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ID PMID Title PublicationDate abstract
29378189 JN-2, a C-X-C motif chemokine receptor 3 antagonist, ameliorates arthritis progression in 2018 Mar 15 Rheumatoid arthritis (RA) is a chronic autoimmune disease that is characterized by uncontrolled joint inflammation and destruction of bone and cartilage. Previous studies have shown that C-X-C motif chemokine 10 (CXCL10) has important roles in RA development and that blocking CXCL10 expression effectively inhibits arthritis progression in animal models. However, clinical study using anti-CXCL10 monoclonal antibody (MDX-1100) to block CXCL10 expression in patients with RA did not show significant effectiveness. Therefore, we turned our attention to C-X-C motif chemokine receptor 3 (CXCR3), which is a receptor for CXCL9, CXCL10, and CXCL11, to treat RA. In the present study, administration of JN-2, our newly developed CXCR3 antagonist, ameliorated the progression of arthritis in a collagen-induced arthritis animal model. JN-2 also inhibited CXCR3-induced cell migration and pro-inflammatory cytokine expression of bone marrow-derived macrophages and CD4(+) T cells in vitro. In addition, we found that CXCL10 formed an auto-amplification loop through activation of NFκB. Furthermore, Phosphorylation of p65 at serine 536 played an important role in the auto-amplification of CXCL10. Overall, the present results demonstrated that JN-2 decreased inflammation by inhibiting CXCR3-enhanced cell migration and pro-inflammatory cytokine expression, which then ameliorated arthritis progression.
24618052 Use of rituximab to treat a patient with coexistence of rheumatoid arthritis and ankylosin 2018 Oct Coexistence of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) is rare. Tumor necrosis factor (TNF) inhibitor has been highly successful in controlling inflammation in many patients with AS or RA. Rituximab, which is a chimeric anti-CD20 monoclonal antibody, has been proven effective in RA. Whether rituximab may be effective in AS is presently unclear. Here we report the 18 months follow-up result of a coexisting AS and RA TNF inhibitor failed patient that was treated successfully with rituximab.
30081802 [Characteristics and clinical associations of arterial stiffness and subclinical atheroscl 2018 SJul Te aim of the study was to evaluate parameters of arterial stiffness (AS) (carotid-femoral pulse wave velocity (cf PWV), central pulse pressure (PP), cardio-ankle vascular index (CAVI) and stiffness gradient between aorta and brachial artery) and subclinical atherosclerosis (carotid intima-media thickness (CIMT) and ankle-brachial index (ABI)) according to inflammatory activity in patients with R. MATERIALS AND METHODS: 85 patients with R (EULAR/ACR 2010) were examined (age 59,7±14,3 years, 64,7% with arterial hypertension (AH). Median duration of R was 7 years. PWV and central pulse wave were assessed by applanation tonometry. Arterial stiffness gradient was calculated as a ratio between carotid-femoral and carotid-radial PWV: its elevation ≥1 was considered as arterial stiffness mismatch. ABI and CAVI were measured by sphygmometry. CIMT was assessed according to the standard protocol, CIMT≥0,9 mm was considered as a subclinical marker of atherosclerosis. p.
26474323 Multiple subcutaneous xanthogranuloma at juxta-articular sites with bone cystic changes re 2018 Mar Xanthogranuloma is a benign disease represented as histiocytosis with lipoid deposition which usually occurs in children, but rarely in adults. We report a case of an adult patient with multiple subcutaneous xanthogranuloma at juxta-articular sites with bone cystic changes, manifesting similar clinical profiles to rheumatoid arthritis. Although very rare, we should consider the possibility of xanthogranulomatosis in the diagnosis of rheumatoid arthritis, especially in atypical cases.
30572433 Utility of power Doppler ultrasonography for detecting forefoot bursae in early rheumatoid 2018 Dec RATIONALE: Power Doppler ultrasonography (PDUS) in musculoskeletal ultrasound (MSUS) is a sensitive and reliable method for the assessment of rheumatoid arthritis (RA). The association between ultrasound-detectable forefoot bursae and the development of RA has gained attention. However, a few studies have evaluated the utility of PDUS for examining forefoot bursae in early RA. We report the case of an RA patient who developed reduced foot mobility and had detectable intermetatarsal bursitis with remarkable power Doppler (PD) signals in MSUS at the onset of RA. PATIENT CONCERNS: A 40-year-old Japanese woman diagnosed with palindromic rheumatism visited our department due to sustained forefoot pain and difficulty walking. The levels of both rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA) were high. She had opening toes with swelling in metatarsophalangeal (MTP) joints. PDUS showed intermetatarsal bursitis with mild MTP synovitis. DIAGNOSES: We diagnosed RA by comprehensive judgment based on the 2010 American College of Rheumatology and European League Against Rheumatism classification criteria for RA. INTERVENTIONS: We administered 6.0 mg/wk of methotrexate (MTX) and 2.0 mg/d of prednisolone (PSL) followed by an increase of MTX to 10 mg/wk. OUTCOMES: After those treatments, the patient's symptoms showed improvement. As of this writing, the patient's remission has been maintained for >2 months. LESSONS: Her case suggests that PDUS is useful for the detection of forefoot bursitis, and the detection of forefoot bursitis by PDUS may provide the opportunity to make an early diagnosis of RA.
29734890 Long-term Outcome of Open Synovectomy with Radial Head Resection for Rheumatoid Elbow. 2018 Jun BACKGROUND: We reviewed our surgical results of open synovectomy with radial head resection for rheumatoid elbow. METHODS: We reviewed the 20 patients (22 elbows) underwent open synovectomy for rheumatoid elbows retrospectively. The minimum follow-up period is over 10 years, and the average was 13 years 4 months. Surgical outcomes were evaluated using the VAS pain scale, range of motion, and radiologic outcomes including Larsen's grade and carrying angle. RESULTS: The mean VAS score was 39 (range, 10-90) at last follow-up. The only one patient underwent revision surgery. The mean flexion-extension range of elbow was -28°-112° and arc of motion was 82° before surgery. The mean flexion-extension range of elbow was -23°-114°, and arc of motion was 90° at last follow-up. Radiologic findings of nine elbows in 21 elbows worsened at last follow-up according to the Larsen-s grade. Carrying angle increased by mean 4.2°, and it increased by 10° or more in four elbows. CONCLUSIONS: Our results show that open synovectomy with radial head resection resulted in functional motion maintenance and pain control for a long time, but often resulted in an elbow valgus deformity. Our findings suggest open synovectomy can be considered as palliative treatment for painful rheumatoid elbow.
30503725 Combined synovectomy and extensor carpi radialis longus transfer to realign and stabilise 2019 May BACKGROUND: In patients with rheumatoid arthritis, the surgical treatment of wrist lesions relies on synovectomy combined with stabilisation and realignment of the carpal bones. The objective of this study was to evaluate the outcomes and define the indications of extensor carpi radialis longus (ECRL) transfer to the extensor carpi ulnaris (ECU) as described by Clayton and Ferlic. HYPOTHESIS: ECRL-to-ECU transfer combined with synovectomy can prevent the development and/or progression of rheumatoid deformities at the wrist. MATERIAL AND METHODS: A retrospective observational study was performed in 16 wrists. The following data were collected before and after surgery: pain, synovitis, range of motion, carpal height, ulnar translocation and radial deviation of the carpal bones, and Larsen's grade of the radio-carpal and mid-carpal joints. RESULTS: After a mean follow-up of 42.5 months after surgery, pain relief was noted in 14 cases and synovitis resolution in 10 cases. Mean mobility gains were 19.7° in extension and 5.7° in flexion. The radiographs showed a decrease in carpal height, whereas radial deviation and ulnar translocation were unchanged. No change was seen in the radio-carpal and mid-carpal joint lines. In the 3 wrists that required mid-carpal arthrodesis due to advanced disease before surgery, the radio-carpal joint line was unchanged and outcomes were the same as in the overall population. DISCUSSION: ECRL-to-ECU transfer combined with synovectomy provides pain relief and prevents radio-carpal destabilisation. The main indication of ECRL transfer is reducible radial deviation and ulnar translocation. ECRL is also indicated in combination with mid-carpal arthrodesis in the small minority of patients who have predominant mid-carpal involvement with a Larsen grade greater than 2. LEVEL OF EVIDENCE: IV, retrospective observational study.
26457807 Negative pressure wound therapy and skin grafting for necrotizing fasciitis in a patient w 2018 Mar Herein, we present a case of necrotizing fasciitis (NF) in a patient with rheumatoid arthritis (RA) treated with abatacept. Cultures of the patient's leg effusion revealed group A Streptococcus. Treatment included antibiological drugs, repeat debridement, negative pressure wound therapy (NPWT), and skin grafting. This case highlights the need for suspicion of severe bacterial infection for early diagnosis and effective treatment. NF with RA can be treated effectively with repeat debridement and NPWT.
28725981 Certolizumab pegol was effective for treating residual synovitis after total knee arthropl 2018 Apr We present the case of a 59-year-old female who developed rheumatoid arthritis in 2007. Right total knee arthroplasty (TKA) was performed in 2008. Although she was treated with methotrexate (MTX) after the operation, this treatment was insufficient. Infliximab (IFX) was introduced in 2001, and she achieved clinical remission. Left TKA was performed in October 2014. Because active synovitis was not detected by ultrasound after the operation, IFX was discontinued. She had been treated with MTX 8 mg weekly. However, arthralgia of the bilateral knees developed in March 2015. Ultrasound showed synovial hypertrophy with vascular signals representing postoperative residual synovitis. She was given certolizumab pegol. According to ultrasound, the synovitis had improved after 3 months.
29939979 Comparison of Ultrasound, Radiography, and Clinical Investigations in the Diagnosis of Ear 2018 Jun 25 BACKGROUND Early diagnosis and treatment of rheumatoid synovitis can reduce the progression of rheumatoid arthritis (RA). However, in the early stages of rheumatoid synovitis, patients may only have non-specific musculoskeletal symptoms, and plain film radiographs may not detect early synovial changes. The aim of this study was to compare the sensitivity and specificity of ultrasound with radiography, and clinical investigations in the detection of rheumatoid synovitis in patients presenting with nonspecific musculoskeletal symptoms. MATERIAL AND METHODS This was a non-randomized, cross-sectional, clinical study that included 189 patients who had nonspecific musculoskeletal symptoms. All patients underwent clinical investigations, postero-anterior and dorsal radiographic imaging, and bilateral grey-scale ultrasound examinations of the third and second metacarpophalangeal (MCP) joints, the third and the second proximal interphalangeal (PIP) joints, the second and the fifth metatarsophalangeal (MTP) joints, and the wrist. RESULTS There was no clear predictive value for detection of early synovitis by clinical investigations alone. Plain film radiography of patients only provided accurate information of joint erosions but less information for synovitis. Grey-scale ultrasound was more effective at detecting early synovitis compared with clinical investigations (p=0.00015; q=4.548) and compared with plain film radiography (p=0.0002; q=4.537), and quantified the synovial changes. The predictive values of plain film radiography and clinical investigations had 0.43 and 0.24 sensitivity and 0 specificity compared with ultrasound. CONCLUSIONS The findings of this study support the use of grey-scale ultrasound in the detection of early rheumatoid synovitis of the fingers and the wrist.
30511707 The prophylactic effect of a Eugenia aquea extract against oxidative stress and inflammati 2018 Dec 13 Rheumatoid arthritis (RA) is the most common human autoimmune disease. A petroleum ether extract of Eugenia aquea (E. aquea) was analyzed by GC/MS. Antioxidant and anti-inflammatory activities were investigated in rats with adjuvant-induced arthritis (AIA). An AIA rat model received orally/daily a vehicle, diclofenac (100 mg per kg b.w.), and E. aquea extract (50 or 100 or 200 mg per kg b.w.; for 21 days). Fifty-five out of 70 compounds (97.77%) were identified: eucalyptol (34.14%), α-pinene (15.91%), l-verbenone (8.01%), camphor (7.38%) and borneol (6.74%). In an acute oral toxicity study, the E. aquea extract did not show any toxic effects in rats at 2000 mg/ kg-1. Only a high dose of the E. aquea extract or diclofenac significantly alleviated (P < 0.05-0.001) all complications observed in arthritic rats, including body weight loss, articular/extra-articular oxidative injury and synovial joint inflammation by increasing food intake as well as improving the antioxidant defense system and inflammatory marker. The dose-dependent modulatory activity of the E. aquea extract was statistically significant. It was equivalent to and sometimes even better than that of diclofenac. The present study proved the antioxidant and anti-inflammatory activities of the E. aquea extract, which could be attributed to the presence of eucalyptol and α-pinene.
25195628 A case with rheumatod arthritis and atraumatic odontoid fracture: disappearence of bony la 2018 Nov We aim to draw attention to occult, atraumatic fractures of the odontoid process in patients with rheumatoid arthritis (RA) and to underline difficulties encountered during clinical and radiological diagnosis. A forty-seven years old man with RA for 4 years had occipital pain for 1 year without any history of trauma. Later, he developed weakness in the upper extremities, but he did not realize weakness in the lower extremities due to deformities. Contrast magnetic resonance imaging revealed a linear fracture of odontiod process and myelopathy. Cervical computed tomography scan revealed an old fracture border with separated and almost disappeared remnant of the tip of the odontoid without free particles in the cord. It was impossible to evaluate atlantoaxial and vertical subluxations with craniometric measurements due to destruction of the tip of odontoid. Following occipitocervical fusion and decompression and a rehabilitation program, his muscle strength improved; however, functional myelopathy stage did not change. Atraumatic fractures of the odontoid process may be more common than reported and may cause compression of the spinal cord or brain stem. Surgery is the treatment of choice but functional recovery is limited once neuronal damage has occurred. Erosion of the critical landmarks makes it difficult to diagnose and follow up atlantoaxial subluxation and/or vertical subluxation, therefore clinicians should consider radiographical follow-ups during the course of the disease.
29634338 Incorporating motivational interviewing into rheumatology care. 2018 Apr 12 Deborah Palmer, Advanced Nurse Practitioner, North Middlesex University Hospital, and Yasser El Miedany, Consultant Rheumatologist, discuss ways to close the gap between disease control and patient empowerment.
30194601 Gene Delivery of Alpha-1-Antitrypsin Using Recombinant Adeno-Associated Virus (rAAV). 2018 The challenge for alpha-1-antitrypsin (AAT also known as SERPINA1) gene therapy is to achieve long term and high levels of AAT production. Recombinant adeno-associated virus (rAAV) vector has several advantages for AAT gene delivery including no viral genes in the vector, no requirement of integration for long-term transgene expression, low immunogenicity, and wide tropism. AAV-mediated AAT gene therapy has been developed and tested in animal models for AAT deficiency, type 1 diabetes, rheumatoid arthritis, and osteoporosis. AAV-mediated AAT gene therapy has also been tested in clinical studies and has shown promising results. Here we describe the methods of rAAV-AAT vector construction and production as well as AAT gene delivery through (1) liver-directed, (2) muscle-directed, and (3) mesenchymal stem cell (MSC)-mediated routes. We will also describe methods for the evaluation of AAT expression for each delivery approach.
29974382 Mapping between HAQ-DI and EQ-5D-5L in a Chinese patient population. 2018 Nov OBJECTIVES: In order to address the current deficiency of health utility evidence relevant for economic evaluations involving treatments for rheumatoid arthritis (RA) in the Chinese setting, this study aims to develop a mapping algorithm linking the Health Assessment Questionnaire (HAQ) and EQ-5D-5L in a Chinese population of patients with RA. METHODS: An estimation sample was obtained from a cross-sectional study that collected HAQ, the pain Visual Analogue Scale, and EQ-5D-5L in RA patients in two tertiary referral hospitals in China. Mapping algorithms were derived in this study using two alternative regression methods: the beta regression and a multivariate ordered probit regression. The internal validity of the mapping algorithms was assessed in each case by calculating predictive performance using a bootstrapping procedure. RESULTS: Of the several algorithms developed using these data, predictive performance was shown to be better when VAS pain was included as a predictor and when the multivariate ordered probit regression method was used, rather than the beta regression method. The algorithms developed were shown to be comparable, in terms of predictive performance, to existing mapping studies despite the small sample size of the estimation data. CONCLUSION: It is hoped that the availability of these algorithms will facilitate the development of cost-effectiveness studies evaluating RA treatments in the Chinese health care setting.
30557124 The effect of biologic agents on bone homeostasis in chronic inflammatory rheumatic diseas 2019 May Osteoporosis (OP) and increased fracture risk are widely observed comorbidities in chronic inflammatory rheumatic diseases (CIRDs). Improved knowledge of the immune/inflammatory pathways, which characterise the pathophysiology of rheumatoid arthritis (RA) and seronegative spondyloarthropathies (SpA), such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA), have provided the link between inflammation and bone loss, via a complex network of bone cells, T and B cells, pro-inflammatory cytokines such as TNF-α, IL1, IL6, IL17, IL23, costimulator molecules, signalling pathways including both RANKL/RANK/OPG and Wnt signallings. The complex osteoimmunologic network in CIRDs suggested that the powerful anti-inflammatory activity of biologic drugs, beyond the control of the disease, was likely to reduce OP and fracture risk. In this respect, the available data deriving from clinical and experimental studies, conducted with TNF-α, IL6 and IL1 blockers, and B and T cell therapies, have demonstrated a beneficial effect on bone mineral density (BMD) and/or bone turnover markers (BTs). However, whether these drugs are able to positively influence also fracture risk has not yet been established, since the data available are sparse and inconclusive. Thus, systemic bone loss and increased fracture rates still remain relevant comorbidities that should be considered for screening and prevention, and proper treatment of patients with CIRDs despite the biologic therapy.
29504319 Anti-Arthritic Effect Of Thymoquinone In Comparison With Methotrexate On Pristane Induced 2018 Jan BACKGROUND: Rheumatoid arthritis inflammatory joint disease which is chronic in nature. Since long various researches are carried out to find the remedy of this disease but still a lot of work needed to be done. METHODS: This comparative study was performed from March to August 2013 at Postgraduate Medical Institute, Lahore. A total of thirty-two female Sprague-Dawley rats were randomly divided into four equal groups (n=8); group A was kept as healthy control, group B was kept as positive control, group C was treated with thymoquinone and group D was treated with methotrexate. Arthritis developed within two weeks in group B, group C and group D after giving a single shot of pristane intradermally. Treatment was started on day 15. At day 30 (time of dissection) paw weight and histopathological sections of ankle joints of all the animals were taken. RESULTS: The results shown significant rise in paw weight and score of histopathological parameters in group B, group C and group D when compared with healthy control rats. Thymoquinone and methotrexate treated groups shown reduction in paw weight and score of histopathological parameters when compared to positive control rats with p-value 0.001each. The difference between groups C and D was insignificant (p-value 0.062). CONCLUSIONS: Study results supported the anti-inflammatory and disease modifying activities of thymoquinone as it significantly reduces both paw weight and histological parameters of joint inflammation.
29762203 Preparing patients for biologic medications for dermatologic and rheumatic diseases. 2018 Jun Psoriasis, psoriatic arthritis, and rheumatoid arthritis are prevalent conditions that often require a team of primary care and specialist healthcare professionals for the most optimum patient outcomes. Primary care providers can facilitate referrals to dermatology and rheumatology specialists by obtaining the needed screening workup for patients who need treatment with immunosuppressive therapies. This article reviews tuberculosis screening, hepatitis screening, and vaccinations to be administered before patients begin biologic medications.
29478798 Therapeutic plasma exchange for hyperviscosity syndrome secondary to high rheumatoid facto 2018 Apr Hyperviscosity syndrome (HVS) is most commonly associated with Waldenstrom's macroglobulinemia, where it may be life-threatening. HVS may also occur in autoimmune diseases; data pertaining to efficacy of therapeutic plasma exchange (TPE) in HVS arising in non-malignant gammopathy are limited. We report a case of 71-year-old female with erosive rheumatoid arthritis with profoundly elevated rheumatoid factor (57,400 IU/ml; normal <35) who presented with findings consistent with HVS: profound weakness, headache, epistaxis and plasma viscosity (8.5 centipoise). She was successfully treated with pulsed high-dose steroids and TPE. Her symptoms of HVS have not recurred and the plasma viscosity has remained less than 3 centipoise. Given a slow onset of non-specific symptoms, HVS may be missed, incurring high risk of adverse effect. In symptomatic patients with high RF activity, a high index of suspicion for HVS is necessary to ensure timely identification and treatment with TPE, a safe and effective therapy.
30392568 Fatty oil from Securidaca inappendiculata exerted therapeutic effects on adjuvant-induced 2018 Nov Securidaca inappendiculata Hassk. (SI) is a medicinal plant used to treat rheumatoid arthritis (RA) in South China. A substantial amount of fatty oil was isolated from SI (SIF), however little knowledge about its chemical composition and medicinal potentials was obtained. In this study, we analyzed its chemical composition with methyl esterification based GC-MS method, and investigated the therapeutic potentials on adjuvant-induced arthritis (AA) in mice. MTT and western-blot methods were employed to investigate its effects on proliferation rate and protein expressions in MH7A cells, respectively. It was revealed SIF was mainly comprised of saturated and monosaturated fatty acids, and the two predominant compounds were palmitic acid (36.89%) and oleic acid (31.12%). Treatment with SIF at 100 mg/kg resulted in significant alleviation of AA severity in mice, together with reduced synovial hyperplasia and inflammatory infiltration in joints, and decreased levels of sialic acid, malondialdehyde and alkaline phosphatase in serum. Results from immunohistochemical assays hinted the protective effects of SIF on joints were associated to the inhibition on production of some pathological factors in synovium, including IL-1β, TNF-α and MMP-9. SIF inhibited the proliferation of MH7A cells in a concentration dependent manner, and abrogated phosphorylation of p65 in vitro. These evidences collectively suggested SIF could suppress the pathological functions of fibroblast-like synoviocyte, and protect joints from destruction under AA conditions.