Browse

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

ID PMID Title PublicationDate abstract
29558352 [Malnutrition and obesity among patients with rheumatoid arthritis and chronic inflammator 2018 Chronic inflammatory status in patients with rheumatoid arthritis (RA) due to metabolic changes has an effect on body composition. Up to two thirds of patients may be affected by the loss of body cell mass and, thereby, malnutrition including its most severe form - cachexia. Among patients with RA and malnutrition, the total body weight is not reduced and the muscle loss is partially compensated by an increase in body fat. The excess of visceral and trunk adipose tissue is the main factor of increased prevalence of insulin resistance and metabolic syndrome in RA patients. On the other hand, an increased level of abdominal obesity in RA patients is related to the decreased concentration of adiponectin and reduced joint damage, which determines the reduced level of functional impairment. This is the reason why body mass index (BMI) is especially inadequate indicator of body composition in RA patients. In clinical practice, even though BMI is an inadequate body composition indicator, low BMI values in RA patients can be used to detect a particularly fragile sub-set of patients that deserve particular attention. RA patients with BMI intermediate values probably have good control of the disease but they can nonetheless be malnourished. Obese RA patients may or may not have better articular prognosis but should be subjected to the same degree of attention regarding cardiovascular risk factors as obese subjects in the general population. Irrespective of the inflammatory process, body composition is the result of a complex network of interconnected factors, like physical activity, nutritional intake and chronic corticosteroid treatment.
29141572 A Clinical Update and Global Economic Burden of Rheumatoid Arthritis. 2018 Feb 13 BACKGROUND AND OBJECTIVE: Rheumatoid arthritis (RA) is a predominant inflammatory autoimmune disorder. The incidence and prevalence of RA is increasing with considerable morbidity and mortality worldwide. The pathophysiology of RA has become clearer due to many significant research outputs during the last two decades. Many inflammatory cytokines involved in RA pathophysiology and the presence of autoantibodies are being used as potential biomarkers via the use of effective diagnostic techniques for the early diagnosis of RA. Currently, several disease-modifying anti-rheumatic drugs are being prescribed targeting RA pathophysiology, which have shown significant contributions in improving the disease outcomes. DISCUSSION: Even though innovations in treatment strategies and monitoring are helping the patients to achieve early and sustained clinical and radiographic remission, the high cost of drugs and limited health care budgets are restricting the easy access of RA treatment. Both direct and indirect high cost of treatment are creating economic burden for the patients and affecting their quality of life. CONCLUSION: The aim of this review is to describe the updated concept of RA pathophysiology and highlight current diagnostic tools used for the early detection as well as prognosis - targeting several biomarkers of RA. Additionally, we explored the updated treatment options with side effects besides discussing the global economic burden.
29573593 The evidence base for psychological interventions for rheumatoid arthritis: A systematic r 2018 Jun BACKGROUND: Psychological interventions are an important but often overlooked adjunctive treatment option for patients with rheumatoid arthritis. Findings from systematic reviews of psychological interventions for this patient group are conflicting. A systematic review of reviews can explain inconsistencies between studies and provide a clearer understanding of the effects of interventions. OBJECTIVES: To: 1) determine the effectiveness of psychological interventions in improving biopsychosocial outcomes for adults with rheumatoid arthritis, 2) determine the relationship between the intensity of the psychological interventions (number of sessions, duration of sessions, duration of intervention) on outcomes, and 3) assess the impact of comparator group (usual care, education only) on outcomes. DESIGN: We conducted a systematic review of reviews using the following inclusion criteria: 1) randomised controlled trials of psychological interventions (including cognitive behavioural therapy, supportive counselling, psychotherapy, self-regulatory techniques, mindfulness-based cognitive therapy and disclosure therapy) provided as an adjunct to medication, 2) included rheumatoid arthritis patients aged ≥ 18 years, 3) reported findings for at least 1 of the primary outcomes: pain, fatigue, psychological status, functional disability and disease activity and 4) were published in English between January 2000 and March 2015 (updated January 2018). DATA SOURCES: We searched in MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. Reference lists were searched for additional reviews. REVIEW METHODS: Study selection and 50% of the quality assessments were performed by two independent reviewers. Methodological quality was measured using the Assessment of Multiple Systematic Reviews checklist. Data extraction was conducted by one reviewer using a predesigned data extraction form. RESULTS: Eight systematic reviews met inclusion criteria (one review was excluded due to its low-quality score). Small post intervention improvements in patient global assessment, functional disability, pain, fatigue, anxiety and depression were observed. The effect on coping, self-efficacy and physical activity was greater. Improvements in depression, coping and physical activity were maintained (8.5-14 months). Interventions delivered over a longer period with a maintenance component appeared more effective. Attention, education, and placebo control groups produced some improvements but not as large as those produced by the psychological interventions. CONCLUSIONS: Psychological interventions result in small to moderate improvements in biopsychosocial outcomes for patients with rheumatoid arthritis in addition to those achieved by standard care. Several priorities for future research were identified, including determining the cost effectiveness of non-psychologically trained health professionals delivering psychological interventions.
30385703 Does Rheumatoid Arthritis Really Improve During Pregnancy? A Systematic Review and Metaana 2019 Mar OBJECTIVE: We performed a systematic review and metaanalysis to assess rheumatoid arthritis (RA) disease activity during pregnancy using objective disease activity scoring systems. METHODS: A systematic review of PubMed, EMBASE/Medline, Cochrane, and LactMed databases was performed. Our inclusion criteria for analysis were prospective studies, more than 5 patients per study, and data on RA using an objective scoring system conducted by a clinician/health professional. RESULTS: Ten studies were eligible for final analysis, which included 237 patients, of which prepartum data were available for 204 patients. Postpartum disease activity was recorded in 135 pregnancies. CONCLUSION: Disease activity improved in 60% of patients with RA in pregnancy and flared in 46.7% postpartum.
29808295 Expert recommendations on the psychological needs of patients with rheumatoid arthritis. 2018 Dec OBJECTIVE: To establish feasible and practical recommendations for the management of the psychological needs of patients with rheumatoid arthritis (RA) from the moment of diagnosis through the course of the disease. METHODS: A nominal group meeting was held with an RA expert team including rheumatologists and psychologists, at which a guided discussion addressed the most important psychological and emotional needs in RA. Based on the comments collected, and a literature review, a matrix document of recommendations for telematics discussion was prepared, as well as a Delphi survey to test agreement with these recommendations. Agreement was defined if at least 80% of participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grading of recommendations was established following the Oxford criteria, and the degree of agreement through the Delphi. RESULTS: Thirteen recommendations were established, addressing several key processes: (1) identification of psychological problems and needs in patients with RA, and a guideline for their management in daily practice; (2) communication with patients; (3) referral criteria to mental health professionals. CONCLUSIONS: These recommendations are intended to help health care professionals openly address the psychological aspects of patients in daily practice to follow and treat them properly.
31174819 Central nervous system involvement in rheumatoid arthritis patients and the potential impl 2018 Aug Central nervous system (CNS) involvement is quite unusual in patients with rheumatoid arthritis (RA), although cerebral vasculitis, rheumatoid nodules and meningitis have all been reported, and patients with RA may also have CNS comorbidities such as stroke and neuro-degenerative and demyelinating syndromes. It has been found that biological drugs, especially anti-tumour necrosis factor-alpha (anti-TNF-α) drugs, slightly increase the risk of developing demyelinating diseases, and they are consequently discouraged in patients with multiple sclerosis and related disorders. Furthermore, the risk of opportunistic CNS infections is increased in immunosuppressed patients. To review the current literature concerning CNS involvement in patients with RA (including RA-related forms and comorbidities) and the incidence of new-onset CNS diseases in patients with RA undergoing biological treatment (anti-TNF or non-anti-TNF drugs), the Medline database was searched using the key words 'rheumatoid arthritis', 'central nervous system', 'anti-TNF', 'abatacept', 'tocilizumab', 'rituximab' and 'anakinra'. Abstracts not in English were excluded. We selected 76 articles published between 1989 and 2017, which were divided into four groups on the basis of whether CNS involvement was RA-related or not and according to the type of biological agent used (TNF inhibitors or other agents). The RA-related diseases included aseptic meningitis, vasculitis and cerebral rheumatoid nodules, which benefit from immunosuppressive treatments. CNS comorbidities included stroke, seizures, dementia and neuropsychiatric disorders, which have been frequently described in biological agent-naïve patients with RA, and other rarely reported neurological diseases, such as extra-pyramidal syndromes and demyelinating disorders. CNS comorbidities are relatively frequent among patients with RA and may be related to systemic inflammation or concomitant medications. The use of anti-TNF drugs is associated with the risk of developing demyelinating diseases, and CNS infections have been described in patients treated with anti-TNF and non-anti-TNF agents. Non-anti-TNF drugs may be preferred in the case of demyelinating diseases, cerebral vasculitis or neurolupus. Patients with RA may suffer from CNS involvement as a manifestation of RA or as a comorbidity. The treatment of such medical conditions should be guided on the basis of their etiopathogenesis: steroids and immunosuppressants are useful in the case of RA-related CNS diseases but are often detrimental in other situations. Similarly, the choice of biological agents in patients with RA with CNS complications should be guided by a correct diagnosis in order to prevent further complications.
30206671 Sleep impairment: an obstacle to achieve optimal quality of life in rheumatoid arthritis. 2018 Dec Sleep impairment is a common clinical condition in patients with rheumatoid arthritis. There are several confounding factors for poor sleep quality including inflammation, pain, comorbidities, and medications. Consequences of impaired sleep vary within a wide spectrum, as well. These include exacerbated inflammation and inflammation-related symptoms, mental and physical fatigue, mood disorders, daytime sleepiness, and poor quality of life. Sleep impairment in rheumatoid arthritis and its association with disease-related variables including health-related quality of life have been studied several times in the literature. Therefore, it would be of value to review the existing data on the crosstalk between sleep and rheumatoid arthritis. In the present article, the mechanism, confounders, and consequences of this association will be reviewed in detail. The evaluation of sleep impairment in rheumatoid arthritis along with the potential management strategies will be discussed.
30217550 Neutrophils: Novel key players in Rheumatoid Arthritis. Current and future therapeutic tar 2018 Nov Rheumatoid Arthritis (RA) is a complex systemic autoimmune disease in which various cell types are involved. Among them, neutrophils have been recognized as important players in the onset and the progression of RA. The pathogenic role of neutrophils in RA lies in the alteration of several processes, including increased cell survival and migratory capacity, abnormal inflammatory activity, elevated oxidative stress and an exacerbated release of neutrophil extracellular traps. Through these mechanisms, neutrophils can activate other immune cells, thus perpetuating inflammation and leading to the destruction of the cartilage and bone of the affected joint. Given the considerable contribution of neutrophils to the pathophysiology of RA, several studies have attempted to clarify the effects of various therapeutic agents on this subtype of leukocyte. To date, recent studies have envisaged the role of new molecules on the pathogenic profile of neutrophils in RA, which could represent novel targets in future therapies. In this review, we aim to review the pathogenic role of neutrophils in RA, the effect of conventional treatments and biologic therapies, and the new, potential targets of neutrophil-derived molecules for the treatment of RA.
29798748 One year in review 2018: novelties in the treatment of rheumatoid arthritis. 2018 May The current approach to treatment of rheumatoid arthritis (RA) includes early and aggressive intervention aiming to reach early and persistent low disease activity and remission. New drugs have improved the therapeutic armamentarium of rheumatologists, providing new options for patients. Beyond these innovations, new evidence has improved the safety of therapies and provided tools for the optimisation of long-term management of RA. This paper reviews the most relevant studies published over the last year in the field of treatment of RA.
30251128 Use of prognostic factors of rheumatoid arthritis in clinical practice and perception of t 2018 Dec The aim of the study is to benchmark the use and attributed importance of well-established prognostic factors in rheumatoid arthritis (RA) in daily clinical practice, and to contrast the use of factors with their ability to predict outcome. Medline was searched (inception-Sep. 2016) for systematic reviews on factors predicting death, disability, structural damage or remission in RA. All factors identified were compiled in a matrix of factors × outcomes, and scoping reviews for each cell were then performed. A survey to 42 rheumatologists randomly selected explored the use of the list of prognostic factors and inquired about the perceived strength of association with poor prognosis. In a second round, participants were exposed to evidence from the matrix and to responses from other participants. Change on perceived strength of association was evaluated. Rheumatologists report using prognostic factors in clinical practice on a daily basis. Very young onset, joint counts at diagnosis, rheumatoid factor, ACPA, and radiographic erosions are used frequently and correctly recognized as strong predictors. Comorbidities and other associated problems, such as obesity, low bone mineral density, cardiovascular disease, or extra-articular manifestations, are perceived as moderately associated to prognosis but, nevertheless, rheumatologists also use them profusely. Genetic and other biomarkers and osteitis by magnetic resonance are less accessible in daily practice and they obtained better results on second round (probably after knowing the strength of association with prognosis). Rheumatologists use widely most prognostic factors with a strong predictive value. However, factors with low evidence of prognostic value are also used and some factors are not used despite good evidence.
29464524 Physical articular examination in the activity of rheumatoid arthritis: a systematic revie 2018 Jun To summarize evidence concerning the articular examination needed to determine rheumatoid arthritis (RA) activity (follow-up or control) via a systematic review. A search of Medline, Embase, Lilacs, SciELO, the Web of Science, the National Technical Reports Library, and the reference lists of relevant studies through March 2017 was conducted using a systematic methodology to identify studies of patients with RA older than 18 years in which a detailed description of the physical examination or a description of the components of the articular examination was provided. Of 8322 references, 74 studies were included according to the selection criteria, and 6 references were ultimately included at the end of the review. Most of the included studies (n = 5) were associated with a moderate risk of bias. There was great variability among the studies and the articular examination methods used. Some studies presented the examination with a complete specification of the technique (n = 2), the consensus of rheumatologists (n = 2), or training through audiovisual materials and face-to-face courses (n = 2), but none of the studies explicitly showed the technique by which the physical examination was performed. Despite the importance of the clinical evaluation and physical examination of patients with RA for diagnosis, prognosis, clinimetrics, and follow-up, evidence concerning how to perform the articular examination is scarce.
28872725 Dorsal Root Ganglion Field Stimulation Prevents Inflammation and Joint Damage in a Rat Mod 2018 Apr OBJECTIVES: Electrical stimulation of the dorsal root ganglion (DRG), referred to here as ganglionic field stimulation (GFS), is effective in reducing clinical pain, probably by interrupting transmission of afferent impulse trains on sensory neurons as they pass through the DRG. We therefore tested whether efferent impulse trains conveyed by sensory neurons, which contribute to neurogenic inflammation, may also be interrupted by GFS. MATERIALS AND METHODS: Collagen-induced arthritis, a model of clinical rheumatoid arthritis, was initiated in rats concurrently with the insertion of an electrode for GFS at the fourth lumbar DRG. Continuous GFS (20 Hz pulse rate, current at 80% of the motor threshold) was initiated 6 days later and continued for 14 days. Plantar pain sensitivity, ankle arthritis score, and dimensions of the foot and ankle were determined one hour after termination of GFS. RESULTS: The foot/ankle contralateral to GFS developed hypersensitivity to threshold and noxious mechanical stimulation, swelling, and high arthritis score, all of which were normalized in the foot/ankle ipsilateral with GFS. Histology showed GFS limited joint destruction. Electrophysiological recording showed GFS can block efferent impulse trains. CONCLUSIONS: Our findings show that GFS can reduce neurogenic inflammation and the resulting joint damage in a model of rheumatoid arthritis, probably by blocking the transit of impulse trains through the DRG. GFS may have clinical utility in limiting joint destruction in inflammatory arthritis such as rheumatoid arthritis.
29376442 Drug delivery targets and systems for targeted treatment of rheumatoid arthritis. 2018 Dec Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease that selectively attacks human joints. The common non-targeted treatment approaches lead to obvious side effect and systemtic complication for RA patients. Therefore, targeted drug delivery for treatment of RA has gained much attetntion in the past few years. In this paper, we reviewed the potential targets (folate receptor, angiogenesis, matrix metalloproteases, selectins, vasoactive intestinal peptide receptor andFc-γ receptor) that could be utilised to facilitate the specific delivery of drugs to the inflammed synovium and also presented different drug delivery systems for targeting RA, including the liposomes, various types of nanoparticles, polymeric micelles and the macromolecular prodrugs. The strategies combining nanotechnologies and ligand mediated active targeting for RA would be emphatically illustrated, which was expected to be helpful for identifying technologies and drug delivery methods for targeted treatment of RA.
30094941 Rheumatoid Arthritis of Knee Joints: MRI-Pathological Correlation. 2018 Aug OBJECTIVE: To evaluate the correlation between features of knee joint rheumatoid arthritis (RA) identified on MRI and histological examination as a means of elucidating the pathogenesis of joint destruction in RA. METHODS: This is a prospective analysis of 26 knee joints of 22 patients who underwent total knee arthroplasty (TKA) for the treatment of RA. Based on the degree of destruction of articular cartilage and the menisci, the occurrence of bone marrow edema and bone erosion, and synovial thickening, the stage of the knee joints were classified using MRI by two radiologists. Differences in the severity of destruction of the articular cartilage of the medial and lateral femoral condyles and medial and lateral tibial plateaus, the medial and lateral menisci, and bone were compared using analysis of variance with a post-hoc test, and the Mann-Whitney U-test. Samples of cartilage, subchondral bone, menisci, and synovium were obtained from the resected knee specimens during TKA and analyzed semiquantitatively using microscopy and immunohistochemistry. Histological differences between areas of bone erosion and bone marrow edema were evaluated using a Mann-Whitney U-test. RESULTS: The extent of articular destruction was classified as grade 4 for the medial and lateral femoral condyles and the medial and lateral tibial plateaus for most patients, with an average destruction grade of 3.6 (F = 5.455, P = 0.002), with the least amount of destruction identified on the lateral femoral condyle. The majority of knee joints in the RA patients were at stage 3 (21/26, 80.8%), followed by stage 4 (4/26, 15.4%). Fibrosis, thinning and destruction, and hyperplasia were the most severe pathological changes in cartilage. In a total of 26 specimens, 36 areas of bone marrow edema and 68 areas of bone erosion were identified, with fibrosis, a mosaic structure of bone, and lymphocyte infiltration being the most severe changes in these areas. The degree of meniscus destruction was classified as grade 4 in the majority patients for both the medial and lateral meniscus, with an average degree of meniscal destruction over all specimens of 3.85, and greater destruction of the medial meniscus than of the lateral meniscus (Z = 2.062, P = 0.039). Fibrosis and engulfing calcified debris were the most severe pathological manifestations. Synovitis was also identified in all 26 specimens, with hyperplasia of intima cells and lymphocyte and plasma cell infiltration being the most severe pathological manifestations. CONCLUSIONS: Severe destruction of the articular cartilage and menisci is a characteristic feature of RA. Bone marrow edema and bone erosion can both also be found, but are less characteristic. Synovial infiltration may be the triggering mechanism of the destruction of the cartilage, menisci, and bone marrow. However, the origin of bone marrow edema requires further investigation.
29661045 Recent approaches for targeted drug delivery in rheumatoid arthritis diagnosis and treatme 2018 Rheumatoid arthritis (RA) is a chronic inflammatory disease with complex pathology characterized by inflammation of joints, devastation of the synovium, pannus formation, bones and cartilage destruction and often is associated with persistent arthritic pain, swelling, stiffness and work disability. In conventional RA therapy, because of short biological half-life, poor bioavailability, high and frequent dosing is required. Thereby, these anti-RA medications, which unable to selectively target affected zone, may cause severe side effects in extra-articular tissues. Today, nanotechnology has emerged as promising tool in the development of novel drug delivery systems for the treatment and diagnosis of intractable diseases such as RA. Active targeting in RA nanomedicine has also been introduced a successful way for facilitating specific uptake of therapeutic agents by the disease cells. In this review, it is attempted to describe various targeted drug delivery systems (localized and receptor-based) used for RA diagnosis and therapy. Then, we highlight recent developments related to various non-viral gene delivery systems for RA gene therapy.
29871535 Cardiovascular outcomes of patients with rheumatoid arthritis prescribed disease modifying 2018 Jul INTRODUCTION: Rheumatoid arthritis (RA) is associated with a heightened risk of cardiovascular disease (CVD), with both traditional CV risk factors and inflammation contributing to this risk. AREAS COVERED: This review highlights the burden of CVD in RA and associated traditional CV risk factors, including the complexity of dyslipidemia in RA and the so-called 'lipid paradox.' Furthermore, the recognized RA-disease-specific factors associated with higher risk of CVD and the role of systemic inflammation in the pathogenesis of CVD in RA will be addressed. With the advent of biologic and targeted synthetic therapies in the treatment of RA, the effect of conventional and newer generation disease modifying anti-rheumatic therapies (DMARDs) on CV risk and associated risk factors will also be discussed. EXPERT OPINION: Identifying the RA phenotype at greatest risk of CVD, understanding the interplay of increased traditional risk factors, common inflammatory processes and RA-specific factors, and personalized use of DMARDs according to disease phenotype and comorbidity to reduce this risk are key areas for future research.
28205390 Circulating adiponectin and visfatin levels in rheumatoid arthritis and their correlation 2018 Mar AIM: This study aimed to evaluate the relationship between circulating adiponectin and visfatin levels and rheumatoid arthritis (RA) and to establish a correlation between serum adipokine levels and RA activity. METHODS: We conducted meta-analyses on serum/plasma adiponectin or visfatin levels in patients with RA and controls and correlation coefficients between circulating adiponectin and visfatin levels and Disease Activity Score of 28 joints (DAS28) in RA patients. RESULTS: Eleven studies comprising 813 RA patients and 684 controls were included in this meta-analysis. The meta-analysis revealed that adiponectin levels were significantly higher in the RA group than in the control group (standardized mean difference [SMD] = 1.529, 95% confidence interval [CI] = 0.354-2.704, P = 0.011). Circulating adiponectin level was not associated with RA activity based on DAS28 and C-reactive protein (CRP) levels. Visfatin levels were significantly higher in the RA group than in the control group (SMD = 2.575, 95% CI: = 0.963-4.189, P = 0.002). A trend of positive correlation among circulating visfatin levels and DAS28 and CRP levels was found (correlation coefficient = 0.416, 95% CI: = -0.917 to 0.795, P = 0.177; correlation coefficient = 0.366, 95% CI: = -0.074 to 0.687, P = 0.101, respectively). CONCLUSIONS: Our meta-analysis demonstrated that circulating adiponectin levels were significantly higher in patients with RA than in controls. Circulating visfatin levels were significantly higher in patients with RA than in controls and a positive correlation between circulating visfatin level and RA activity is suggested.
30227811 Serological Electrodetection of Rheumatoid Arthritis Using Mimetic Peptide. 2018 BACKGROUND: Rheumatoid arthritis is the most common inflammatory autoimmune disease in the world. Recently new targets for its detection were developed as alternatives to classic biomarkers, including the M-12 peptide, that mimics carbonic anhydrase III. Thus, the application of this peptide for the development of new detection devices is attractive. OBJECTIVE: Our goal was to construct a modified electrode for immobilization of M-12 peptide and detection of a rheumatoid arthritis biomarker in serum of patients. METHODS: 3-Hydroxybenzoic acid was electropolymerized onto graphite electrodes, and M-12 peptide was immobilized by adsorption. Negative and positive serum samples for rheumatoid arthritis were diluted and applied onto the electrode. Detection was carried in potassium ferrocyanide/ ferricyanide solution by differential pulse voltammetry. Atomic force microscopy and scanning electron microscopy were used to evaluate electrode surfaces. RESULTS: Cyclic voltammograms indicated the poly(3-hydroxybenzoic acid) formation and increase of electroactive area. Immobilization of M-12 probe increased current by 1.2 times, and negative serum addition caused no suitable difference. However, positive serum showed expressive decrease in the current signal of about 2.2 times, possibly due to steric hindrance when the anti-CA3 antibody interacts with the M-12 peptide, decreasing the electron transfer. Microscopies images corroborated with the electrochemical detection, showing evident changes in the morphology of the electrode surfaces. CONCLUSION: The bioelectrode was able to discriminate positive and negative serum samples of rheumatoid arthritis by a considerable decrease in the current signal value. Morphological analyses supported the electrochemical results. Thus, the constructed bioelectrode offers a new platform for detection of rheumatoid arthritis.
29846814 Cardiovascular Safety of Biologics and JAK Inhibitors in Patients with Rheumatoid Arthriti 2018 May 30 PURPOSE OF REVIEW: Increased cardiovascular (CV) risk and associated mortality in rheumatoid arthritis (RA) are not fully explained by traditional CV risk factors. This review discusses the epidemiology and mechanisms of increased CV risk in RA and treatment effects on CV risk focusing on biologic disease-modifying anti-rheumatic drugs (DMARDs) and JAK inhibitors. RECENT FINDINGS: Intermediary metabolic changes by inflammatory cytokines are observed in body composition, lipid profile, and insulin sensitivity of RA patients, leading to accelerated atherosclerosis and increased CV risk. Successful treatment with DMARDs has shown beneficial effects on these metabolic changes and ultimately CV outcomes, in proportion to the treatment efficacy in general but also with drug-specific mechanisms. Recent data provide further information on comparative CV safety between biologic DMARDs or JAK inhibitors as well as their safety signals for non-atherosclerotic CV events. CV benefits or safety signals associated with DMARD treatments can differ despite similar drug efficacy against RA, suggesting that both anti-inflammatory and drug-specific mechanisms are involved in altering CV risk.
30375970 [Diagnosing and treating rheumatoid arthritis]. 2018 Oct 29 Rheumatoid arthritis (RA) is a chronic, autoimmune joint disease associated with increased risk of multiorgan involvement and comorbidities such as osteoporosis, cardiovascular disease, and infections. Therefore, doctors in other specialities should have knowledge of RA. No diagnostic criteria are available, but the classification criteria are often used as a diagnostic tool. Early initiation of effective immunosuppressive treatment is essential to improve outcome. The cornerstone of treatment is intra-articular administration of glucocorticoids in combination with methotrexate.