Browse

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

ID PMID Title PublicationDate abstract
29269680 Severe Adult-onset Still Disease with Constrictive Pericarditis and Pleuritis That Was Suc 2018 Apr 1 Adult-onset Still disease (AOSD) is a systemic inflammatory disease characterized by fever, arthritis and rash. Corticosteroids represent a promising therapeutic option for AOSD; however, some resistant cases require immunosuppressants and biologic agents. We herein report the case of a 29-year-old Japanese man with severe AOSD, accompanied by constrictive pericarditis (CP) and pleuritis. Although 2 courses of steroid pulse and subsequent high-dose of prednisolone and cyclosporine A improved the patient's CP and pleuritis, his fever and inflammatory responses persisted. Tocilizumab (TCZ) was added to his treatment, which resulted in a rapid remission. This case suggests the usefulness of TCZ in the treatment of severe AOSD with CP and pleuritis.
28744788 Extended high-frequency audiometry as early detection of hearing loss in primary Sjögren 2017 Oct The aim of the study is to evaluate hearing function by extended high-frequency audiometry in primary Sjögren Syndrome (pSS) and to correlate it with disease activity. All patients diagnosed with pSS were recruited within 1 year. Patients underwent otologic evaluation, extended high-frequency audiometry, tympanogram, and the ESSPRI scale evaluation. A total of 63 (60 female and 3 male) patients with mean age 49.5 ± 9.9 years with pSS were included. We detected a hearing loss prevalence of 95.2% (60 patients) in both ears in very high frequencies (10000-16,000 Hz). The hearing loss of all patients was sensorineural. There was no significant difference between the degree of disease activity and the hearing thresholds. We enrolled 188 subjects with a mean age of 47.20 ± 9.7 years as a healthy control group. We compared the hearing thresholds of both ears of patients with pSS versus the healthy control group and observed a significant difference in frequencies above 500 Hz. Sensorineural hearing loss was found in pSS patients in frequencies above 4000 Hz. Sensorineural hearing loss was highly prevalent in pSS patients, predominantly in very high frequencies. We claim that sensorineural hearing loss could be an associated symptom of primary Sjögren syndrome and suggest further research to support this conclusion.
26910594 The Prevalence of Dry Eye and Sjögren Syndrome in Patients with Migraine. 2017 Jun PURPOSE: To evaluate the presence of dry eye and primary Sjögren syndrome (SS) in patients with migraine. METHODS: In total, 46 eyes of 46 patients with migraine (group 1) and 50 eyes of 50 healthy subjects (group 2) were included in this study. Detailed ophthalmologic, neurologic and rheumatologic examination were performed on all participants. Ocular surface disease index questionnaire, tear function tests, visual analog scale for pain, serologic analysis were also performed. RESULTS: Dry eye symptoms and findings were significantly higher and more severe in group 1 when compared with group 2. Primary SS was not found in any of the participants. The migraine lifetime duration was negatively correlated with the tear function tests while it was positively correlated with the ocular surface disease index scores. CONCLUSIONS: Dry eye symptoms and findings are higher in migraine patients when compared with the healthy subjects without the presence of Sjögren syndrome.
29093421 Hypertrophic Pachymeningitis in Sjögren's Syndrome. 2018 Feb 1 Although central nervous system manifestations seem common in primary Sjögren's syndrome, hypertrophic pachymeningitis is rare. We herein describe a case of Sjögren's syndrome that was associated with hypertrophic pachymeningitis. Sjögren's syndrome should be considered as a cause of hypertrophic pachymeningitis.
29240793 Dental implants in Sjögren's syndrome patients: A systematic review. 2017 OBJECTIVES: The Sjögren's syndrome (SS) is a chronic autoimmune disease that affects salivation and consequently the health of oral tissues. The aim of this systematic review was to investigate the implant survival rate, marginal bone loss (MBL) and biological complications of dental implants in SS patients. MATERIALS AND METHODS: Eligibility criteria included prospective and retrospective cohort studies, controlled clinical trials, and randomized clinical trials (RCTs). An electronic search without date or language restrictions was carried out in MEDLINE, Cochrane, Web of Science, and LILACS until June 2017. In addition, manual search and in the grey literature were also conducted. The search process, data analysis, and quality assessment were performed by two independent reviewing authors. The protocol of this systematic review was registered in PROSPERO under number CRD42016053277. RESULTS: The search and selection process yielded 6 studies, published between 1997 and 2016. An average of 93.7% survival in a mean period of 3.97 years of follow-up was observed. A low number of MBL and biological complications were reported by the studies. All the studies analyzed observed an improvement in life quality of subjects with SS and rehabilitated through dental implants. CONCLUSIONS: With the limitations of this review and based on the available data, the dental implant therapy in SS patients seems to present high implant survival rate, low MBL and low biological complications. In addition, all included studies observed an increase in the quality of life of SS patients who were rehabilitated through dental implants.
29132785 Nonrheumatoid Arthritis of the Hand. 2018 Jan Arthropathy of the hand is commonly encountered. Contributing factors such as aging, trauma, and systemic illness all may have a role in the evolution of this pathology. Besides rheumatoid arthritis, other diseases affect the small joints of the hand. A review of nonrheumatoid hand arthropathies is beneficial for clinicians to recognize these problems.
28326738 [Dental implantation in a patient with Sjögren's syndrome: a case report]. 2017 Feb 1 We reported one case of a patient with Sjögren's syndrome and dental implant. This patient was followed up for more than one year. The patient was diagnosed with Sjögren's syndrome for 5 years and treated with long-term corticosteroid. Four implant-tissue interface hydrophilic implants were placed on 15, 16, 44, and 46 of the mandibular and maxillary areas. After the surgery was completed, the patient was treated with oral antibiotic and "shenggu pills" to prevent infection and glucocorticoid to manage Sjögren's syndrome. Consequently, six implants were placed in other parts of the mandibular and maxillary areas. After more than one year of follow-up, the implants and prosthesis remained stable and had no complications. Cone beam CT reconstruction showed good implant-bone combination.
29295286 Characterizing Restorative Dental Treatments of Sjögren's Syndrome Patients Using Electro 2017 Scant knowledge exists on the type of restorative treatments Sjögren's syndrome patients (SSP) receive in spite of their high dental disease burden due to hyposalivation. Increased adoption of electronic dental records (EDR) could help in leveraging information from these records to assess dental treatment outcomes in SSP. In this study, we evaluated the feasibility of using EDR to characterize the dental treatments SSP received and assess the longevity of implants in these patients. We identified 180 SSP in ten years of patients' data at the Indiana University School of Dentistry clinics. A total of 104 (57.77%) patients received restorative or endodontic treatments. Eleven patients received 23 implants with a survival rate of 87% at 40 months follow-up. We conclude that EDR data could be used for characterizing the treatments received by SSP and for assessing treatment outcomes.
28365582 The Relationship Between Cardiac Conduction Times, Cardiovascular Risk Factors, and Inflam 2017 May OBJECTIVE: To investigate the prevalence of conduction disorders in patients with early arthritis and the relationship with inflammation and traditional cardiovascular (CV) risk factors. METHODS: Patients with rheumatoid arthritis (RA) have a 2-fold higher risk of sudden cardiac death, possibly owing to conduction disorders. This increased risk might already be present at the clinical onset of arthritis. Therefore, we assessed electrocardiography, blood pressure, 28-joint Disease Activity Score (DAS28), lipid profile, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level in 480 patients with early arthritis at baseline and after 1 year. RESULTS: The prevalence of conduction disorders was 12.5%. Conduction times at baseline were not associated with DAS28, ESR, or CRP levels and did not change during antirheumatic treatment. Baseline and the improvement in DAS28 (European League Against Rheumatism response), ESR, and CRP were significantly associated with heart rate, lipid profile, and blood pressure. Elevated total cholesterol and blood pressure were associated with an increased QRS time. The change in heart rate differed 7.3 bpm between patients with the least versus largest DAS improvement. CONCLUSION: The prevalence of conduction disorders in patients with early arthritis was 12.5%, which is similar to the general population and was not associated with changes in inflammation markers. However, a high cholesterol was associated with a prolonged QRS time. Therefore, the emphasis of CV risk management in arthritis should not be only on treatment of disease activity but also on traditional CV risk factors. The relationship between the improvement in disease activity and heart rate is remarkable because this could imply a 10-year CV mortality risk difference of 24%.
28394827 Fibromyalgia, a missed comorbidity in spondyloarthritis: prevalence and impact on assessme 2017 Jul PURPOSE OF REVIEW: Fibromyalgia is a clinical representation of the neurobiological phenomenon of central sensitization, characterized by chronic widespread pain, fatigue, sleep disturbance, and other symptoms. Fibromyalgia may occur in conjunction with chronic rheumatic diseases, driven by the effects of chronic pain and inflammation and likely influenced by the patient's genetic and psychoemotional background. This article reviews the data on prevalence of concomitant fibromyalgia and its impact on disease assessment in patients with spondyloarthritis (SpA) and psoriatic arthritis (PsA). RECENT FINDINGS: Fibromyalgia occurs in 2-8% of the general population. In AxSpA cohorts the prevalence has been reported in 4-25%, and in PsA, 16-22%, the majority being female. Measures of disease activity which are comprised partly or wholly of patient-reported outcomes such as pain and patient global are significantly higher in patients with concomitant fibromyalgia and do not improve as much with treatment as more objective measures, a finding which has been observed in other diseases such as rheumatoid arthritis and lupus. SUMMARY: Fibromyalgia occurs in a significant proportion of patients with SpA and PsA. Disease activity measures with subjective elements are conflated in patients with fibromyalgia and do not reliably assess true inflammatory disease. This needs to be taken into account when evaluating the impact of immunomodulatory therapy.
31643442 Golimumab. 2012 Golimumab is a human monoclonal antibody to tumor necrosis factor (TNF) alpha that is used in the treatment of rheumatoid arthritis and ulcerative colitis. Golimumab has been linked to a low rate of serum enzyme elevations during therapy, but has not been linked to cases of idiosyncratic, clinically apparent liver injury with jaundice. Because golimumab is a potent inhibitor of TNF alpha, it is likely to cause reactivation of chronic hepatitis B in susceptible patients.
31643785 Certolizumab. 2012 Certolizumab is a Fab fragment of a monoclonal antibody to human tumor necrosis factor alpha (TNFα) which has potent antiinflammatory activity and is used in the therapy of severe rheumatoid arthritis and inflammatory bowel disease. Certolizumab has had limited use and has yet to be specifically linked to instances of idiosyncratic acute liver injury or reactivation of hepatitis B, but is likely to cause similar hepatic injury to what has been described for other TNFα antagonists such as infliximab and adalimumab.
30516931 2017 Nov The CADTH Common Drug Review (CDR) approach to reviewing Inflectra followed the CDR Procedure and Submission Guidelines for Subsequent Entry Biologics (March, 2014). The CDR team reviewed the information provided by the manufacturer regarding product information, indications under review, the manufacturer’s requested listing criteria, biosimilarity, extrapolation, and cost. Clinical Study Reports and published articles were also appraised. Reviewers provided a critical appraisal of the clinical evidence, a discussion of extrapolation from the indications of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) to inflammatory bowel disease (IBD), and an evaluation of cost. [Table: see text]
28913168 Feasibility of photoacoustic/ultrasound imaging of synovitis in finger joints using a poin 2017 Dec We evaluate a portable ultrasound and photoacoustic imaging (PAI) system for the feasibility of a point-of-care assessment of clinically evident synovitis. Inflamed and non-inflamed proximal interphalangeal joints of 10 patients were examined and compared with joints from 7 healthy volunteers. PAI scans, ultrasound power Doppler (US-PD), and clinical examination were performed. We quantified the amount of photoacoustic (PA) signal using a region of interest (ROI) drawn over the hypertrophic joint space. PAI response was increased 4 to 10 fold when comparing inflamed with contralateral non-inflamed joints and with joints from healthy volunteers (p < 0.001 for both). US-PD and PAI were strongly correlated (Spearman's ρ = 0.64, with 95% CI: 0.42, 0.79). Hence, PAI using a compact handheld probe is capable of detecting clinically evident synovitis. This motivates further investigation into the predictive value of PAI, including multispectral PAI, with other established modalities such as US-PD or MRI.
28765712 Mean cost per number needed to treat with tocilizumab plus methotrexate versus abatacept p 2017 INTRODUCTION: Biological disease-modifying antirheumatic drugs are particularly recommended for use in patients who are poor responders, are intolerant to conventional disease-modifying antirheumatic drugs (cDMARDs), or in whom continued treatment with cDMARDs is deemed inappropriate. We estimated the efficacy and treatment costs associated with the use of tocilizumab (TCZ) plus methotrexate (Mtx) versus abatacept (ABT) plus Mtx in the treatment of rheumatoid arthritis (RA) in patients previously treated with Mtx. METHODS: Clinical data from a Technology Appraisal Guidance published in January 2016 by the National Institute for Health and Care Excellence were used. Pharmacoeconomic comparison between biological agents was carried out to estimate the respective cost for the number needed to treat (NNT) compared to cDMARDs using both American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) criteria. A 6-month period was considered. Direct medical costs including pharmacological therapy, administration, and monitoring were considered. RESULTS: Using both ACR and EULAR criteria, TCZ subcutaneously (sc) or intravenously (iv) had a lower NNT (higher efficacy) compared to ABT (iv/sc). The most significant differences in favor of TCZ were observed using EULAR criteria. Related to the level of efficacy observed, TCZ (iv/sc) had a lower cost for NNT with both ACR and EULAR criteria compared to ABT (iv/sc). Sensitivity analysis confirmed these results. CONCLUSION: TCZ (iv/sc) represents a more cost-effective option than ABT (iv/sc) in the treatment of RA in patients previously treated with Mtx.
28571182 Prevalence of Autonomic Neuropathy in Patients of Rheumatoid Arthritis and Its Correlation 2017 Apr INTRODUCTION: Autonomic Neuropathy (AN), found to be a strong predictor of sudden cardiac death, has been reported variably in patients with Rheumatoid Arthritis (RA). Manifesting as sweating disturbances, gastrointestinal irregularities, bladder or erectile dysfunction, AN can significantly affect a patient's quality of life and alter the course of the disease. AIM: This study was undertaken to find out the prevalence and severity of AN in RA patients attending the Rheumatology Clinic at a Tertiary Care Hospital in New Delhi, India and also to investigate its correlation with patient and disease factors such as age, gender, disease severity, duration and serological status. MATERIALS AND METHODS: In this cross-sectional study, AN was assessed subjectively by a survey of autonomic symptoms. Cardiac autonomic involvement was assessed by five cardiovascular reflex tests as described by Ewing: Heart Rate (HR) response to deep breathing, standing, and Valsalva and Blood Pressure (BP) response to standing and sustained handgrip. RESULTS: A total of 31 RA patients and 31 age and sex matched healthy volunteers were recruited. Upon analysis it was found that the prevalence of cardiac AN was significantly higher in patients (80.65%) as compared to controls (51.61%) (p=0.016). Positive correlation with disease severity was observed with the patient reported questionnaire but not with the objective cardiovascular reflex tests. No significant correlation between grade of AN and patient's age, gender, disease duration or serological status was established. CONCLUSION: At the end of the study, it was concluded that the pathological mechanisms responsible for autonomic dysfunction are more active in RA as compared to others.
28280641 Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rhe 2017 Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed.
28116197 Giant Baker's Cyst Associated with Rheumatoid Arthritis. 2017 We report a rare case of a "giant Baker's cyst-related rheumatoid arthritis (RA)" with 95 × 26 mm dimensions originating from the semimembranosus tendon. The patient presented with chronic pain and a palpable mass behind his left calf located between the posteriosuperior aspect of the popliteal fossa and the distal third of the calf. In MRI cystic lesion which was located in soft tissue at the posterior of gastrocnemius, extensive synovial pannus inside and degeneration of medial meniscus posterior horn were observed. Arthroscopic joint debridement and partial excision of the cyst via biomechanical valve excision were performed. The patient continued his follow-up visits at Rheumatology Department and there was no recurrence of cyst-related symptoms in 1-year follow-up. Similar cases were reported in the literature previously. However, as far as we know, a giant Baker's cyst-related RA, which was treated as described, has not yet been presented.
29109890 Gossypiboma Resection after Eight Years in a Patient with Rheumatoid Arthritis and Diabete 2017 Gossypiboma is the term used to refer to a mass formed by surgical material left in the body cavity after surgery. We present the case of a middle-aged woman with a history of rheumatoid arthritis controlled with corticosteroids and biologic therapies, uncontrolled type II diabetes mellitus, and cesarean section with postoperative bleeding eight years earlier, who presents with right lower quadrant abdominal pain and is found to have a gossypiboma from her previous operation. A subsequent operation is undertaken to remove the gossypiboma. After the procedure, our patient's diabetes and chronic back pain greatly improve, raising the question of gossypiboma's role in these diseases. A review of our patient's records found that a correct sponge count was recorded after her cesarean section, raising questions about the operating room policies regarding surgical counts, the presence of falsely correct counts, and the need for postoperative plain films in procedures with an increased risk of a retained object. Our patient's presentation eight years after the inciting surgery raises questions about the involvement her immunosuppressive therapy may have had in cloaking the gossypiboma. Our case also raises the question of surgical culpability, including the ethical and legal considerations for apology from the culpable surgeon.
28013554 The emerging roles of B cells as partners and targets in periodontitis. 2017 Feb Initial studies of periodontal disease suggested that T cell-mediated immunity against oral Gram-negative microorganisms is a key player in the pathogenesis of this inflammatory disease. Recent investigations, however, revealed that B cells are also engaged. Given their chief role in innate-like and adaptive immune responses, B cells could exert protective functions in periodontitis. However, the periodontal bacteria-specific antibody response is generally unable to halt disease progression in affected subjects, suggesting that the antibodies produced could exhibit low anti-bacterial blocking functions or opsonophagocytic potential, and/or unfavorable effects. Moreover, although microbial antigens are involved in the induction of the inflammatory responses in human adult periodontitis, endogenous antigens also may contribute to the chronicity of this common disease. Not only antibodies to self-antigens, such as collagen, are locally produced, but the autoreactivities observed in aggressive periodontitis are more severe and diverse than those observed in chronic periodontitis, suggesting that autoimmune reactivity could play a role in the tissue destruction of periodontal disease. Further support for a pathological role of B cells in periodontitis comes from the finding that B cell-deficient mice are protected from bacterial infection-induced alveolar bone loss. Studies in patients indicate that B cells and plasma cells, together with osteoclastogenic factors (RANKL and osteoprotegerin) and specific cytokines involved in their growth and differentiation (BAFF and APRIL) participate in the induction of the pathological bone loss in periodontitis. This novel insight suggests that selective targeting of B cells could represent a future therapeutic avenue for severe periodontal disease.