ribonucleic acid expression as well as the deterioration in the antioxidant defense system were significantly improved as a result of BV and hesperidin administration. Both treatments also markedly counteracted the severe inflammatory changes and leukocytic infiltration in the periarticular tissue of the ankle joints. In addition, BV and hesperidin obviously amended the lymphoid hyperplasia in white pulps of spleen as well as the widening of the medulla and mononuclear cell infiltration found in thymus. CONCLUSION: Bee venom and hesperidin administration produced their ameliorative effects on rheumatoid arthritis via their antioxidant, antiinflammatory and immunomodulatory potentials. BV plus hesperidin particularly seemed to be the most potent in improving rheumatoid arthritis in Wistar rats.
28070627 [Tendinopathy in rheumatic diseases]. 2017 Mar Involvement of tendons and tendon sheaths is frequently found in the most common inflammatory systemic diseases, rheumatoid arthritis and spondyloarthritis. In rheumatoid arthritis tendon manifestations occur as tenosynovitis, with swelling and pain of the tendons mainly on the hands and feet. In spondyloarthritis the involvement of tendons presents as enthesitis with pain and swelling directly at the attachment points of tendons to the bony structures and more commonly in the lower extremities. Pathological alterations of tendons can be normally visualized by sonography and only sometimes with magnetic resonance imaging (MRI) or scintigraphy. Furthermore, it is important for diagnostics and effective therapy to detect all joints involved by means of clinical, sonographic and radiological examination as well as laboratory parameters of inflammation, antibody serology (e.g. anti-CCP antibodies) and HLA-B27. The histopathological alterations of tendinopathy in rheumatic diseases differ from degenerative/posttraumatic tendinopathy in their expression of the changes; however, a clear differentiation of the different rheumatic inflammatory systemic diseases is histopathologically not possible. Therapeutically, systemic medication is the most important part of treatment in rheumatic diseases. Local therapeutic measures can be employed in the treatment of tenosynovitis and enthesitis. In the case of failure or lack of efficacy of the medication and conservative therapy, tenosynovectomy is performed for persistent tenosynovitis and reconstructive surgical procedures are necessary for tendon ruptures.
28808949 Practical Management of Respiratory Comorbidities in Patients with Rheumatoid Arthritis. 2017 Dec Lung disease is one of the most common causes of extra-articular morbidity and mortality in patients with rheumatoid arthritis (RA). Development of pulmonary manifestations may be due to the systemic disease itself; to serious respiratory adverse events such as pneumonitis and infections secondary to therapy; or to lifestyle habits such as smoking. Rheumatologists often need to make important treatment decisions and plan future care in RA patients with respiratory comorbidities, despite the absence of clear evidence or consensus. In this review we evaluate the clinical assessment and management of RA-associated interstitial lung disease, bronchiectasis, serious (including opportunistic) infection, and smoking-related diseases. We summarize the international recommendations for the management of such conditions where available, refer to published best practice on the basis of scientific literature, and propose practical management suggestions to aid informed decision-making.
28783408 Sjögren's syndrome. 2017 Aug 2 This review discusses important aspects of the diagnosis and management of Sjögren's syndrome, covering clinical features, diagnosis and management, and summarizes recent developments in diagnosis, prognostication and treatment.
29259607 Associations between Viral Infection History Symptoms, Granulocyte Reactive Oxygen Species 2017 To evaluate the effects of infectious episodes at early stages of rheumatoid arthritis (eRA) development, 59 untreated eRA patients, 77 first-degree relatives, from a longitudinal Tatarstan women cohort, were included, and compared to 67 healthy women without rheumatoid arthritis (RA) in their family history. At inclusion, informations were collected regarding both the type and incidence of infectious symptom episodes in the preceding year, and granulocyte reactive oxygen species (ROS) were studied at the basal level and after stimulation with serum-treated zymosan (STZ). In the eRA group, clinical [disease activity score (DAS28), health assessment questionnaire] and biological parameters associated with inflammation (erythrocyte sedimentation rate, C-reactive protein) or with RA [rheumatoid factor, anticyclic citrullinated peptide (anti-CCP2) antibodies] were evaluated. An elevated incidence of infection events in the previous year characterized the eRA and relative groups. In addition, a history of herpes simplex virus (HSV) episodes was associated with disease activity, while an elevated incidence of anti-CCP2 autoantibody characterized eRA patients with a history of viral upper respiratory tract infection symptoms (V-URI). Granulocyte ROS activity in eRA patients was quantitatively [STZ peak and its area under the curve (AUC)] and qualitatively (STZ time of peak) altered, positively correlated with disease activity, and parameters were associated with viral symptoms including HSV exacerbation/recurrence, and V-URI. In conclusion, our study provides arguments to consider a history of increased viral infection symptoms in RA at the early stage and such involvement needs to be studied further.
28504697 The transcriptional coactivator TAZ regulates reciprocal differentiation of T(H)17 cells a 2017 Jul An imbalance in the lineages of immunosuppressive regulatory T cells (T(reg) cells) and the inflammatory T(H)17 subset of helper T cells leads to the development of autoimmune and/or inflammatory disease. Here we found that TAZ, a coactivator of TEAD transcription factors of Hippo signaling, was expressed under T(H)17 cell-inducing conditions and was required for T(H)17 differentiation and T(H)17 cell-mediated inflammatory diseases. TAZ was a critical co-activator of the T(H)17-defining transcription factor RORγt. In addition, TAZ attenuated T(reg) cell development by decreasing acetylation of the T(reg) cell master regulator Foxp3 mediated by the histone acetyltransferase Tip60, which targeted Foxp3 for proteasomal degradation. In contrast, under T(reg) cell-skewing conditions, TEAD1 expression and sequestration of TAZ from the transcription factors RORγt and Foxp3 promoted T(reg) cell differentiation. Furthermore, deficiency in TAZ or overexpression of TEAD1 induced T(reg) cell differentiation, whereas expression of a transgene encoding TAZ or activation of TAZ directed T(H)17 cell differentiation. Our results demonstrate a pivotal role for TAZ in regulating the differentiation of T(reg) cells and T(H)17 cells.
28283095 Is it Sjögren's syndrome or burning mouth syndrome? Distinct pathoses with similar oral s 2017 Apr Sjögren's syndrome (SS) and burning mouth syndrome (BMS) typically occur in postmenopausal women. Although these conditions have significantly different etiopathogeneses, patients with SS or BMS often present with analogous oral complaints. The similarities between the two conditions have led to considerable confusion on the part of medical and dental practitioners, and those with BMS or SS often wait years to receive a diagnosis. Therefore, it is imperative for clinicians to understand the characteristic subjective and objective features of each disease and how these can be used to distinguish them. This review will discuss the proposed etiology, clinical manifestations, histopathology, diagnostic criteria, and patient management of SS and BMS. We also identify key differences between the two pathoses that aid in establishing the correct diagnosis. Recognition of the defining features of each condition will lead to reduced time to diagnosis and improved patient management for these poorly understood conditions.
29069728 A single nucleotide polymorphism of AIRE gene located in the 21q22.3 increases the risk of 2017 Sep 22 Several studies addressed the association of autoimmune regulator (AIRE) gene polymorphism with the risk of rheumatoid arthritis (RA); however, their conclusions were inconsistent. For better investigating the effects of this polymorphism on the risk of RA, we conducted this study to evaluate the role of AIRE rs2075786 polymorphism in the risk of RA. Four eligible studies involving 6,755 cases and 7,970 controls were identified by searching the databases of PubMed, CNKI and EMBASE up to February 2017. Our study revealed that AIRE rs2075786 polymorphism was associated with an increased risk of RA under all genetic models. In the subgroup analysis, AIRE rs2075786 polymorphism contributed to RA susceptibility among Asians, but not among Caucasians. To summarize,, this meta-analysis confirms that AIRE rs2075786 polymorphism may play a significant role in increasing the risk of RA. Stratification analysis by ethnicity reveals that AIRE rs2075786 polymorphism is associated with an increased risk of RA among Asians, but not among Caucasians. These findings need further validation in the large multicenter case-control studies.
28255337 Baricitinib in rheumatoid arthritis: evidence-to-date and clinical potential. 2017 Feb Biologics have changed expectation and outcomes for rheumatoid arthritis (RA). However, the optimal duration and sequence of therapy for this disease has yet to be determined. Also, a significant number of patients do not satisfactorily respond to currently available therapies. The Janus kinase (JAK) inhibitors represent a new class of therapies for RA. These drugs work uniquely by inhibiting intracellular pathways thought to be important in the pathogenesis of RA. They are available as oral agents, which is also different from the currently available biologics. Baricitinib has now been evaluated in four phase III clinical trials, and although safety concerns cannot fully be answered until the drug is studied over longer periods of time, the data to date suggest that this drug with its once daily dosing, rapid onset of action and efficacy as monotherapy represents an important addition to the RA therapeutic armamentarium. Further study and experience will better define how baricitinib will be used and by which patients.
28979589 Ulna Autograft for Wrist Arthrodesis: A Novel Approach in Failed Wrist Arthoplasty. 2017 Rheumatoid arthritis is a polyarthropathy affecting approximately 1% of the population worldwide. Wrist involvement is observed around 75% of patients, resulting in substantial disability and morbidity. A multidisciplinary approach to management of such patients is undertaken to prevent disease progression, many go on to develop debilitating disease requiring surgical intervention. Total wrist arthroplasty and arthrodesis are the main options available for those with end-stage disease, with arthroplasty preferred due to its ability to preserve a good degree of wrist function. Where complications occur with total wrist arthroplasty, salvage surgery with arthrodesis can be considered, however this requires satisfactory bone stock to enable stable fusion of the joint following arthroplasty. We report our experience of Ulna strut allografts in wrist arthrodesis in the management of failed total wrist arthroplasty.
32185269 The clinical utility of gene expression examination in rheumatology. 2017 Sep Rheumatoid arthritis (RA) is a chronic inflammatory disease with unknown etiology that affects various pathways within the immune system, involves many other tissues and is associated with pain and joint destruction. Current treatments fail to address pathophysiological and biochemical mechanisms involved in joint degeneration and the induction of pain. Moreover, RA patients are extremely heterogeneous and require specific treatments, the choice of which is complicated by the fact that not all patients equally respond to therapy. Gene expression analysis offer tools for patient management and personalization of patient's care to meet individual needs in controlling inflammation and pain and delaying joint destruction.
28831382 Capnocytophaga canimorsus sepsis in a methotrexate-treated patient with rheumatoid arthrit 2017 Capnocytophaga canimorsus is a gram-negative rod that can be transmitted primarily by dog bites. This life-threatening organism commonly causes sepsis in patients with splenectomy or alcoholism. A 53-year-old rheumatoid arthritis male treated with methotrexate (MTX) for 5 years was admitted for a 4-day history of fever and dyspnea. He had been bitten on a finger by the family dog 4 days before onset. Laboratory tests revealed pancytopenia, acute renal failure, and evidence of disseminated intravascular coagulation, and he subsequently developed acute respiratory distress syndrome. Furthermore, blood cultures grew gram-negative bacilli and despite intensive treatment, he died 5 days after admission. Later, C. canimorsus was identified from his culture samples using a species-specific polymerase chain reaction. C. canimorsus infections should be considered in the differential diagnosis of sepsis for immunocompromised hosts following animal bites.
28559993 Propofol inhibits cell proliferation and invasion in rheumatoid arthritis fibroblast-like 2017 Propofol is an anesthetic drug commonly used in the clinical practice. The aim of this study is to explore the effect of propofol on the aggressive behaviors of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLSs). Propofol treatment for 48 or 72 h significantly inhibited the viability of RA-FLSs, but a 24-h treatment did not produce cytotoxic effects. Propofol exposure for 48 h led to reduction of proliferation and induction of apoptosis in RA-FLSs, which was coupled with increased Bax and decreased Bcl-2 and survivin levels. Additionally, treatment with propofol for 24 h significantly suppressed the migration and invasion of RA-FLSs. Mechanistically, propofol inhibited nuclear factor-κB (NF-κB) activity. Overexpression of constitutively active NF-κB p65 reversed the inhibitory effects of propofol on RA-FLSs. Taken together, propofol exerts anti-proliferative and anti-invasive effects on RA-FLSs via the NF-κB pathway and may have therapeutic potential in treatment of RA.
30207571 The Validity and Reliability of Turkish Version of the Jenkins Sleep Evaluation Scale in R 2018 Jun OBJECTIVES: This study aims to assess the validity and reliability of the Jenkins Sleep Evaluation Scale (JSS) when applied to a Turkish population with rheumatoid arthritis. PATIENTS AND METHODS: The Turkish version of JSS (JSS-TR) was obtained after translation from English into Turkish, according to standard guidelines. The study included 61 patients of rheumatoid arthritis (13 males, 48 females; mean age 50.5 years; range 19 to 72 years) as defined by the American College of Rheumatology 2010 criteria. The internal consistency (Cronbach's alpha) was assessed for reliability. Content and construct validity (convergent and divergent validities) were evaluated. The relationships between the JSS-TR and the Pittsburgh Sleep Quality Index, the Multidimensional Assessment of Fatigue scale, subgroups of the Nottingham Health Profile, and the Stanford Health Assessment Questionnaire were assessed for convergent validity. In addition, the relationships between the JSS-TR and age, disease duration, visual analog scale patient global score, and disease activity score 28 were assessed for divergent validity. RESULTS: The Cronbach's alpha of JSS-TR was 0.80. All questions and the answer choices for the scale were understood well and related to some dimension of sleep demonstrating good content validity. The JSS-TR had good correlations with functional parameters (which are convergent), and poor or insignificant correlations with non-functional parameters (which are divergent). This implies that the JSS-TR had good construct validity in the context of this study. Overall, the JSS-TR had the best correlation with the Pittsburgh Sleep Quality Index (Spearman's rank correlation coefficient=0.76). CONCLUSION: The JSS-TR is a valid and reliable instrument. It is a simple and effective tool which can be used to evaluate sleep disturbances in rheumatoid arthritis patients in both daily practice and clinical research.
30207580 Association of the Commitments and Responsibilities of the Caregiver Within the Family to 2018 Jun OBJECTIVES: This study aims to investigate the commitments and responsibilities of the family caregiver of rheumatoid arthritis patients and determine the association of these to the disease activity. PATIENTS AND METHODS: The study included a total of 240 subjects, consisting of 60 rheumatoid arthritis patients (8 males, 52 females; mean age 50.4±11.1 years; range 25 to 76 years) with their respective 60 primary caregivers (42 males, 18 females; mean age 43.1±15.3 years; range 12 to 77 years) and 60 OA patients (7 males, 53 females; mean age 62.8±9.0 years; range 45 to 85 years) with their respective 60 primary caregivers (38 males, 22 females; mean age 47.6±13.2 years; range 27 to 87 years). Disease severity and pain of patients were assessed through visual analog scale. Sedimentation and C-reactive protein values were recorded during routine visits. Patients were stratified by disease activity that was determined by disease activity score-28. Caregivers of patients evaluated disease severity and pain by visual analog scale, and completed Caregiver Reaction Assessment (CRA) and Caregiver Strain Index questionnaires. For a more objective assessment, tasks related to care, household, and assistance and allocated time periods for each group of tasks were queried. RESULTS: When CRA and Caregiver Strain Index were compared in terms of disease activity, patients significantly differed in impact on schedule subscale of CRA (p<0.05). Similarly, disease activity was significantly associated with impact on finance subscale of CRA (p<0.05). Impact on health subscale of CRA was also correlated with disease activity; i.e., the higher the disease activity score-28, the more negative impact on health of the caregiver. CONCLUSION: Patient care is an important part of rheumatoid arthritis management. Chronic diseases form commitment on patient's caregiver. That the care of the patient may be associated with many factors related to both the patient and the caregiver should not be underestimated. We suggest that caregiver's strain may be correlated with disease activity.
29126980 Brain-derived neurotrophic factor in adjuvant-induced arthritis in rats. Relationship with 2018 Mar 2 OBJECTIVES: Both peripheral and central brain-derived neurotrophic factor (BDNF) levels are decreased in depression and normalized by efficient anti-depressive therapies. While depression symptoms are frequent in rheumatoid arthritis, BDNF has been poorly investigated in this pathology. Therefore, the present study explored cerebral and peripheral BDNF in arthritis rats as well as the link between brain BDNF and the two factors recently involved in the pathogenesis of depression and present in rheumatoid arthritis namely inflammation and endothelial dysfunction. METHODS: The brain (hippocampus and frontal cortex) and blood (serum) were collected in rats subjected to adjuvant-induced arthritis (AIA) when inflammatory symptoms and endothelial dysfunction are fully developed. Anhedonia as a core symptom of depression symptom was assessed from preference for a saccharin drinking solution. Inflammation was assessed from the arthritis score and serum levels of TNFα and IL-1β. Treatment with the arginase inhibitor N(w)-hydroxy-nor-l-arginine (nor-NOHA) was used as a strategy to prevent endothelial dysfunction without improving inflammatory symptoms. RESULTS: As compared to controls, AIA rats displayed decreased brain BDNF levels that coexisted with anhedonia but contrasted with increased BDNF levels in serum. Brain BDNF deficiency correlated neither with arthritis score nor with pro-inflammatory cytokines levels, while it was mitigated by nor-NOHA treatment. A positive correlation was observed between serum BDNF and TNFα levels. CONCLUSIONS: Our study reveals that arthritis decreases BDNF levels in the brain and that endothelial dysfunction rather than inflammation contributes to the decrease. It also identifies a disconnection between serum and brain BDNF levels in arthritis.
29061239 Neurologic Manifestations of Primary Sjögren Syndrome. 2017 Nov The neurologic manifestations of primary Sjögren syndrome are varied and can be divided anatomically into 2 categories: peripheral neuropathies and central nervous system (CNS) conditions. Distal sensory and sensorimotor neuropathies are the most common manifestations of peripheral nerve disease in primary Sjögren syndrome. CNS manifestations associated with primary Sjögren syndrome include focal central lesions, conditions that mimic multiple sclerosis, encephalitis, aseptic meningitis, cerebellar syndromes, movement disorders, and problems with memory, cognition, and depression. The heterogeneity of neurologic manifestations in primary Sjögren syndrome complicates the approach to treatment, which should be directed toward the underlying neuropathologic mechanism.
28491854 MPO-ANCA-associated necrotizing glomerulonephritis in rheumatoid arthritis; a case report 2017 Mar BACKGROUND: Renal involvement in rheumatoid arthritis (RA) is common and has a negative impact on patient survival. Only few cases have been reported of necrotizing glomerulonephritis (GN) associated with myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) in patients with RA. CASE PRESENTATION: We report a patient with RA who developed a necrotizing GN associated with ANCA-MPO, treated with rituximab (RTX). A 55-year-old man with a 27-year history of RA under secukinumab was referred to our nephrology clinic with worsening renal function associated with microhematuria and proteinuria. Our laboratory evaluation showed hypocomplementemia and positive titers for MPO-ANCA (615 U/mL). A renal biopsy demonstrated pauci-immune necrotizing GN. The patient was treated with 3 consecutive pulses of methylprednisolone followed by oral prednisolone (1 mg/Kg) and rituximab (1000 mg, repeated 14 days later). After a 10-month follow-up, the arthritis remains well-controlled, renal function stabilized, proteinuria improved and MPO-ANCA titer normalized (6.3 U/mL). CONCLUSIONS: Necrotizing GN is a rare but a serious condition and an early diagnosis is essential to treatment. This is the first case of necrotizing GN (without extra-renal manifestations of vasculitis) in a patient with active RA, successfully treated with RTX.
28559961 Autophagy inhibitor regulates apoptosis and proliferation of synovial fibroblasts through 2017 BACKGROUND AND OBJECTIVE: Mounting studies have illustrated an important role of autophagy in various diseases, but few studies have reported its contribution to rheumatoid arthritis (RA) and the underlying mechanism was largely unknown. This study aimed to investigate whether autophagy inhibitors could regulate apoptosis and proliferation through PI3K/AKT pathway in RA. METHODS: RA animal model was established by collagen induction. General observations and degree of joint swelling were observed. Inflammatory response, cell survival related factors and apoptosis were also detected in synovial fibroblasts. In addition, cultured rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) were subjected to TNF-α treatment in vitro, and TNF-α induced cell autophagy, synovial cell proliferation and apoptosis were detected. Moreover, cell cycle and cytokine secretion protein, along with the above parameters, were analyzed. RESULTS: Results from the animal model showed that autophagy inhibitors attenuated inflammatory reaction and synovial hyperplasia, while promoted synovial fibroblasts apoptosis. Meanwhile, inhibition of autophagy promoted cell apoptosis and reversed cell proliferation in vitro, also blocked cell in the G2/M arrest and reduced the S phase cells. Furthermore, we observed that inhibition of PI3K/AKT pathway reversed TNF-α mediated autophagy and cytokine secretion. CONCLUSION: autophagy inhibitors could mitigate inflammation response, inhibiting RA-FLS cell proliferation while promoting cell apoptosis by the PI3K/AKT pathway.