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ID PMID Title PublicationDate abstract
30092163 Prevalence and factors associated with sarcopenia in patients with rheumatoid arthritis. 2019 Jul Objectives: Sarcopenia is characterized by loss of muscle strength and mass, leading to falls and adverse health outcomes. Our aim was to determine the prevalence of sarcopenia in patients with rheumatoid arthritis (RA) and to identify factors associated with sarcopenia in these patients. Methods: A cross-sectional study of 388 consecutive women with RA was conducted, assessing muscle mass and strength, and walking speed. Falls and bone fractures sustained over the prior year were evaluated. The association between sarcopenia and RA characteristics, falls, and bone fractures was evaluated using logistic regression analyses. Results: The prevalence of sarcopenia was 37.1% (14.7%, severe sarcopenia; 22.4%, sarcopenia), with 49.0% classified as having low muscle mass. The incidence of falls, fractures, and lower bone mineral density was higher in patients with than without sarcopenia. Age, RA duration, Steinbrocker's stage, the high Mini-Nutritional Assessment-Short Form score and the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) were independent factors associated with sarcopenia. Conclusion: We confirmed that sarcopenia develops in a significant proportion of patients with RA. Age, longer disease duration, joint destruction and malnutrition were positively associated with sarcopenia, with the use of bDMARDs being negatively associated.
29675622 Rheumatoid arthritis in the indigenous qom population of Rosario, Argentina: aggressive an 2018 Sep To describe the baseline and follow up epidemiological/clinical characteristics of rheumatoid arthritis (RA) in a community-based cohort of the qom population. RA (ACR criteria) patients identified (n = 40) or not (n = 25) in the previous study were included. Baseline and follow-up visits (3, 6, and 12 months) were performed. Treatment adherence and modification, disability (Health Assessment Questionnaire Disability Index-HAQ-DI), and Disease Activity [DAS-28 (ESR)] were ascertained. At 12 months, complete and incomplete lost to follow-up patients were identified. The estimated RA prevalence was 3%. The patients' mean (SD) disease duration was 110.5 (17.9) and their median delay in diagnosis 30.4 (IQR 52.8) months; mean (SD) age and years of formal education were 39.8 (1.6) and 5.3 (SD 0.3); 58 (89.2%) were female, and 89.2% were seropositive. At baseline, their mean DAS-28 (ESR) was 4.8 (SD 0.9) with 67.7% having high disease activity and 32.3% moderate; 76.9% reported HAQ-DI ≥ 0.8. At 12 months, three patients have died; 13 (20.9%) were "completely" and 19 (30.6%) "incompletely" lost to follow-up. There were favorable changes over time for disease activity (p ˂ 0.001), HAQ-DI (p ˂ 0.001), and treatment modifications (p ˂ 0.001) but no changes in treatment adherence (p = 0.260). The main cause of lost to follow-up was migration. This population has one of the highest RA prevalence rate reported. Patients had an aggressive and disabling disease, with poor adherence to treatment. Improvements of clinical parameters over time were observed.
30557125 Tryptophan metabolism in rheumatoid arthritis is associated with rheumatoid factor and pre 2019 May OBJECTIVES: Tryptophan and its metabolites have been suggested to play a role in inflammatory processes. However, studies in rheumatoid arthritis (RA) are scarce, which prompted us to investigate two cohorts of RA patients to better understand the importance of tryptophan metabolism in this disease. METHODS: Tryptophan and its metabolites were characterised by ELISA in a cross-sectional cohort 1 (81 RA, 55 OA) and a longitudinal cohort 2 (25 RA, 3 visits over 6 months) to investigate discriminatory power between diseases and predicitive value for radiologic outcome, respectively. Radiologic outcome was monitored by RA MRI Score (RAMRIS), including grading of synovitis, bone oedema and erosion, as well as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) index assessing cartilage quality of the MCP II joint. RESULTS: RA patients showed higher levels of serum serotonin (RA: 206.8 ng/ml ± 156.7; OA: 81.2 ng/ml ± 63.6) and estimated indoleamine (2,3)-dioxygenase (IDO) activity (kynurenine / tryptophan ratio; RA: 0.065±0.067; OA: 0.021±0.010). IDO activity showed similar, or better discriminatory power between RA and OA (AUC 0.914) than anti-CCP antibody level (AUC 0.922) and rheumatoid factor (RF, AUC 0.783), respectively. In cohort 2, regression analysis revealed a predictive value of baseline serotonin levels and IDO activity for changes in RAMRIS score and erosions at month six, respectively. CONCLUSIONS: This study supports the hypothesis that tryptophan and its metabolites can be used as biomarkers predicting radiologic outcome and discriminate between RA and OA patients. Overall, our results strengthen the notion that tryptophan metabolism is closely linked to RA disease mechanisms.
29626944 Molecular Imaging of Inflammatory Arthritis and Related Disorders. 2018 May Rheumatic disorders comprise a number of diseases that range from benign, mildly symptomatic degenerative disease to severe systemic disorders such as giant-cell vasculitis with dramatic consequences such as acute blindness. The former is relatively common, whereas the latter is rare. In between, commonly encountered disorders such as rheumatoid arthritis and the various spondyloarthritides, with or without peripheral enthesitis, are daily challenges for the caring physician. Clinical evaluation is of utmost importance and is constantly described under the form of specialist guidelines in all parts of the world. Objective assessment of inflammatory arthritis and related disorders is of interest both for the care of the individual patient and for the assessment of the effects of the many novel experimental therapies proposed in this field, most of them being very expensive. High-resolution ultrasound, CT and spectral CT, MRI using various sequences, and molecular imaging using either gamma camera imaging (including SPECT-CT) or PET-CT are all proposed for a better assessment of these diseases. This review focuses on the several nuclear medicine techniques that are or may become useful to helping provide better patient care in this field and is mainly oriented to inflammatory rheumatic disorders, excluding mechanical degenerative diseases.
30583069 Longitudinal changes in pulmonary function and respiratory impedance of rheumatoid arthrit 2019 Mar The aim of this study was to examine long-term changes in pulmonary function and respiratory impedance (Zrs) as assessed by forced oscillation technique (FOT) of rheumatoid arthritis (RA)-related pulmonary disorders. Data of 42 RA patients who underwent pulmonary function tests and Zrs measurements at least twice at a >900-day interval were retrospectively reviewed. Zrs, respiratory resistance (Rrs) and reactance (Xrs), were measured as a function of oscillatory frequency from 4 to 36 Hz. The Rrs and difference between inspiratory and expiratory phases of Xrs were significantly decreased. Annual changes in Xrs parameters significantly correlated with those of spirometric parameters. Zrs parameters were significantly different between the low (the lower 75 percentile of incidence) and high (the top quartile) frequency of adverse respiratory event groups. The Zrs combined with spirometry may be beneficial to evaluate alterations in respiratory functions of RA.
30463603 Sequence of joint tissue inflammation during rheumatoid arthritis development. 2018 Nov 21 OBJECTIVE: Subclinical joint inflammation in patients with arthralgia is predictive for progression to rheumatoid arthritis (RA). However, the time course of progression for bone marrow edema (osteitis), synovitis, and/or tenosynovitis is unsettled. This longitudinal study assessed the course of magnetic resonance imaging (MRI)-detected subclinical joint inflammation during progression to RA. METHODS: Patients that progressed from clinically suspect arthralgia (CSA) to RA underwent 1.5-T MRI of the metacarpophalangeal (MCP), wrist, and metatarsophalangeal (MTP) joints at presentation with arthralgia and at first identification of synovitis assessed through physical examination (n = 31). MRIs were evaluated for osteitis, synovitis, tenosynovitis, and erosions by two readers, blinded for clinical data and order in time. To estimate changes in MRI scores between the asymptomatic state and CSA onset, scores of MRI features at CSA baseline were compared with scores from age-matched symptom-free persons. RESULTS: At presentation with CSA, synovitis and tenosynovitis scores were higher than scores from age-matched symptom-free persons (p = 0.004 and p = 0.001, respectively). Anti-citrullinated protein antibody (ACPA)-positive arthralgia patients also had increased osteitis scores (p = 0.04). Median duration between presentation with arthralgia and RA development was 17 weeks. During progression to RA, synovitis and osteitis increased significantly (p = 0.001 and p = 0.036, respectively) in contrast to tenosynovitis and erosion scores. This pattern was similar in both ACPA subsets, although statistical significance was reached for synovitis and osteitis in ACPA-negative but not ACPA-positive RA. CONCLUSION: Increased tenosynovitis and synovitis scores at CSA onset and the increase in synovitis and osteitis during progression to RA suggest an 'outside-in' temporal relationship of arthritis development, in particular for ACPA-negative RA. For ACPA-positive RA, further studies are needed.
30194273 Characteristics of difficult-to-treat rheumatoid arthritis: results of an international su 2018 Dec OBJECTIVES: Patients with difficult-to-treat rheumatoid arthritis (RA) remain symptomatic despite treatment according to current European League Against Rheumatism (EULAR) management recommendations. These focus on early phases of the disease and pharmacological management. We aimed to identify characteristics of difficult-to-treat RA and issues to be addressed in its workup and management that are not covered by current management recommendations. METHODS: An international survey was conducted among rheumatologists with multiple-choice questions on disease characteristics of difficult-to-treat RA. Using open questions, additional items to be addressed and items missing in current management recommendations were identified. RESULTS: 410 respondents completed the survey: 50% selected disease activity score assessing 28 joints >3.2 OR presence of signs suggestive of active disease as characteristics of difficult-to-treat RA; 42% selected fatigue; 48% selected failure to ≥2 conventional synthetic disease-modifying antirheumatic drugs (DMARDs) AND ≥2 biological/targeted synthetic DMARDs; 89% selected inability to taper glucocorticoids below 5 mg or 10 mg prednisone equivalent daily. Interfering comorbidities, extra-articular manifestations and polypharmacy were identified as important issues missing in current management recommendations. CONCLUSIONS: There is wide variation in concepts of difficult-to-treat RA. Several important issues regarding these patients are not addressed by current EULAR recommendations.
27452347 Factors influencing remission in rheumatoid arthritis patients: results from Karnataka rhe 2018 Nov AIM: To study the prevalence of remission in rheumatoid arthritis (RA) patients and the influence of different factors like literacy, socioeconomic status, presence of comorbidity and treatment strategy in achieving remission. METHODS: The study involved 1990 RA patients who were recruited for the Karnataka Rheumatoid arthritis comorbidity (KRAC) study. Based on the factors evaluated, the study participants were classified as follows: age, < 30 years, 30-39 years, 40-49 years, 50-59 years and ≥ 60 years; educational status, illiterate/no formal education, high school or less, graduate, post-graduate and doctorate; family income (₹ per annum), < 50 000, 50-100 000, 100-500 000, and > 500 000; duration of illness prior (DOIP): ≤ 6 months, 6-24 months, 24-120 months and > 120 months. Joint counts were performed by a rheumatologist or trained joint assessor. To assess the treatment outcome, the disease activity score was calculated using the Disease activity Score of 28 joints - erythrocyte sedimentation rate (DAS 28-3 ESR). RESULTS: As per the DAS 28-3 ESR score, around 20% (n = 397) of the study subjects achieved remission. The corresponding mean ± SD of DAS 28-3 ESR noted for remission and non-remission groups were 2.13 ± 0.42 and 4.32 ± 1.28. The majority of the patients were treated with double disease-modifying anti-rheumatic drugs (DMARDs) (60.7%). The likelihood of remission was found to be more in patients who reported DOIP ≤ 6 months. Furthermore, the chances of remission reduced with increase in patient's age and the highest remission rate was noted for 30-39 years age group (59%), followed by 40-49 years (35.4%) and 50-59 years (19.7%). CONCLUSION: The prevalence of remission noted was around 20%. Early treatment, escalating dose of DMARDs, and patient counseling are important contributing factors for attaining remission.
28917998 Clinical characteristics and outcomes in polyarticular septic arthritis. 2018 Jul OBJECTIVES: Septic polyarthritis is rarer than septic monoarthritis, but associated with higher mortality. Septic polyarthritis may be difficult to distinguish clinically from noninfectious inflammatory arthritis. We describe one of the largest samples of septic polyarthritis with the aim of distinguishing septic monoarthritis from polyarthritis. METHODS: We conducted a retrospective study of adults admitted to tertiary care with septic monoarthritis and polyarthritis. Baseline characteristics, microbial profiles, joint involvement, length of stay, and 60-day readmission rates were determined. RESULTS: We identified 464 and 42 cases of septic monoarthritis and polyarthritis, respectively, including 7 cases of septic polyarthritis with comorbid rheumatoid arthritis. Compared to those with septic monoarthritis, patients with septic polyarthritis were more likely to have rheumatoid arthritis (P<0.01), sepsis (P<0.01), and higher peripheral (P<0.001) and synovial (P<0.001) white blood cell counts. Operative intervention rates were similar, but mean length of stay was longer in polyarticular septic arthritis (P<0.001). Patients with septic polyarthritis with/without underlying rheumatoid arthritis were similar in terms of presenting features and outcomes, except for more frequent immunosuppressive therapy in rheumatoid arthritis (P<0.01). CONCLUSIONS: In this sample of patients with septic arthritis, patients with septic polyarthritis were more likely to have systemic infection at presentation than those with septic monoarthritis. Despite this difference, patients with septic monoarthritis and polyarthritis tended to have similar outcomes. While rheumatoid arthritis was observed more frequently among patients with septic polyarthritis, those with/without underlying rheumatoid arthritis had similar presenting features and outcomes.
29389829 Therapeutic drug monitoring of biologicals in rheumatoid arthritis: a disconnect between b 2018 May PURPOSE OF REVIEW: To give an overview of recently published articles covering therapeutic drug monitoring (TDM) of biological DMARDs (bDMARDs) in rheumatoid arthritis. RECENT FINDINGS: In the last 18 months, two clinical studies and nine reviews were found after a systematic literature search. Most (narrative) reviews conclude that TDM should be used to improve biological treatment in rheumatoid arthritis patients, whereas most of the clinical studies (including 13 studies identified earlier) whenever scrutinized do not support this conclusion. This disconnect between sobering data from prediction studies and test-treatment diagnostic studies and optimistic TDM beliefs in reviews is caused by failure to recognize incorrect study designs, false positives because of lack of validation after explorative multiple testing, cherry picking of studies, and incorrect interpretation of test characteristics. SUMMARY: Serum (anti)-drug level monitoring has been extensively studied in rheumatoid arthritis, but correctly designed and executed interventional prediction studies or test-treatment intervention studies are sparse and mostly negative. In contrast, many reviews advocate use of biological TDM in rheumatoid arthritis. On the basis of current evidence, therapeutic drug monitoring of biologicals cannot be recommended in the treatment of rheumatoid arthritis patients, although two clinical scenarios deserve further study.
29472917 Senescent T-Cells Promote Bone Loss in Rheumatoid Arthritis. 2018 OBJECTIVE: T-cells are critical players in the pathogenesis of osteoporosis in patients with rheumatoid arthritis (RA). Premature senescence of lymphocytes including the accumulation of senescent CD4(+) T-cells is a hallmark feature of RA. Whether T-cell senescence is associated with bone loss in RA patients is elusive so far. METHODS: This includes a prospective study of consecutive patients with RA (n = 107), patients with primary osteopenia/-porosis (n = 75), and healthy individuals (n = 38). Bone mineral density (BMD) was determined by dual-energy X-ray absorptiometry scan. Flow cytometry, magnetic-associated cell sorting, and cell culture experiments were performed to analyze the pro-osteoclastic phenotype and the function of senescent CD4(+)CD28(-) T-cells. RESULTS: Patients with osteopenia/-porosis yielded a higher prevalence of senescent CD4(+)CD28(-) T-cells than individuals with normal BMD, in the RA, as well as in the non-RA cohort. Receptor activator of nuclear factor kappa-B ligand (RANKL) was expressed at higher levels on CD4(+)CD28(-) T-cells as compared to CD28(+) T-cells. Stimulation with interleukin-15 led to an up-regulation of RANKL expression, particularly on CD28(-) T-cells. CD4(+)CD28(-) T-cells induced osteoclastogenesis more efficiently than CD28(+) T-cells. CONCLUSION: Our data indicate that senescent T-cells promote osteoclastogenesis more efficiently than conventional CD28(+) T-cells, which might contribute to the pathogenesis of systemic bone loss in RA and primary osteoporosis.
29670135 Clinical characteristics and risk factors for overlapping rheumatoid arthritis and Sjögre 2018 Apr 18 This study investigated the clinical characteristics and risk factors for overlapping rheumatoid arthritis and Sjögren's syndrome (RA/SS). Patients with RA/SS in Peking Union Medical College Hospital from January 2012 to January 2017 were retrospectively analysed and compared to those of sex- and age-matched RA or SS controls. Logistic regression analysis was used to identify risk factors. Altogether, 105 consecutive patients with RA/SS were enrolled. Ninety-seven (92.4%) of them were female, with a mean age of 51.5 ± 13.3 years or 45.2 ± 14.7years at the diagnosis of SS or RA, respectively. In addition to arthritis and Sicca symptom, patients with RA/SS had more visceral involvements including interstitial lung disease (ILD), and haematologic involvement, and received more glucocorticoid treatments than controls (p < 0.05). RA-onset, simultaneous-onset and SS-onset patients had significant differences in age at RA diagnosis, fever and thrombocytopenia (p < 0.05). Multivariate logistic analysis indicated that arthritis (OR = 44.804), rheumatoid factor (RF) (OR = 5.973), and anti-CCP (OR = 2.545) were independent risk factors for SS overlapping with RA. Xerostomia (OR = 3.960), ILD (OR = 6.210), and anti-SSA (OR = 24.640) were independent predictors of RA overlapping with SS. RA/SS patients have more visceral involvements. Our findings highlight the roles of arthritis/RF/anti-CCP and xerostomia/ILD/anti-SSA in the development of this overlapping disease.
27908254 Current Surgical Treatment Options of Rheumatoid Shoulder. 2018 BACKGROUND: Rheumatoid Arthritis (RA) is an inflammatory disease with destructive pattern. Patients are suffering from pain and decreased functional outcome as the disease progress. Certain joints are widely discussed in the literature as well as shoulder girdle, but shoulder girdle surgical treatment options' indications and superiorities to each other were not compared entirely. MATERIALS AND METHODS: Treatment options, such as; synovectomy and bursectomy, resection interposition arthroplasty, hemiarthroplasty, humeral resurfacing arthroplasty, anatomical total shoulder arthroplasty and reverse shoulder arthroplasty, are examined for their timing, advantages, disadvantages and comparison. RESULTS: Patients' age is the main factor about the decision making in rheumatoid arthritis. Young aged patients demand high activity level, but as a result loosening of the implant is frequently encountered. Thus, the protection of the bone stock as much as possible must be the priority. For a young patient with disabling pain should be evaluated for less invasive surgeries such as; synovectomy and bursectomy, resection interposition arthroplasty and also for hemiarthroplasty for preservation of glenoid bone stock. But rotator cuff status, glenoid bone stock evaluation and grading of the glenoid defect become more important in old aged patients and the correct decision making can only be made by combining these factors. CONCLUSIONS: Age, functional demand, rotator cuff status and adequacy of glenoid bone stock are defined as major criteria for an optimal treatment. Even though RA patients require additional care for a good functional outcome; with correct decision-making, high quality of life is achievable.
29334721 Efficacy and safety of tocilizumab in Korean patients with active rheumatoid arthritis. 2019 Jul BACKGROUND/AIMS: To investigate the efficacy and safety of tocilizumab (TCZ) humanized anti-interleukin-6 receptor monoclonal antibody, in Korean patients with active rheumatoid arthritis (RA) refractory to conventional disease modifying anti-rheumatic drugs (DMARDs) including methotrexate (MTX). METHODS: The main study was a 24-week, randomized, double-blind, controlled trial that was followed by a 48-week, open-labeled, extension phase. TCZ (8 mg/kg) or placebo was intravenously administered every 4 weeks. RESULTS: Those treated with TCZ showed more favorable outcomes in terms of 20% according to the American College of Rheumatology response criteria (ACR20) and ACR50 responses, individual parameters of ACR core set, disease activity score in 28 joints (DAS28) remission, and European League Against Rheumatism (EULAR) response at week 24. These improvements were maintained or increased during the extension period. DAS28 remission at week 72 was associated with EULAR good response at week 12. The patients who experienced any adverse event (AE) were more frequent in the TCZ group compared to the placebo group. Most AEs were mild or moderate in intensity, although TCZ therapy had possible AEs including serious infection, abnormal liver function, and atherogenic lipid profile. CONCLUSION: TCZ infusion add-on is highly efficacious and well-tolerated in Korean patients with active RA refractory to conventional DMARDs including MTX. EULAR good response at week 12 could predict DAS28 remission at week 72.
29731456 [Diagnosis and treatment of rheumatoid arthritis:toward the best practice. Towards precisi 2018 Biologics made a big paradigm shift in the treatment for rheumatoid arthritis(RA). In the next step, current research for RA shifts from traditional approach for average patients to precision medicine using huge omics data from patients. Multiomics analysis for the specimen from patients will play an important role for the establishment of precision medicine for RA.
29843653 A case of scleritis associated rheumatoid arthritis accompanying an intraocular elevated l 2018 May 30 BACKGROUND: Scleritis and/or uveitis sometimes accompanies patients who suffer from rheumatoid arthritis. However, few studies have reported scleritis and/or uveitis accompanying a fundus elevated lesion, such as an intraocular tumor. In this study, we report a case of rheumatoid uveitis associated with an intraocular elevated lesion. CASE PRESENTATION: A 66-year-old female visited another eye clinic and was diagnosed as bilateral anterior uveitis, and was prescribed steroid eye drops for treatment. She had previously been diagnosed as rheumatoid arthritis at the age of 30 years. Due to vitreous opacity that appeared in her right eye, we increased the instillation of steroid eye drops and the amount of oral prednisolone. Although the inflammation had improved, anterior uveitis relapsed, and an intraocular whitish elevated lesion resembling an intraocular tumor at the superior nasal retina appeared. We speculated this lesion to be a granuloma complicated with rheumatoid arthritis. Thus, we increased the amount of prednisolone administration, and the lesion began to shrink and ultimately fully disappeared. CONCLUSIONS: We strongly believe that our case's lesion was a subretinal granuloma related with rheumatoid arthritis, as it disappeared by increased corticosteroid treatment. Our findings show that we should consider rheumatoid arthritis in a differential diagnosis of such types of fundus elevated lesions.
29058033 Greater rheumatoid arthritis joint improvement with more subjects achieving response acros 2018 May We compared the change in joint inflammation and the proportion of subjects achieving threshold levels of improvement using the existing methods employing ultrasonography on pre-determined joint sites versus novel methods. These novel methods select the most affected joints based on (i) ultrasonography-the Individualized-Ultrasound (IUS) method, or (ii) ultrasonography and clinical joint assessment-the individualized-Composite-Ultrasound (ICUS) method. Mean 3-month change in total inflammation score (ΔTIS) and 95% CI was computed for each method on 24 RA subjects initiated or escalated on treatment. Individual improvement in TIS per subject, calculated as the 3-month ΔTIS divided by the maximum possible TIS score expressed as a percentage, was used to obtain the proportion of subjects achieving response across improvement categories. Mean 3-month ΔTIS was significantly greater (p values ranging from 0.0003 to 0.0026) for novel versus existing methods using 12- and 7-joint approaches. Using 12-joint approach, percentages of subjects in improvement categories ≥5%, ≥10%, ≥15% and ≥20% were, respectively, 50, 37.5, 12.5 and 8.3% for IUS; 58.3, 37.5, 12.5 and 8.3% for ICUS; and 16.7, 0, 0 and 0% for the existing method. Using 7-joint approach, the respective category percentages were 62.5, 37.5, 25 and 12.5% for IUS; 62.5, 41.7, 16.7 and 8.3% for ICUS; and 12.5, 4.2, 4.2 and 0% for the existing method. Novel ultrasound methods are more likely to detect improvement in joint inflammation, with more subjects achieving response across improvement categories, thereby representing a substantial advantage over the existing methods. However, this requires confirmation in larger RA cohorts.
29731454 [Diagnosis and treatment of rheumatoid arthritis:toward the best practice. Statistical gen 2018 Statistical genetics is a research field that assessed causality of human genome variations on phenotypes. Recent development of genome sequencing technologies provided abundant lists of causal genome variations associated with human clinical phenotypes. Integration of disease genome information with a variety of epigenetics by trans-layer omics analysis elucidated cell type specificity of the diseases, disease biology, and genome-based novel drug discovery.
30456915 Identification of symptom clusters and their synergistic effects on quality of life in rhe 2019 Apr AIMS: To examine the presence of symptom clusters and synergistic effects of symptom clusters on quality of life in rheumatoid arthritis patients. BACKGROUND: Rheumatoid arthritis patients frequently experience multiple concurrent symptoms of pain, fatigue, and depression. DESIGN: A nonexperimental, cross-sectional correlation design. METHODS: The study participants were 179 rheumatoid arthritis patients. Data were collected between August and December 2016. A hypothetical model was developed based on the Theory of Unpleasant Symptoms Model: physiological antecedents included disease activity and obesity; symptoms of pain, fatigue, and depression were hypothesized as being clustered, and quality of life was taken as the outcome variable. RESULTS: Disease activity had significant direct effects on pain, fatigue, and depression and indirect effects on fatigue and depression, whereas obesity had a significant direct effect on fatigue alone. Three symptom clusters, namely, pain fatigue, fatigue depression, and pain-fatigue depression were identified and found to have significant synergistic effects on quality of life. CONCLUSIONS: Our findings support the importance of managing clusters of symptoms simultaneously, that is, collective symptom management. Inter-cluster dynamics between symptoms should be considered when nurses develop symptom management strategies or self-management programs to improve the quality of life of rheumatoid arthritis patients.
29870122 Novel tool in rheumatoid arthritis diagnosis-The usage of urease flap region peptidomimeti 2018 Jun Rheumatoid arthritis (RA) is an autoimmune inflammatory disease. Early diagnosis can prevent joint erosion. However, available biomarkers do not always allow for clear distinction between RA and non-RA individuals. It has become known that bacteria/viruses are among the environmental triggers that initiate RA via multiple molecular mechanisms. Thus, to better understand the role of bacteria in RA, we synthetized 6 peptidomimetics of bacterial ureases' flap region. These peptides were then used to distinguish RA patients from healthy people sera by immunoblotting. Most patients' sera were bound to peptidomimetic characteristic for Enterobacter sp. and Klebsiella sp. flap urease. We also found similarities between peptidomimetic sequence and human proteins connected with RA. This pilot study suggests that bacteria may trigger RA via mechanism of molecular mimicry of urease to host proteins and ureases flap peptidomimetics may be potential candidate as a new additional diagnostic test.