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ID PMID Title PublicationDate abstract
29241877 Adult onset Still's Disease. 2018 May 11 Adult onset Still's disease is a rare systemic condition at the crossroads between auto-inflammatory syndromes and autoimmune diseases, with considerable heterogeneity in terms of clinical presentation, evolution and severity. This article reviews the main advances and lesser known aspects of this entity related to its clinical spectrum (atypical cutaneous lesions, unusual manifestations, macrophage activation syndrome, disease phenotypes), the emerging controversy around its association with delayed malignancy, the search for new biomarkers for its diagnosis, evaluation of prognosis (clinical factors, prognostic indexes and biomarkers to identify patients at risk of severe organ failure or life-threatening complications), and the determinants in the choice of biological treatment.
30276474 Balneotherapy in chronic inflammatory rheumatic diseases-a narrative review. 2018 Dec Since ancient time, thermal baths and mudpacks have been used as treatments for rheumatic diseases and other musculoskeletal complaints. Despite basic researches suggest an anti-inflammatory effect of spa therapy, there is no consensus about the benefits of balneotherapy in patients with chronic inflammatory rheumatic diseases. The aim of this review is to summarize the currently available information on clinical effects of balneotherapy in these diseases. We did a literature search for articles considering the randomized controlled trials (RCTs) published until today. Although many selected studies do not have an elevated methodological quality, data from these RCTs support a beneficial effect of spa therapy. Balneotherapy highly improves the clinical course of the disease in patients with predominant axial involvement, such as with ankylosing and enteropathic spondylitis; the effects are less favorable in patients with predominant peripheral articular inflammation, such as rheumatoid arthritis. Good results have been observed in patients with psoriatic arthritis, but only few RCTs have been conducted on this disease. Spa therapy appears safe, and adverse events have been reported only in a few patients.
30280235 [Biologics and further new drugs for rheumatic diseases since 2000]. 2018 Nov BACKGROUND: Rheumatoid arthritis (RA), psoriatic arthritis and axial spondyloarthritis are severe diseases, which without adequate treatment lead to extremely reduced mobility, functional status and quality of life. OBJECTIVE: The effects of biologics and further new antirheumatic drugs on the burden of disease. METHODS: Evaluation of study results and register data dealing with the efficacy and safety of these drugs. RESULTS: Biologics have been proven to dramatically improve the outcome of all three diseases and contributed to the fact that remission is a realistic target today. In addition, the cardiovascular risk and mortality in RA have been reduced and structural damage is considerably blocked by biologics. Recently Janus kinase (JAK) inhibitors contributed to the treatment possibilities in the same way. Biologics as well as JAK inhibitors offer an excellent safety profile and tolerability with infections being the most important risk. CONCLUSION: With the availability of biologics and additional new drugs all three diseases have lost the status of difficult to treat diseases. Their usage according to the guidelines ensures that the burden of disease can been minimalized in most cases. The benefit-risk profile of these drugs has been shown to be excellent.
30627294 Management of Inflammatory Cardiac Masses. 2018 Dec Systemic rheumatologic and inflammatory disorders can affect almost any organ system, including the heart. The cardiac valves, conduction system, myocardium, endocardium, pericardium, and coronary arteries may be affected. Intracardiac masses may develop as part of the disease process or a consequence of their therapy, such as methotrexate-associated nodulosis. Optimal therapy in these cases is not known, since many patients are asymptomatic and the potential benefit of surgical excision must be weighed against its associated morbidity and mortality. Importantly, these inflammatory masses must be differentiated from thrombus, infection, and primary and metastatic tumors. We present three cases of inflammatory cardiac masses associated with rheumatoid arthritis and Wegener's granulomatosis, which were successfully treated conservatively, and propose a management algorithm. The benefits of such an approach must be individualized and weighed against the risks of systemic embolization, stroke and obstruction.
29755457 Androgen-Induced Immunosuppression. 2018 In addition to determining biological sex, sex hormones are known to influence health and disease via regulation of immune cell activities and modulation of target-organ susceptibility to immune-mediated damage. Systemic autoimmune disorders, such as systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis are more prevalent in females, while cancer shows the opposite pattern. Sex hormones have been repeatedly suggested to play a part in these biases. In this review, we will discuss how androgens and the expression of functional androgen receptor affect immune cells and how this may dampen or alter immune response(s) and affect autoimmune disease incidences and progression.
29500791 Safety, Effectiveness, and Treatment Persistence of Golimumab in Elderly Patients with Rhe 2018 Jun INTRODUCTION: Golimumab has been proven as an effective treatment for rheumatoid arthritis in clinical trials. However, there is a scarcity of data regarding its use in elderly patients in a real-world setting. This study aims to evaluate the safety, effectiveness, and treatment persistence of golimumab in elderly Japanese patients (≥ 75 years) with rheumatoid arthritis. METHODS: This study was a post hoc analysis of post-marketing surveillance data on 5137 Japanese patients with active rheumatoid arthritis who received golimumab for 24 weeks. The study population was divided into two age groups (younger: < 75 years and elderly: ≥ 75 years), and the safety, effectiveness, and treatment persistence of golimumab were assessed. Also, the reasons for discontinuing golimumab treatment were analyzed by multi-logistic regression. RESULTS: During golimumab treatment over 24 weeks, younger and elderly groups exhibited comparable improvement of disease activity as measured by EULAR response criteria with similar overall rates of adverse events. However, the survival curve of golimumab for elderly patients was significantly different from that for younger patients due largely to the discontinuation at 4 weeks. The most common reason for discontinuation in elderly patients was patient choice, while it was disease progression in younger patients. Analysis of elderly patients who discontinued treatment by their own decision identified EULAR good response as a factor associated with continuation of golimumab treatment whereas no predictive factor associated with discontinuation was identified. CONCLUSIONS: The safety and effectiveness of golimumab treatment in elderly Japanese patients aged 75 years or older were comparable to those in younger patients in real-world clinical practice. Analysis of the survival curves suggested that continuous use of golimumab might further improve clinical benefit of golimumab in elderly patients, underpinning the importance of effective communication between physicians and elderly patients based on the treat-to-target strategy. FUNDING: Janssen Pharmaceutical K.K. and Mitsubishi Tanabe Pharma Corporation.
29515924 Iatrogenic T-Cell Lymphoma with Associated Hemophagocytic Lymphohistiocyotsis in a Patient 2018 Patients with rheumatoid arthritis are at increased risk of hematological malignancies, especially when exposed to immunosuppressive therapy. The mechanisms of lymphomagenesis remain poorly understood but factors implicated include high disease activity, exposure to antitumoral necrosis factor medications, and Epstein-Barr virus infection. Lymphoid malignancies of T-cell origin are uncommon in patients with rheumatoid arthirits. Clinical presentation with associated hemophagocytic lymphohistiocyotsis is rare and confers a poor prognosis. This case report illustrates a case of a patient with long-standing rheumatoid arthritis and an iatrogenic peripheral T-cell lymphoma with secondary hemophagocytic lymphohistiocytosis who achieved a complete response after intensive chemotherapy.
30567235 Treatment of advanced stage methotrexate-associated lymphoproliferative disorders (MTX-LPD 2018 Dec 13 We present two cases of patient's with long-standing autoimmune diseases being treated with immunosuppressants that developed aggressive lymphoproliferative disorders. Immunosuppressants have a well-known association with disorders. Sustained regression of these lymphoproliferative disorders occurred with simple discontinuation of these immunosuppressive agents.
30775555 Effects of eldecalcitol and ibandronate on secondary osteoporosis and muscle wasting in ra 2018 Dec OBJECTIVES: Rheumatoid arthritis (RA) is characterized by chronic inflammation of the synovium, progressive erosion of the articular cartilage, and joint destruction. RA also causes secondary osteoporosis and muscle wasting. We investigated the effects of ibandronate (IBN), a bisphosphonate; eldecalcitol (ELD), an active vitamin D3 derivative; and combination treatment with both agents on secondary osteoporosis and muscle wasting using adjuvant-induced arthritis rats. METHODS: Arthritis was induced in 8-week-old male Lewis rats. Rats were randomized into 4 treatment groups and an untreated normal control group: IBN (subcutaneously, once every 2 weeks, 10 μg/kg), ELD (orally, once daily, 30 ng/kg/day), IBN + ELD, vehicle, and control. Paw thickness measurements were performed for evaluation of arthritis. The femur was scanned using dual-energy X-ray absorptiometry. Cross-sectional areas of left tibialis and anterior muscle fibers and the expression of MuRF1, atrogin-1, MyoD, and myogenin in the gastrocnemius muscle were measured to evaluate muscle wasting. RESULTS: IBN and/or ELD increased bone mineral density (BMD) in the femur. In addition, there was an additive effect of combination treatment compared with single treatments for BMD. However, IBN and/or ELD did not inhibit muscle wasting in adjuvant-induced arthritis rats. CONCLUSIONS: Combination treatment with IBN and ELD may be effective for secondary osteoporosis associated with RA. Other treatments are necessary for muscle wasting associated with RA. Studies in humans are needed to confirm these findings.
30210584 The role of golimumab in inflammatory arthritis. A review of the evidence. 2018 Sep BACKGROUND: Golimumab (GOL) is a tumor necrosis factor inhibitor that is used for various types of inflammatory arthritis such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). This article is a systematic review of the evidence for the efficacy and safety of golimumab in inflammatory arthritides, specifically RA, PsA and AS. METHODS: We conducted a search of randomized controlled trails in MEDLINE [PubMed], CENTRAL, Embase, and Current Controlled Trials databases (ClinicalTrials.gov) through 2017 for studies that evaluated golimumab in inflammatory arthritides. We focused on pivotal, phase III trials for this review of the safety and efficacy of the drug. However, as some important information is not available in detail in publications from the phase III studies, additional individual studies pertaining to antidrug antibodies were also included. RESULTS: A total of 12, randomized, double-blind, placebo-controlled studies were included in this review of literature. Two trials focused on the GOL response in the PsA population, four trials focused on the GOL response in the AS population, and five trials focused on the GOL response in the RA population. Additional studies that evaluated autodrug antibodies produced in patients using GOL were also included. CONCLUSION: Golimumab was found to be clinically effective and also have a good safety profile in the treatment of RA, PsA, and AS based on data available from large studies.
29192804 Hecogenin exhibits anti-arthritic activity in rats through suppression of pro-inflammatory 2018 Feb Hecogenin is a steroidal sapogenin isolated from the leaves of Agave genus species that plays an important role in the treatment of a variety of inflammatory diseases. The aim of the present study was to evaluate the anti-arthritic activity of hecogenin in Complete Freund's adjuvant-induced arthritis in rats. The hecogenin (40 µl of 50 µg/kg, orally) and hecogenin + fluticasone (40 µl of 25 µg/kg, each, orally) was tested against Complete Freund's adjuvant-induced arthritis in rats by evaluating various parameters such as paw volume, arthritic score, joint diameter, spleen weight, thymus weight, haematological and biochemical parameters and pro-inflammatory cytokines. Histopathological and radiological analyzes of ankle joints were also carried out. Treatment of rats with hecogenin and its combination elicited significant reduction in paw edema, arthritic score and joint diameter. Hecogenin and its combination also inhibited joint destruction in histopathological and radiological analyzes of ankle joint. Hecogenin and its combination significantly increased the levels of red blood cells and hemoglobin but decreased the white blood cell count. The anti-arthritic activity was also confirmed with the change in biochemical parameters and myeloperoxidase assay. In the present investigation, hecogenin and its combination prevent destruction of cartilage and protect synovial membrane with improving health status through haematonic properties and down regulation of various cytokines. Hence, hecogenin may be a potential therapeutic candidate for the treatment of rheumatoid arthritis.
29686437 Monocyte-related biomarkers of rheumatoid arthritis development in undifferentiated arthri 2018 OBJECTIVES: Enhanced/disturbed activities of monocytes are crucial for perpetuation and for development of rheumatoid arthritis (RA). Therefore, knowledge about monocyte activities and regulation of molecular pathways operating within monocytes early in the course of RA development may help to predict the progression to the full-blown disease. We aimed to investigate the profile of miRNAs expression in circulating monocytes and monocyte-related cytokines in sera of individuals at undifferentiated arthritis (UA) stage, wich could serve as new biomarkers for RA development. MATERIAL AND METHODS: Magnetically sorted monocytes from peripheral blood of 20 UA patients served for total RNA isolation. RNA samples were used for microRNA profiling. Concentrations of CCL3/MIP-1α, M-CSF, CCL2/MCP-1, IL-6, TNF-α and IL-15 in sera of UA patients were measured using ELISA assays. Verification of diagnosis after 4 years of follow-up led to the identification of patients who developed RA (UA→RA patients) and patients who remained still in UA phase (UA → UA patients). Comparisons between patients groups were performed using two-tailed Mann-Whitney U test. RESULTS: We identified 50 miRNAs in monocytes with the largest variation of expression across all patients samples. From these selected miRNAs, expression of miR-642b-5p, miR-483-3p, miR-371b-5p were significantly up-regulated and miR-25-3p and miR-378d were significantly down-regulated in UA → RA vs. UA → UA patients. This specific pattern of miRNAs expression in circulating monocytes paralleled elevated IL-15 and M-CSF concentrations in sera of UA patients who progressed to RA. CONCLUSIONS: Results of our pilot study indicate that altered activity of monocytes can be detected at early stages of RA. We found new miRNA candidates differentially expressed in peripheral blood monocytes and elevated concentrations of IL-15 and M-CSF involved in monocyte activity and differentiation in patients with UA who subsequently developed RA, in comparison to UA patients who did not progress to RA after 4 years follow-up.
30091017 Intractable pneumothorax due to rupture of subpleural rheumatoid nodules: a case report. 2018 Aug 8 BACKGROUND: In rare cases, rheumatoid pleural nodules can rupture into the pleural cavity to cause pneumothorax or empyema. We report successful surgical treatment of a patient with an intractable secondary pneumothorax due to rupture of a subpleural rheumatoid nodule into the pleural cavity. CASE PRESENTATION: A 75-year-old man with a medical history of rheumatoid arthritis, acute coronary syndrome, and diabetes was admitted to our hospital because of left chest pain and dyspnea. A chest X-ray and chest computed tomography (CT) scan showed a left pneumothorax and several small subpleural nodules with cavitation. Repeated pleurodesis via a chest tube failed to improve the pneumothorax, so we decided to perform thoracoscopic surgery. Air leakage was detected in the left upper lobe where the subpleural nodule was visible on chest CT. Resection of the lesion successfully resulted in resolution of the air leakage. The final pathological diagnosis of the subpleural nodule was a pulmonary rheumatoid nodule. The patient has had no evidence of recurrence of pneumothorax after surgery. CONCLUSIONS: We obtained a final pathological diagnosis of a rheumatoid nodule that caused an intractable pneumothorax. Pneumothorax associated with rupture of rheumatoid nodules in the subpleural cavitary is difficult to treat with thoracoscopic surgery as a second-line treatment.
29354135 MicroRNA-155-at the Critical Interface of Innate and Adaptive Immunity in Arthritis. 2017 MicroRNAs (miRNAs) are small non-coding RNAs that fine-tune the cell response to a changing environment by modulating the cell transcriptome. miR-155 is a multifunctional miRNA enriched in cells of the immune system and is indispensable for the immune response. However, when deregulated, miR-155 contributes to the development of chronic inflammation, autoimmunity, cancer, and fibrosis. Herein, we review the evidence for the pathogenic role of miR-155 in driving aberrant activation of the immune system in rheumatoid arthritis, and its potential as a disease biomarker and therapeutic target.
30647482 Benefits of wrist splinting in patients with rheumatoid arthritis. 2018 OBJECTIVES: The goal was to present the use of a functional wrist splint and its impact on hand function in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: The study group comprised 104 women aged 18-65 and diagnosed with RA, who were treated in the Rheumatology Clinic and Outpatient Department of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. The control group consisted of 40 healthy women in the same age group. Assessment of the hand function was the research method. RESULTS: Our results revealed substantially deteriorated function of the rheumatoid hand in relation to the healthy hand. The use of a wrist stabiliser is justified in patients with RA due to its beneficial impact, such as improved hand strength and dexterity and reduced pain. Based on the results obtained, it may be assumed that it is mainly patients with moderate and high disease activity who require stabilisation. The small number of patients in remission and with low disease activity was a limitation of the study. Hands with RA require an individual approach, and the most effective methods slowing down development of deformation should be sought. The results presented in this article may provide a starting point for further research on the most favourable wrist stabilisation in order to improve hand function in RA. CONCLUSIONS: Our study showed that the hand function of women with RA is limited due to deteriorated grip quality and manual dexterity in comparison to healthy persons. Wrist stabilisation improves hand function in patients with RA.
30585275 A meta-analysis of the relationship between body mass index and risk of rheumatoid arthrit 2018 The present meta-analysis aimed to evaluate the relationship between body mass index (BMI) and rheumatoid arthritis (RA). A systematic search of the Cochrane, Pubmed, and Embase databases was conducted to identify relevant studies published before September 2017 using terms related to BMI and RA. Fixed or random-effect models were used to estimate the pooled relative risk (RR) with 95 % confidence interval (CI). Subgroup analyses by sex were performed to investigate the association between BMI and RA in male and female subgroups. A total of 14 eligible studies containing 353,948 patients were included in the analysis. The pooled results suggested that the odds ratios (ORs) of RA were 1.08 (95 % CI: 1.00~1.15) for overweight, and 1.32 (95 % CI: 1.11~1.54) for obesity, respectively, suggesting that a higher BMI increases the risk of RA compared to normal weight. Further subgroup analyses showed a positive association between BMI and RA risk but only in females, with a RR of 1.11 (95 % CI: 1.00~1.22) for overweight and 1.40 (95 % CI: 1.24~1.57) for obesity. In conclusion, an increased BMI may lead to a higher risk for RA development. Furthermore, the positive association between BMI and RA risk may be stronger in female populations than in males. However, additional analyses are needed.
31413489 Functional and Radiographic Outcomes of the Sauvé-Kapandji and Darrach Procedures in Rheu 2019 Aug Background Deterioration of the distal radioulnar joint (DRUJ) in rheumatoid arthritis (RA) manifests as pain, weakness, and reduced range of motion. The Darrach and Sauvé-Kapandji (S-K) procedures are used when medical management fails to control these symptoms. However, there is a paucity of literature comparing the outcomes of these procedures. The purpose of this study is to compare the clinical and radiographic outcomes of the Darrach and S-K procedures in RA patients. Materials and Methods This is a retrospective, single institution cohort study of RA patients who underwent the Darrach or S-K procedure between 2008 and 2016. Ulnar translation, range of motion, and functional improvement were compared. Results Nine patients (13 wrists) underwent the Darrach procedure, and nine patients (11 wrists) underwent the S-K procedure. The average length of follow-up was 1.3 years. Pain, function, and range of motion improved in both groups. The degree of ulnar translation did not significantly change after either procedure. Conclusion Given their similar outcomes, we found no evidence that the S-K procedure is superior to the Darrach procedure or vice versa. However, when surgery is indicated for younger RA patients with DRUJ disease and ulnar translation, the S-K may be better suited to prevent radiocarpal joint dislocation.
30258348 Alzheimer's Disease and Rheumatoid Arthritis: A Mendelian Randomization Study. 2018 Alzheimer's disease (AD) is the most common neurodegenerative disease. In recent years, multiple pathway analyses of AD genome-wide association studies (GWAS) have been conducted, and provided strong support for immune pathways in AD. Rheumatoid arthritis (RA) is a chronic autoimmune disease. It is reported that antirheumatic drugs had protective effect on dementia in RA patients. However, observational studies have reported a controversial inverse relationship between AD and RA. In addition, Mendelian randomization studies have also been performed to evaluate the association of RA with AD. However, these studies reported inconsistent association of RA with AD. Until now, it is still unclear that AD is a causally associated with RA. Here, we performed a Mendelian randomization study to investigate the causal association of AD with RA. We analyzed the large-scale AD GWAS dataset (74,046 individuals) and RA GWAS dataset (58,284 individuals) from the European descent. However, we did not identify any significant association of AD with RA using inverse-variance weighted meta-analysis (IVW), weighted median regression and MR-Egger regression.
30210612 Overexpression of CD64 on CD14(++)CD16(-) and CD14(++)CD16(+) monocytes of rheumatoid arth 2018 Sep It is well-known that monocytes are a heterogeneous cell population and different monocyte subsets play important roles in rheumatoid arthritis (RA). Cluster of differentiation (CD)64 is one of Fc receptor, which initiates immunological and inflammatory reactions. However, the roles in RA remain to be elucidated. In the present study, the expression of CD64, CD40, CD163, CD206, HLA-DR, CD80 and CD86 on monocytes and the expression of CD64 on monocyte subsets were determined by flow cytometry. The expression of CD64 on monocyte subsets in patients with RA was further analyzed for their correlation with markers of autoimmune response, inflammation, disease activity of RA and serum cytokines. Compared to the health volunteers, the expression of CD64 on monocytes and each monocyte subset were significantly elevated in RA patients. The expression of CD64 on CD14(++)CD16- and CD14++CD16+ monocytes were positively correlated with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA) and disease activity score 28 (DAS28). Furthermore, the expression of CD64 on CD14++CD16+ monocytes was found to be associated with the serum level of IL-6. In conclusions, these data demonstrated the expression of CD64 on CD14++CD16- and CD14++CD16+ monocytes are elevated and associated with the disease activity in RA.
30619860 Diet, Microbiota, and Gut Permeability-The Unknown Triad in Rheumatoid Arthritis. 2018 Growing experimental and clinical evidence suggests that a chronic inflammatory response induced by gut dysbiosis can critically contribute to the development of rheumatic diseases, including rheumatoid arthritis (RA). Of interest, an adherence to a Mediterranean diet has been linked to a reduction in mortality and morbidity in patients with inflammatory diseases. Diet and intestinal microbiota are modifying factors that may influence intestinal barrier strength, functional integrity, and permeability regulation. Intestinal microbiota may play a crucial role in RA pathogenesis, but up to now no solid data has clarified a mechanistic relationship between gut microbiota and the development of RA. Nonetheless, microbiota composition in subjects with RA differs from that of controls and this altered microbiome can be partially restored after prescribing disease modifying antirheumatic drugs. High levels of Prevotella copri and similar species are correlated with low levels of microbiota previously associated with immune regulating properties. In addition, some nutrients can alter intestinal permeability and thereby influence the immune response without a known impact on the microbiota. However, critical questions remain to be elucidated, such as the way microbiome fluctuates in relation to diet, and how disease activity may be influenced by changes in diet, microbiota or diet-intestinal microbiota equilibrium.