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ID PMID Title PublicationDate abstract
29881381 Current Insights in Microbiome Shifts in Sjogren's Syndrome and Possible Therapeutic Inter 2018 Sjogren's syndrome (SS) is an autoimmune disease, among the most common ones, that targets mainly the exocrine glands as well as extra-glandular epithelial tissues. Their lymphocytic infiltration leads to manifestations from other organs (e.g., kidneys, lungs, liver, or thyroid), apart from sicca symptoms (xerostomia and keratoconjunctivitis). SS is more prevalent in women than in men (9:1). Moreover, p.SS patients are in increased risk to develop lymphoma. Certain autoantibodies (e.g., antibodies against ribonucleoprotein autoantigens Ro-SSA and La-SSB) are ultimate hallmarks for the disease. It was not known until recently that culture-independent techniques like next-generation sequencing (NGS) facilitate the study of the microbe communities in humans and scientists achieved to define the outlines of the microbiome contribution in health and disease. Researchers have started to investigate the alterations in diversity of the oral, ocular, or intestinal microbiota in SS. Recent studies indicate that dysbiosis may play a significant role in SS pathogenesis. At the same time, the cause or effect is not clear yet because the dysfunction of salivary glands induces alterations in oral and intestinal microbiome which is linked to worsen of symptoms and disease severity. If the human microbiome proves to play a key role in pathogenesis and manifestation of SS, the next step could be new and promising therapeutic approaches such as probiotics or prebiotics. This mini review focuses on the alterations of microbiome of SS patients, their connection with immune tolerance and new therapeutic strategies involving diet manipulation toward future personalized medicine.
29992753 The involvement of Toll-like receptor 9 in the pathogenesis of erosive autoimmune arthriti 2018 Sep Endogenous nucleic acids and their receptors may be involved in the initiation of systemic autoimmune diseases including rheumatoid arthritis (RA). As the role of the DNA sensing Toll-like receptor (TLR) 9 in RA is unclear, we aimed to investigate its involvement in the pathogenesis of autoimmune arthritis using three different experimental models of RA. The data obtained revealed involvement of TLR9 in the T cell-dependent phase of inflammatory arthritis. In rats with pristane-induced arthritis (PIA), TLR9 inhibition before disease onset reduced arthritis significantly and almost completely abolished bone erosion. Accordingly, serum levels of IL-6, α-1-acid-glycoprotein and rheumatoid factor were reduced. Moreover, in TLR9(-/-) mice, streptococcal cell wall (SCW)-induced arthritis was reduced in the T cell-dependent phase, whereas T cell-independent serum-transfer arthritis was not affected. Remarkably, while TLR7 expression did not change during in vitro osteoclastogenesis, TLR9 expression was higher in precursor cells than in mature osteoclasts and partial inhibition of osteoclastogenesis was achieved only by the TLR9 antagonist. These results demonstrate a pivotal role for TLR9 in the T cell-dependent phases of inflammatory arthritis and additionally suggest some role during osteoclastogenesis. Hence, endogenous DNA seems to be crucially involved in the pathophysiology of inflammatory autoimmune arthritis.
29642170 A case of adult onset Still's disease with mutations of the MEFV gene who is partially res 2018 Apr RATIONALE: Familial Mediterranean fever (FMF) and adult onset Still's disease (AOSD) have overlapping features, and are categorized as being on the spectrum of autoinflammatory diseases (AIDs). FMF is more prevalent in the Mediterranean region but rarely, described in the Chinese population. PATIENT CONCERNS: We present an interesting case of a Han Chinese AOSD patient with episodic fever, wheals, and polyarthritis for 2 years. DIAGNOSIS: Sequencing analysis found exon 2 mutations of the MEFV gene (c.329T>C [L110P], and c.442G>C [E148Q]). INTERVENTION: Her arthritis was well-controlled with colchicine treatment, but fever, and rashes were not. OUTCOMES: She eventually received tocilizumab, in addition to colchicine, and her symptoms completely disappeared. LESSONS: MEFV mutations may exist in AOSD patients, and treatment with colchicine might be helpful in such patients.
30042606 Beta burns following radionuclide synovectomy. 2018 Radionuclide synovectomy (RSV) is a form of minimally invasive treatment of persistent joint inflammation. The procedure has a high safety profile and the occurrence of serious adverse events, such as full-thickness skin radiation necrosis, is rare. Less severe radiation events, while more common, are usually benign and self-limiting. We present two cases of low-grade beta burns that developed after RSV, despite proper injection technique. The potential long-term risk of such exposure is also discussed, with reference to historical radiation incidents. While low-grade beta burns after RSV usually pose little danger to the patient, any clinician involved in radionuclide treatment of arthritis should be aware of their existence and management.
29670337 UK-South Asian patients' experiences of and satisfaction toward receiving information abou 2018 BACKGROUND: Rheumatoid arthritis (RA) causes painful joint inflammation and is incurable, but treatments control RA. Drug regimens are complex, and patients often do not take their medication as expected. Poor medication adherence can lead to poorly controlled disease and worse patient outcomes. Biologics treatments are expensive and require full engagement from patients. We have previously shown that patients from Black ethnic minority backgrounds do not fully engage into treatment plan. This study explored the patients' experiences in and satisfaction toward receiving information about biologics and future support preferences in South Asian patients with RA. METHODS: Twenty South Asian patients with RA from Royal Wolverhampton Hospitals NHS Trust and Central Manchester University Hospitals NHS Foundation Trust participated in individual semistructured interviews. Interviews were transcribed and data were analyzed by using thematic analysis approach. RESULTS: Four overarching themes describe the patients' experience in and satisfaction toward receiving information on biologics: 1) current provision of information regarding the "biologics journey" and understanding of RA: in this theme, non-English-speaking patients expressed heightened anxiety about stepping up to biologics; 2) experience and perceptions of biologics: many patients were positive about the biologic experience; however, there were patient-perceived delays in getting on to the biologics; 3) factors influencing willingness to try biologics: in this theme, a number of factors were identified including seeking advice from doctors abroad; and 4) recommendations on the desired information to fully understand the use of biologics: some patients valued group discussions, while others suggested receiving RA and biologic information through a video interaction. CONCLUSION: This novel study provides insight into South Asian RA patients' experiences in and satisfaction toward receiving information about biologics. South Asian patients with RA reported a range of perceptions about biologics and support preferences, many of which may not be shared with the non-South Asian population.
35140540 Is It the Age at Disease Onset or the Disease Radiological Severity That Affects Cervical 2018 BACKGROUND: Cervical spine involvement in patients with rheumatoid arthritis (RA) can cause pain and disability, with a variety of neurologic signs and symptoms. OBJECTIVES: To investigate the relationship between structural cervical spine involvement in patients with RA with the age at disease onset and the degree of radiologic severity of RA measured by Larsen scoring. PATIENTS AND METHODS: This cross-sectional study included 50 adult patients with RA. Patients who complained or not complained from symptoms of cervical spine involvement in RA were included; we did X-ray of the cervical spine, hands, and feet; Larsen scoring method; disease activity score (DAS28); and Neck Disability Index. RESULTS: The results revealed that patients with cervical involvement tend to be younger at their disease onset than those with no cervical involvement, as detected by cervical X-ray. The relation was significant P < .05 regarding all cervical involvements except for basilar invagination. Disease radiological severity (measured by Larsen score) significantly increases the risk for subaxial subluxation, P = .040. All other cervical complications of RA tend to have nonsignificant relation with disease severity. Using univariate binary regression analysis for risk factors for cervical involvement showed that the only probable risk factor for cervical involvement (detected by X-ray) in patients with RA is age at disease onset. CONCLUSIONS: The early age at disease onset tends to affect cervical spine involvement in patients with RA more than the disease radiological severity.
30316470 Magnetic Resonance Imaging in Rheumatology. 2018 Nov Magnetic resonance (MR) imaging has traditionally only played a small role in the clinical care of most patients with arthritis. However, with modern therapeutic strategies, early diagnosis is now more important than ever before. Consequently, advanced MRI techniques and applications now play a crucial role in managing an increasing proportion of rheumatology patients. This article reviews MR imaging techniques that are in widespread use and in development for detection and quantification of inflammation and structural damage in arthritis. It focuses on the role of MR imaging for diagnosis, management, and research in inflammatory arthropathies. Osteoarthritis and gout are briefly reviewed.
30305931 Feasibility of cardiovascular disease risk assessments in rheumatology outpatient clinics: 2018 OBJECTIVE: The European League Against Rheumatism recommends implementing cardiovascular disease (CVD) risk assessments for patients with inflammatory joint diseases (IJDs) into clinical practice. Our goal was to design a structured programme for CVD risk assessments to be implemented into routine rheumatology outpatient clinic visits. METHODS: The NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) started in April 2014 as a quality assurance project including 11 Norwegian rheumatology clinics. CVD risk factors were recorded by adding lipids to routine laboratory tests, self-reporting of CVD risk factors and blood pressure measurements along with the clinical joint examination. The patients' CVD risks, calculated by the European CVD risk equation SCORE, were evaluated by the rheumatologist. Patients with high or very high CVD risk were referred to their primary care physician for initiation of CVD preventive measures. RESULTS: Data collection (autumn 2015) showed that five of the NOCAR centres had implemented CVD risk assessments. There were 8789 patients eligible for CVD risk evaluation (rheumatoid arthritis (RA), 4483; ankylosing spondylitis (AS), 1663; psoriatic arthritis (PsA), 1928; unspecified and other forms of spondyloarthropathies (SpA), 715) of whom 41.4 % received a CVD risk assessment (RA, 44.7%; AS, 43.4%; PsA, 36.3%; SpA, 30.6%). Considerable differences existed in the proportions of patients receiving CVD risk evaluations across the NOCAR centres. CONCLUSION: Patients with IJD represent a patient group with a high CVD burden that seldom undergoes CVD risk assessments. The NOCAR project lifted the offer of CVD risk evaluation to over 40% in this high-risk patient population.
30789688 2018 Jul 4 The coverage of rituximab, under the various government-sponsored drug plans, includes a maximum of two courses per year; rituximab is not currently reimbursed for maintenance treatment. In 2007, the Canadian Agency for Drugs and Technologies in Health reviewed rituximab under the Common Drug Review. Rituximab was given a positive recommendation, however the Committee noted that the evidence for repeated doses was insufficient and that retreatment should be considered only in patients who achieved a response followed by a loss of effect. Clinicians would like to prescribe rituximab to patients, prior to a flare or loss of effect. Therefore, a review of the evidence is needed to support the administration of rituximab as regularly scheduled therapy to maintain remission or low disease activity in patients with moderate to severe rheumatoid arthritis.
30071175 Recent advances in devices for vagus nerve stimulation. 2018 Aug INTRODUCTION: Vagus nerve stimulation (VNS) has become a valuable treatment option for refractory epilepsy and depression. To improve clinical efficacy and minimize side effects, novel device technology for VNS is under development and investigation. AREAS COVERED: For epilepsy, the AspireSR®, and SenTiva™ VNS therapy systems are the two most recently developed VNS devices. These novel devices have implemented a closed-loop approach and contain a cardiac based seizure detection algorithm. The mechanism of action of VNS remains to be further elucidated, but as preclinical research reveals VNS induced effects on brain plasticity, the autonomic nervous system and the inflammatory response, the indications of VNS are expanding. VNS devices are currently being investigated for stroke rehabilitation, treatment of chronic heart failure and rheumatoid arthritis. Recently devices to noninvasively affect vagus nerve functioning have been developed, with the aim of achieving similar effects without the drawbacks of a surgical procedure and continuous stimulation. EXPERT COMMENTARY: Several animal and human trials have shown promising results with minimal adverse events. However, further research needs to be conducted to validate the use of these devices and decide on optimal stimulation parameters.
29593809 The impact of age, sex, blepharitis, rosacea and rheumatoid arthritis on Demodex mite infe 2018 Mar INTRODUCTION: Two human-specific Demodex species have been described: Demodex folliculorum and Demodex brevis. A medical condition caused by the presence of Demodex is called demodicosis. MATERIAL AND METHODS: The study material comprised eyelashes collected from 1499 patients. RESULTS: Demodex sp. infection was revealed in 47% of patients (487 women and 216 men). We determined the following rates of infection by age groups: 1-25 (8% of infected subjects), 26-40 (36%), 41-55 (50%), 56-70 (67%), over 70 (77%). The sex of the subjects was not identified as a factor conducive to infection (p = 0.108), while their age was positively correlated with the risk of infection (p < 0.005). The 1499 study subjects included patients with blepharitis, rosacea, and rheumatoid arthritis. The study investigated the extent to which the above-mentioned conditions affect the risk of Demodex infection. Applying the method of logistic regression, the infection probability was estimated, depending on the age, sex, and comorbidities such as blepharitis, rosacea, and rheumatoid arthritis. Patients suffering from blepharitis were found to have a nearly 2.5-fold higher risk of Demodex infection than those without blepharitis, and the risk for rosacea patients was determined as three-fold higher than that of the general population. CONCLUSIONS: Blepharitis and rosacea are risk factors for Demodex infection.
30632532 Comparison of Level of Fatigue and Disease Correlates in Patients With Rheumatoid Arthriti 2018 Sep OBJECTIVES: This study aims to compare the levels of fatigue in patients with rheumatoid arthritis (RA) and systemic sclerosis (SSc) and to assess the potential influence of fatigue on clinical variables. PATIENTS AND METHODS: Age- and sex-matched adult patients with SSc (n=50; 6 males, 44 females; mean age 47.7 years; range 23 to 72 years) and RA (n=51; 6 males, 45 females; mean age 50.8 years; range 23 to 71 years) were consecutively recruited. Patients were examined and evaluated for disease specific and generic outcome measures including disease activity parameters, physical functions, psychological status, and health related quality of life measures. Level of fatigue was assessed by Fatigue Severity Scale and Multidimensional Assessment of Fatigue scale. These were interviewed by the same experienced physician who was blind to clinical data. RESULTS: Patients had similar educational and smoking status, as well as functioning and health related quality of life. However, patients with RA declared higher levels on visual analog scale-pain (p=0.012) and higher body mass index than patients with SSc (p<0.0001) and lower distances in six-minute walking test (p=0.002). Levels of fatigue were quite similar between patients with RA and SSc. Levels of fatigue, measured by different scales, were significantly correlated with physical functions and health related quality of life measures and psychometric variables in both groups; however, the correlation coefficients were relatively higher in patients with RA. CONCLUSION: Fatigue is a major problem in patients with RA and SSc. Our findings revealed that level of fatigue was quite similar between patients with RA and SSc and significantly correlated with physical functions and health related quality of life. Patients with RA and SSc should be carefully evaluated for fatigue by using valid scales and the impact of fatigue on clinical measures should not be overlooked.
30154891 Leptin is associated with disease activity but not with anthropometric indices in rheumato 2018 Aug INTRODUCTION: Leptin is a cytokine-like hormone which has a complex role in inflammation. However, the importance of leptin in the pathogenesis of rheumatoid arthritis (RA) is far from being fully elucidated. The aim of the study was to determine serum leptin levels in RA patients and to evaluate whether there is an association between disease activity, anthropometric indices and leptin levels. MATERIAL AND METHODS: This hypothesis-generating study included 55 RA patients and 25 matched healthy subjects. The serum leptin concentration was determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: Median serum leptin level in RA patients of 27.4 ng/ml (14.5-54.9 ng/ml) was statistically significantly higher (p = 0.03) compared with the median leptin value of 16.3 ng/ml (9.6-38.8 ng/ml) determined in healthy controls. The serum leptin level in the high disease activity group was significantly higher (p < 0.0005) than that in the low disease activity group and in healthy controls. A significant difference (p = 0.001) in serum leptin level was also found when the high disease activity group was compared with the moderate disease activity group. In the RA group a statistically significant positive correlation (rho = 0.390; p = 0.003) was observed between serum leptin level and disease activity score (DAS28). CONCLUSIONS: The present results show that serum leptin levels are increased and significantly associated with disease activity in patients with RA and may have a valuable role in the inflammatory reactions and pathogenesis of RA.
29911038 Lean Mass and Disease Activity are the Best Predictors of Bone Mineral Loss in the Premeno 2018 Mar BACKGROUND AND OBJECTIVES: Factors determining bone mineral (BM) loss in rheumatoid arthritis (RA) are not well known. This study aimed to determine the occurrence and predictors of BM loss in the young premenopausal women with RA. METHODS: Ninety-six females with RA and 90 matched controls underwent clinical, biochemical, BM density (BMD), and body composition assessments. RA disease activity was assessed using disease activity score-28 (DAS-28) and hand X-ray. RESULTS: In the young premenopausal females with RA having median symptom and treatment duration of 30 (18-60) and 4 (2-12) months, respectively, with moderate disease activity (DAS-28, 4.88 ± 1.17), occurrence of osteoporosis and osteopenia was 7.29% and 25% at spine, 6.25% and 32.29% at hip, and 17.7% and 56.25% at wrist, respectively (significantly higher than controls). RA patients had lower BMD at total femur, lumbar spine (LS), radius total, and radius ultra-distal. Total lean mass (LM) and BM content were significantly lower in RA (P = 0.022 and <0.001, respectively). In RA, BMD at majority of sites (LS, neck of femur, greater trochanter, radius total, and radius 33%) had the strongest positive correlation with LM followed by body fat percent. RA patients with most severe disease had lowest BMD at different sites and lowest LM. Stepwise linear regression revealed LM followed by DAS-28 to be best predictors of BMD. RA patients receiving glucocorticoids did not have significantly different BMDs from patients not taking glucocorticoids. INTERPRETATION AND CONCLUSION: BM loss is a significant problem in the young premenopausal women with recent-onset RA. LM and disease severity were the best predictors of BMD.
32185335 Rheumatoid Arthritis-associated Interstitial Lung Disease in Greece: A Multicentre Epidemi 2018 Dec Interstitial Lung Disease (ILD) represents one of the most severe complications of Rheumatoid Arthritis (RA). Preliminary data from the RA Greek cohort show a prevalence of 5.3%. Due to scarcity of data, little is known regarding the epidemiological and clinical features of Greek patients with RA-ILD. Moreover, use of pulmonary function tests for prognostic purposes in patients with RA-ILD is still not sufficiently studied. Interestingly, the treatment approach of patients with RA-ILD remains controversial due to high risk of infection, possible drug-related pulmonary toxicity, and scarce evidence regarding the efficacy of medications used in these patients. The aim of this research protocol is to collect data from patients with RA-ILD followed in multiple centres across Greece in order to identify the clinical and epidemiological features of these patients. The second part of the study focuses on the prospective data collection regarding the progression of ILD, the response to different treatment modalities and the incidence of adverse events attributed either to the disease itself or to its treatment in patients with RA-ILD. This study may provide useful evidence in exploring both the natural history and the risk factors contributing to the development of ILD, as well as the efficacy and the adverse events attributed to the medications used in Greek patients with RA-ILD; thus ameliorating the therapeutic approach of RA-ILD patients in daily clinical practice.
29978502 Association of single nucleotide polymorphisms in resistin gene with rheumatoid arthritis 2018 Nov BACKGROUND: Recent evidences have revealed that resistin is associated with the development of rheumatoid arthritis (RA). The aim of this study was to analyze the association of resistin gene single nucleotide polymorphisms (SNPs) with RA susceptibility. METHODS: In this study, we finally analyzed three resistin SNPs (rs1862513, rs3745368, and rs3745367) in 278 RA patients and 276 normal controls recruited from Chinese population using TaqMan SNP genotyping assays. RESULTS: There were no significant differences for the distribution of allele and genotype frequencies of these three SNPs between RA patients and normal controls (all P > .05). The genotype effects of dominant, recessive models were also analyzed, and no significant association was detected (all P > .05). Haplotype analysis suggested that the frequency of haplotype GAA was notably lower in RA patients in comparison with normal controls (OR = 0.317, 95% CI: 0.125-0.807, P = .011). CONCLUSION: In a ward, our results indicated that resistin gene polymorphisms might affect the genetic predisposition of RA in Chinese population.
32185311 Correlates of sedentary behaviour and light physical activity in people living with rheuma 2018 Jun BACKGROUND: Sedentary behaviour (SB) is associated with adverse health outcomes in the general population. Replacing sedentary time with light intensity physical activity (LPA) has been linked with improvements in all-cause and cardiovascular disease mortality in adults. People with Rheumatoid Arthritis (RA) typically spend long periods of time sedentary, but the health consequences of 'too much sitting', and possible benefits of LPA, have not been fully explored in this population. Moreover, little is known regarding the determinants of these behaviours among people living with RA, and such knowledge is required for the development of effective behavioural interventions. AIMS: To examine longitudinal relationships between: 1) objectively-assessed SB/LPA with health outcomes in RA, 2) hypothesised determinants of SB/LPA with objectively-assessed SB/LPA in RA. METHODS: This longitudinal study will secure assessments at baseline (Time 1) and 6-month follow-up (Time 2) from RA patients. At both time points, physical assessments will be undertaken, and questionnaires administered to measure physical (e.g., percentage body fat, disease activity, physical function, pain) and psychological (e.g., depression, anxiety, vitality) health outcomes. Additional questionnaires will be administered to establish hypothesised determinants (i.e., psychosocial, individual differences, and physical environmental). Participants will wear the ActiGraph GT3X accelerometer and activPAL3(μTM) for 7 days to objectively measure SB and LPA. DISCUSSION: Findings will elucidate the health correlates of SB in RA, as well as the relevance of interventions targeting reductions in SB by promoting LPA. Results will also assist in identifying intervention targets (i.e., determinants), with the potential to encourage SB change in RA.
30886984 Atypical presentation of Pneumocystis jirovecii pneumonia in a patient with rheumatoid art 2018 BACKGROUND: We report the case of a patient with rheumatoid arthritis (RA) treated with tofacitinib who developed severe Pneumocystis jirovecii pneumonia (PJP) with an atypical clinical presentation. CASE PRESENTATION: A 78-year old male patient with RA treated with tofacitinib, methotrexate (MTX) and low dose corticosteroids was admitted to the hospital with arthralgia and nausea. Laboratory findings revealed hypercalcemia with normal levels of parathyroid hormone (PTH) and elevated 1,25-(OH)(2) vitamin D levels. A lung CT scan showed bilateral interstitial pneumonic infiltrates. PCR from bronchoalveloar lavage was positive for Pneumocystis jirovecii. Hypercalcemia resolved under PJP treatment and was - after exclusion of other possible causes - probably fungal associated. CONCLUSION: Due to the increased risk of opportunistic infections in immunocompromised patients, the finding of hypercalcemia in conjunction with a pulmonary infection should raise high clinical suspicion of PJP.
30588001 Calcium and vitamin D supplementation with 3-year denosumab treatment is beneficial to enh 2019 BACKGROUND: This 3-year retrospective study compared the outcomes of bisphosphonate-pretreated denosumab therapy with or without vitamin D and calcium supplementation in postmenopausal osteoporosis (OP) patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: Fifty-eight patients under long-term denosumab treatment were divided into groups without (denosumab group; 31 cases) or with (combination group; 27 cases) vitamin D and calcium supplementation. The bone markers of BAP, TRACP-5b, and urinary NTX were measured at baseline and every year for 3 years. We also evaluated bone mineral density (BMD) of the lumbar 1-4 vertebrae (L-BMD) and bilateral total hips (H-BMD) at the same time points. RESULTS: There were no significant differences in the percent changes of serum albumin-corrected calcium between the groups. The percent change in TRACP-5b was significantly higher in the combination group at 2 years. Serum 25-hydroxyvitamin D status was persistently high during therapy in both groups, with significant percent increases over baseline at 2 and 6 months in both groups and at 24 months in the combination group. The percent increase from baseline of serum zinc was significantly higher at 3 years in the combination group over the denosumab group. L-BMD and H-BMD were significantly increased at every time point for 3 years vs pretreatment levels in both groups and were significantly higher in the combination group at all time points. CONCLUSION: Compared with denosumab monotherapy, the combination group displayed significantly increased serum zinc, L-BMD, and H-BMD at 3 years in OP patients with RA. Thus, calcium and vitamin D supplementation may be beneficial to enhance BMD gains, but not necessarily 25-hydroxyvitamin D status, in patients with OP and RA under denosumab.
30542493 Protective effect of avicularin on rheumatoid arthritis and its associated mechanisms. 2018 Dec The present study aimed to investigate the effect of avicularin on rheumatoid arthritis (RA) in vitro, and additionally explore the molecular mechanism. To perform this investigation, an in vitro model of RA was established by treatment of the human RA synovial MH7A cell line with tumor necrosis factor-α (TNF-α). MH7A cells were then treated with various concentrations (10, 30, 100 and 300 µM) of avicularin. Then, the levels of inflammatory factors [interleukin (IL)-1β, IL-6, IL-8, matrix metalloproteinase (MMP)-1 and MMP-13] were measured by ELISA. Cell viability and apoptosis were detected using an MTT assay and flow cytometry, respectively. In addition, the expression levels of genes and proteins were determined reverse transcription quantitative polymerase chain reaction and western blot analysis. The results of the present study indicated that avicularin significantly decreased the levels of inflammatory factors (IL-1β, IL-6, IL-8, MMP-1 and MMP-13), previously increased by TNF-α, in a dose-dependent manner. Concurrently, avicularin inhibited the mRNA and protein expression levels of iNOS and COX-2 increased by TNF-α. It was also identified that TNF-α administration significantly promoted MH7A cell viability and inhibited cell apoptosis, and avicularin treatment dose-dependently inhibited MH7A cell viability and induced cell apoptosis. In addition, these data suggested that avicularin prevented the activation of the mitogen-activated protein kinase kinase (MEK)/nuclear factor kappa light-chain-enhancer of activated B-cells (NF-κB) pathway activated by TNF-α. Taken together, these results demonstrated that avicularin may inhibit the inflammatory response, prevent cell viability and induce apoptosis in human RA synovial cells through preventing the activation of the MEK/NF-κB pathway.