Browse

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

ID PMID Title PublicationDate abstract
30670075 Awareness and perceived risk of cardiovascular disease among individuals living with rheum 2019 Jan 22 BACKGROUND: Individuals with rheumatoid arthritis (RA) are at risk of developing cardiovascular disease (CVD), but patient perceptions of CVD are not routinely assessed. We performed a systematic literature review to evaluate awareness of the association between RA and CVD, and perceived risk of CVD among individuals with RA. METHODS: Three electronic databases (MEDLINE, EMBASE, and PubMed) were searched for English language articles between the years of 1990-2018. Search terms pertained to RA, CVD, knowledge, awareness, or perceptions of CVD risk. Abstracts were screened for inclusion/exclusion by two independent reviewers. RESULTS: A total of 33 abstracts were screened and 6 underwent full review. The overall sample size was 478 subjects and included patients with established RA who were predominantly female with a mean age range of 53 to 64 years. RA disease characteristics relevant to CVD were not uniformly reported, including the use of DMARDs, corticosteroids, or NSAIDs. A high proportion of subjects (range 73 to 97%) were unaware of an increased risk of developing CVD in relation to their RA, and this frequently occurred in those with a greater number of traditional CVD risk factors. Misperceptions about CVD were common, and the majority of subjects misestimated their actual CVD risk. CONCLUSION: Individuals with RA at highest risk for CVD report low awareness and perceived risk of this comorbidity. This represents a knowledge gap in need of intervention but must be tailored to patients' needs. An understanding of the system- and individual-level barriers preventing CVD awareness is needed. Only then will approaches to improve CVD screening and management in RA be successful.
30588556 Functional implications of single nucleotide polymorphisms rs662 and rs854860 on the antio 2019 May BACKGROUND: Atherosclerosis leading to cardiovascular disease (CVD) is the main cause of mortality and morbidity in patients with rheumatoid arthritis (RA). Paraoxonase1 (PON1) is the best understood member of plasma paraoxonases with anti-atherogenic properties. PATIENTS AND METHODS: Spanish RA (n = 549) consecutively recruited from 1 single center and 477 ethnically matched healthy controls were included in a case-control study. The concentration of PON1 was evaluated by means of an enzyme-linked immunosorbent sssay (ELISA). An arylesterase/paraoxonase assay kit was used to evaluate PON1 activity. Sample genotyping was performed by using TaqMan assays-on-demand. All results were expressed as medians ± interquartile range. One-way ANOVA comparisons were done using a nonparametric Kruskall-Wallis test. P values under 0.05 were considered to be significant. RESULTS: The concentration of PON1 in the RA group was higher than in control group (p = 0.0003), although the differences were not significant when PON1 activities were compared between both groups. No significant differences were found related to distributions of rs662 genotypes in RA patients compared to healthy controls. Among rs854860 polymorphisms, overall genotype was widely distributed between RA patients and controls. Overall PON1 concentration in plasma was not significantly different between individuals carrying any of rs662 (p = 0.8501) or rs854860 (p = 0.2741) polymorphisms. Although PON1 levels were not associated with any of the SNPs in the study, differences appear when enzyme activities are compared for each SNP separately. CVD in RA patients correlate with increased PON1 levels and lower PON1 activity. CONCLUSIONS: Although protective role of PON1 against oxidative damage in vivo could be related to other activities, in our study arylesterase activity was useful to identify phenotypic differences with emphasis placed on two SNPs coding for nonconservative amino acid changes in the functional protein.
31660707 Quality of life and clinical outcomes in Polish patients with high activity rheumatoid art 2019 Nov BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disease. Therapy is based on disease-modifying agents. Methotrexate (MTX) is used in first-line therapy and, in the case of failure, its alternatives include leflunomide, which was recommended in Poland within the National Health Fund Therapeutic Program. OBJECTIVES: The purpose of the study was to evaluate the parameters of quality of life of Polish patients with high RA activity during treatment with leflunomide. Additional aims were to evaluate the effectiveness and safety of treatment. MATERIAL AND METHODS: We performed a retrospective analysis of the data from the PLUS study. The PLUS study comprised 887 adult patients from 30 centers. During the study patients received leflunomide in a maintenance dose of 20 mg or 10 mg once daily. Before the study, 100 mg of leflunomide had been administered daily for 3 days, followed by a maintenance dose of 20 mg/day or 10 mg/day for at least a month before enrollment. The PLUS study observation time was up to 12 months with 1 control visit every 3 months. The patients' quality of life was assessed with Health Assessment Questionnaire Disability Index (HAQ-DI). Erythrocyte sedimentation rate (ESR), Disease Activity Score (DAS28) and CRP (C-reactive protein) concentration were used to assess the disease activity. RESULTS: Six hundred seventy-nine patients completed the study. The HAQ-DI decreased after 3 months of observation (mean value 1.46 vs baseline 1.63; p = 0.001) and remained stable. The percentage of patients with HAQ-DI less than 1 and greater than 2 increased from 12.2% to 17.8% and decreased from 33.2% to 20.3%, respectively (p < 0.0001); DAS28 progressively decreased on subsequent visits. C-reactive protein and ESR decreased after 3 months and remained stable. Adverse events were observed in 4.4% of patients. CONCLUSIONS: Treatment with standard leflunomide doses is safe and allows for significant clinical improvement.
31718678 Radiographic progression can still occur in individual patients with low or moderate disea 2019 Nov 12 BACKGROUND: The aim of this retrospective study was to examine the longitudinal association between disease activity and radiographic damage in a cohort of patients with early RA (symptom onset < 1 year) treated according to treat-to-target (T2T) therapy. METHODS: Baseline to 3-year follow-up data were used from patients included in the DREAM remission induction cohort. Patients received protocolized T2T treatment, aimed at 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR) remission. Disease activity (DAS28-ESR and C-reactive protein, CRP) were assessed at least every 3 months; X-rays of the hand and feet at inclusion, 6 months, and 1, 2, and 3 years were scored using modified Sharp/van der Heijde scoring (SHS). Between and within-person associations between time-integrated disease activity and radiographic progression over time were examined. RESULTS: A subset of 229 out of 534 included patients were available for analysis. At the between-patient level, time-integrated DAS28-ESR scores were not significantly correlated with progression at the 6 month and 2-year follow-up and only weakly at the 1-year (Pearson's correlation coefficient r = 0.17, P < 0.05) and 3-year follow-up (r = 0.21, P < 0.05). Individual slopes of the relationship between DAS28-ESR and progression scores in each time interval were significantly correlated over time and the slope of the first 6 months was moderately associated with this slope at later time points (r between 0.39 and 0.59; P values < 0.001). Between 15.9 to 22.7% and 16.7 to 38.5% of patients with low and moderate time-integrated disease activity, respectively, experienced relevant (ΔSHS ≥ 3) radiographic progression at the different time intervals. Analyses using CRP showed similar results. CONCLUSIONS: In early RA patients treated according to T2T, radiographic progression appears to be an individually determined disease process, driven by factors other than consistent high disease activity. For individual patients, the intra-patient relation between disease activity and cumulative radiographic damage during the first 6 months is a good indicator for this relation in later years. TRIAL REGISTRATION: Netherlands Trial Register NTR578, 12 January 2006.
31673413 Incidence of inpatient venous thromboembolism in treated patients with rheumatoid arthriti 2019 OBJECTIVES: To assess incidence rates (IRs) of VTE in patients with rheumatoid arthritis (RA) on different DMARDs and DMARD switchers. METHODS: Adults with RA on a DMARD between 2007 and 2017 were studied in a US claims database. Conventional synthetic DMARD (csDMARD) users, first biologic/targeted synthetic DMARD (b/tsDMARD) users and b/tsDMARD switchers (from a b/tsDMARD to another b/tsDMARD) were followed for inpatient VTE (pulmonary embolism (PE)/deep vein thrombosis (DVT)). Crude and adjusted IR and 95% CIs of VTE were estimated. HRs for VTE were estimated via Cox regression. VTE risk was also evaluated by number of switches between b/tsDMARDs and in patients without a VTE history. RESULTS: The age and sex standardised IR (95% CI) of VTE (per 100 person-years) was 0.86 (0.70 to 1.03), 0.60 (0.52 to 0.68) and 0.58 (0.51 to 0.65) for b/tsDMARD switchers, first b/tsDMARD users and csDMARD users, respectively. After adjustment, b/tsDMARD switchers had an increased risk of VTE, compared with csDMARD users, HR(adj) (95% CI) being 1.36 (1.16 to 1.58), 1.36 (1.13 to 1.63) and 1.47 (1.18 to 1.83) for VTE, DVT and PE, respectively. Compared with first b/tsDMARD users, the HR(adj) (95% CI) for VTE was 1.35 (1.15 to 1.60) for first b/tsDMARD switchers and 1.48 (1.19 to 1.85) for second b/tsDMARD switchers. CONCLUSIONS: In RA, b/tsDMARD switchers have a higher VTE risk compared with csDMARD users and first b/tsDMARD users. Switching b/tsDMARDs may be a proxy for higher disease severity or poorly controlled RA and an important confounder to consider in obtaining unbiased estimates of VTE risk in observational RA safety studies.
31342648 Translation, cross-cultural adaptation and validation of Nepali version of Health Assessme 2019 Oct OBJECTIVE: To translate, cross-culturally adapt and validate the Health Assessment Questionnaire-Disability Index (HAQ-DI) in Nepali language (Nepali HAQ). METHODS: Translation was done fulfilling the methodological standards described by Beaton. Comprehensibility testing of the preliminary version was done in 50 rheumatoid arthritis (RA) patients, and a prefinal version was prepared after making changes in the original version to maintain the equivalence with the target version. Psychometric testing was done in another group of 127 rheumatoid patients to test for content validity and reliability. Construct validity was tested with visual analog score (VAS) and numeric rating scales (NRS) for pain and stiffness. RESULTS: Nepali HAQ was comprehensible in >95% of patients. Reliability testing showed an intraclass coefficient for overall Nepali HAQ of 0.76, ranging from 0.71 to 0.95. The internal consistency was acceptable with a Cronbach's alpha of .92. Construct validity was also acceptable with a moderate correlation between Nepali HAQ and VAS and NRS. CONCLUSIONS: Nepali HAQ is a comprehensible, reliable and valid tool for evaluation of the functional status of Nepalese patients with RA and should be implemented in clinical care and research settings.
31908842 Routine Assessment of Patient Index Data 3 (RAPID3) alone is insufficient to monitor disea 2019 OBJECTIVE: To test the longitudinal association between patient-reported outcome, Routine Assessment of Patient Index Data 3 (RAPID3) and the Disease Activity Score in 28 joints that includes the erythrocyte sedimentation rate (DAS28-ESR) in routine-care patients with rheumatoid arthritis (RA). METHODS: Patients with RA treated with disease-modifying antirheumatic drugs were included in this prospective observational cohort. The longitudinal association between RAPID3 (0-10) and DAS28-ESR and its individual components (swollen joint count (SJC), erythrocyte sedimentation rate (ESR) (mm/hour), tender joint count (TJC) and patient global assessment (PGA)) was tested using generalised estimating equations in patients with more than two consecutive visits with data on RAPID3 and DAS28-ESR. Interactions between RAPID3 and gender, pain, PGA and age at baseline were tested, and if significant (p<0.20) and clinically relevant, models were fit in the corresponding strata. RESULTS: In total, 330 patients were included (mean follow-up 10.7 (SD 9.7) months, female gender 67.9%). The longitudinal association between RAPID3 and DAS28-ESR was weak (β=0.29 (95% CI 0.24 to 0.35), n=207), meaning that one unit increase in RAPID3 corresponded to a 0.29 unit increase in Disease Activity Score in 28 joints (DAS28). RAPID3 was most strongly associated with subjective (TJC: β=0.89 (95% CI 0.61 to 1.17); PGA: β=0.94 (95% CI 0.84 to 1.04)) and not with objective components of DAS28 (SJC: β=0.29 (95% CI 0.17 to 0.41), n=172). The association between RAPID3 and ESR was poor but modified by gender, being only significant in men (β=0.37 (95% CI 0.08 to 0.67)). CONCLUSIONS: These data suggest that RAPID3 does not sufficiently capture changes in objective inflammatory signs. Monitoring by RAPID3 alone is therefore insufficient to follow disease activity in patients wth RA in clinical practice.
31451221 Germacrone alleviates collagen-induced arthritis via regulating Th1/Th2 balance and NF-κB 2019 Oct 20 Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease. The imbalance of T helper type 1 (Th1) and Th2 immune responses contributes to the pathogenesis of this disease. Germacrone is a major bioactive component isolated from Rhizoma Curcuma with multiple bioactivities including anti-inflammation. However, the role and mechanism of germacrone in RA are still unknown. Collagen-induced arthritis (CIA) model was established in male DBA/1 J mice by two immunizations with chicken collagen II. Germacrone was orally administered once per day starting on the day of second immunization for 3 weeks. Arthritis scoring was evaluated every 3 days after second immunization. H&E staining was used for histopathological examination. Levels of tumor necrosis factor (TNF)-α, interferon (IFN)-γ and interleukin (IL)-4 in serum and synovial tissues of mice were detected by ELISA. Th1 and Th2 cell percentage in mouse spleens was analyzed by flow cytometry. IκB and phosphorylation of NF-κB p65 (p-p65) expression in mouse synovial tissues was assayed by Western blot. We found germacrone treatment significantly reduced arthritis score and inflammation in CIA mice. Levels of TNF-α and IFN-γ were elevated, and IL-4 reduced, in the serum and synovial tissues of CIA mice. Germacrone partially reversed levels of these cytokines. Moreover, germacrone decreased the ratio of Th1 to Th2 cells in mouse spleens. Additionally, germacrone remarkably enhanced IκB expression, but suppressed p-p65 level in CIA mice. Taken together, these results suggest that germacrone alleviated the progression of arthritis that might be related to the regulation of Th1/Th2 balance and inactivation of NF-κB pathway.
31169830 Molecular Characterization of Monocyte Subsets Reveals Specific and Distinctive Molecular 2019 Objectives: This study, developed within the Innovative Medicines Initiative Joint Undertaking project PRECISESADS framework, aimed at functionally characterize the monocyte subsets in RA patients, and analyze their involvement in the increased CV risk associated with RA. Methods: The frequencies of monocyte subpopulations in the peripheral blood of 140 RA patients and 145 healthy donors (HDs) included in the PRECISESADS study were determined by flow cytometry. A second cohort of 50 RA patients and 30 HDs was included, of which CD14(+) and CD16(+) monocyte subpopulations were isolated using immuno-magnetic selection. Their transcriptomic profiles (mRNA and microRNA), proinflammatory patterns and activated pathways were evaluated and related to clinical features and CV risk. Mechanistic in vitro analyses were further performed. Results: CD14(++)CD16(+) intermediate monocytes were extended in both cohorts of RA patients. Their increased frequency was associated with the positivity for autoantibodies, disease duration, inflammation, endothelial dysfunction and the presence of atheroma plaques, as well as with the CV risk score. CD14(+) and CD16(+) monocyte subsets showed distinctive and specific mRNA and microRNA profiles, along with specific intracellular signaling activation, indicating different functionalities. Moreover, that specific molecular profiles were interrelated and associated to atherosclerosis development and increased CV risk in RA patients. In vitro, RA serum promoted differentiation of CD14(+)CD16(-) to CD14(++)CD16(+) monocytes. Co-culture with RA-isolated monocyte subsets induced differential activation of endothelial cells. Conclusions: Our overall data suggest that the generation of inflammatory monocytes is associated to the autoimmune/inflammatory response that mediates RA. These monocyte subsets, -which display specific and distinctive molecular signatures- might promote endothelial dysfunction and in turn, the progression of atherosclerosis through a finely regulated process driving CVD development in RA.
31482199 The impact of cardiorespiratory fitness on classical cardiovascular disease risk factors i 2019 Oct Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD). Advanced measures of cardiorespiratory fitness (CRF) are associated with CVD risk factors. The present study aimed to examine whether CVD risk factors can predict clinic-based measures of CRF, using the Siconolfi step test and to determine if exercise can improve RA patients' cardiovascular health. Sixty-five RA patients (46 females, age 58 ± 11 years) completed assessments of CRF, CVD risk factors, body composition and RA characteristics. Ten patients participated in a follow-up 8-week exercise intervention. CRF was low (22 ml kg(-1) min(-1)) and associated with higher diastolic blood pressure (r = - 0.37, p = 0.002), higher global CVD risk (r = - 0.267,  p = 0.031) and worse body composition profile (body fat, r = - 0.48, p < 0.001; waist, r = - 0.65, p < 0.001; hip, r = - 0.58, p < 0.001). Regular exercise significantly improved CRF (p = 0.021), lower body strength (p < 0.001), agility (p < 0.001), systolic blood pressure (p = 0.021), body fat (p = 0.018), waist circumference (p = 0.035), hip circumference (p = 0.016), disease activity (p = 0.002), disability (p = 0.007) and QoL (p = 0.004). Elevated diastolic blood pressure and worse body composition profile are strong predictors of clinic-based measures of CRF. CRF is an important determinant of CVD risk and warrants inclusion in the routine assessment of RA patients. Regular exercise can improve CRF and CVD risk factors without any exacerbation of disease activity and should be offered as part of routine care.
31270722 Receiver operating characteristic analysis of ultrasound joint inflammation in relation to 2019 Oct OBJECTIVE: To investigate whether ultrasound greyscale (GS) and power Doppler (PD) joint inflammation may be useful in identifying rheumatoid arthritis (RA) patients in different states of structural damage and disease activity. METHODS: In this cross-sectional study utilizing 36-joint ultrasonography, bone erosion was scored dichotomously (1 = yes/0 = no) while GS and PD joint inflammations were graded semi-quantitatively (0-3) at each joint recess. Sensitivity, specificity and receiver operating characteristic (ROC) curve analysis was applied to study ultrasound joint inflammation as a clinical marker for identifying patients with erosion score > 4.5 (median) and DAS28 > 2.6, > 3.2 and > 5.1, respectively. RESULTS: 1080 joints and 1800 joint recesses were scanned in 30 RA patients (mean disease duration, 70.3 months). Patients with GS score > 35.5 (median) had significantly higher ultrasound erosion scores when compared to those with GS score ≤ 35.5 (mean (95% CI) ultrasound erosion scores, 9.27 (6.12-12.4) versus 3.33 (2.31-4.36), respectively. p = 0.0027). Patients with PD positivity had significantly higher DAS28 scores compared to those with PD negativity (mean (95% CI) DAS28, 3.84 (3.35, 4.34) versus 2.86 (2.18, 3.54), respectively. p = 0.0457). Area under the ROC curve (AUC) based on cut-off GS scores ≥ 38 to identify patients with ultrasound erosion score >4.5 was 0.82 (sensitivity = 73.3%, specificity = 86.7%, accuracy = 80%). AUC based on cut-off PD scores ≥ 2.5 for identifying patients with DAS28 > 5.1 was 0.88 (sensitivity = 100%, specificity = 69.2%, accuracy = 73.3%). CONCLUSIONS: Ultrasound GS and PD joint inflammation scores can be useful in identifying RA patients with high bone erosion burden (ultrasound erosion score > 4.5) and high disease activity (DAS28 > 5.1), respectively.
30963994 Genetic markers associated with clinical and radiographic response in adalimumab plus meth 2019 Sep OBJECTIVES: Biologics, including tumour necrosis factor inhibitors such as adalimumab (ADA), have significantly improved outcomes in rheumatoid arthritis (RA). Because the clinical course of RA and response to therapy may be influenced by the genetic background of the patient, the objective of this retrospective parallel-assigned case-control analysis was to evaluate the associations between candidate genetic markers for RA with clinical and radiographic responses to ADA + methotrexate (MTX) or MTX monotherapy in the Optimal Protocol for Treatment Initiation with MTX and ADA (OPTIMA) study. METHODS: Three candidate genetic markers were tested: HLA-DRB1 shared epitope (SE), interleukin 4 receptor (IL4R) single nucleotide polymorphism (SNP) rs1805010, and Fc gamma receptor IIb (FcgRIIb) SNP rs1050501. Genetic associations with week 26 clinical and radiographic responses during treatment with ADA + MTX or MTX monotherapy were assessed using summary statistics, chi-square or Fisher's exact test, correlation, regression models, and corrected for multiple-comparisons. RESULTS: Low disease activity (p=0.008) and improvement in American College of Rheumatology 20%, 50% and 70% response criteria (p=0.02, 0.01, and 0.02, respectively) were associated with HLA-DRB1 SE copy numbers in the ADA + MTX treatment arm, and the FcgRIIb SNP was a predictor of remission. The IL4R SNP correlated with radiographic progression in patients receiving MTX monotherapy, supporting previous findings. CONCLUSIONS: This pharmacogenetic analysis identified genetic components that contribute to clinical responses to anti-rheumatic therapy.
31154416 Association of Serum Tocilizumab Trough Concentrations with Clinical Disease Activity Inde 2019 Dec OBJECTIVE: To determine whether serum trough concentrations of tocilizumab (TCZ) administered as a fixed-dose subcutaneous (SC) injection for the treatment of rheumatoid arthritis (RA) are associated with disease activity responses. METHODS: We analyzed datasets from the Israeli branch of the multinational TOZURA study, which evaluated a weekly subcutaneous TCZ treatment regimen in a real-life clinical setting. Generalized estimating equations (GEE) were used to evaluate associations between the TCZ levels and the study outcomes. Linear models and GEE were used to evaluate associations between patient characteristics and TCZ levels. RESULTS: A significant association between the TCZ concentrations and the change in the Clinical Disease Activity Index (CDAI) score was observed. In a multivariate binary GEE model, every increase of 10 µg/ml in the concentration of TCZ was associated with being in a state of CDAI remission or low disease activity (OR 1.41) versus a moderate/high disease activity state. An OR of 1.52 was associated with being in a state of Health Assessment Questionnaire-Disability Index remission. In univariate linear models, there was an inverse association between body mass index (BMI) and improvement in the CDAI score, and the BMI score was associated with lower TCZ concentrations. Patients who weighed > 100 kg had lower TCZ concentrations. CONCLUSION: In the first 24 weeks of treatment with SC TCZ injections, TCZ concentrations were associated with clinical improvement, while body weight and BMI were inversely associated with TCZ concentrations. Personalizing the dose of SC TCZ to body weight may improve outcomes of clinical disease activity in patients with RA.
29575947 The utility of 25-question Geriatric Locomotive Function Scale for evaluating functional a 2019 Mar OBJECTIVES: To investigate the distribution of 25-question Geriatric Locomotive Function Scale (GLFS-25) scores in Japanese rheumatoid arthritis (RA) patients and evaluate relationships with clinical variables. METHODS: Among 15,115 patients registered in the NinJa database for fiscal year 2015, 1710 with complete GLFS-25 and disease activity score-28 (DAS28) data were analyzed. Correlations between GLFS-25 score and clinical variables were assessed by Spearman coefficients. Mean GLFS-25 scores were compared among DAS28 groups (<2.6, 2.6-3.1, 3.2-5.0, ≥5.1) using the Kruskal-Wallis test. To evaluate the performance of the GLFS-25 and Health Assessment Questionnaire Disability Index (HAQ-DI) for predicting DAS28 ≥ 3.2 (moderate/high disease activity), receiver operator characteristic (ROC) curves were constructed. RESULTS: GLFS-25 score was significantly correlated with age, disease duration, DAS28, and HAQ-DI. GLFS-25 score increased in parallel with DAS28. The proportion of patients with locomotive syndrome stage 2 also increased with DAS28. Area under the curve values for HAQ-DI and GLFS-25 score were 0.739 and 0.768, respectively. At a GLFS-25 positive cutoff score ≥16, sensitivity was 0.716 and specificity was 0.661 for predicting DAS28 ≥ 3.2. CONCLUSION: This study documents the GLFS-25 score distribution in Japanese RA patients and demonstrates that GLFS-25 is a useful measure for evaluating functional ability in RA.
30712603 Concentration-dependent viscosity and thermal radiation effects on MHD peristaltic motion 2019 Mar BACKGROUND AND OBJECTIVE: The biomedical fluid which fills the Synovial joint cavity is called Synovial fluid which behaves as in the fluid classifications to Non-Newtonian fluids. Also it's described as a several micrometers thick layer among the interstitial cartilages with very low friction coefficient. Consequently, the present paper opts to investigate the influence of the concentration-dependent viscosity on Magnetohydrodynamic peristaltic flow of Synovial Nanofluid in an asymmetric channel in presence of thermal radiation effect. METHOD: Our problem is solved for two models, in the first model which referred as Model-(I), viscosity is considered exponentially dependent on the concentration. Model-(2), Shear thinning index is considered as a function of concentration. Those models are introduced for the first time in peristaltic or Nanofluid flows literature. The governing problem is reformulated under the assumption of low Reynolds number and long wavelength. The resulting system of equations is solved numerically with the aid of Parametric ND Solve. RESULTS: Detailed comparisons have been made between Model-(I) and Model-(2) and found unrealistic results between them. Results for velocity, temperature and nanoparticle concentration distributions as well as pressure gradient and pressure rise are offered graphically for different values of various physical parameters. CONCLUSIONS: Such models are applicable to rheumatoid arthritis (RA) treatment. Rheumatoid arthritis patients can be treated by applying the magnetic field on an electrically conducting fluid, due to the movement of the ions within the cell which accelerates the metabolism of fluids.
30099861 Effects of Language, Insurance, and Race/Ethnicity on Measurement Properties of the PROMIS 2019 Jul OBJECTIVE: Most studies that have evaluated patient-reported outcomes, such as those utilizing the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a) in rheumatoid arthritis (RA), have been performed in white and English-speaking populations. The aim of our study was to assess the measurement properties of the PF10a in a racially/ethnically diverse population with RA and to determine the effect of non-English language proficiency, insurance status, and race/ethnicity on the validity and responsiveness of the PF10a. METHODS: Data were abstracted from electronic health records for all RA patients seen in a university-based rheumatology clinic between 2013 and 2017. We evaluated the use of the PF10a, floor and ceiling effects, and construct validity across categories of language preference, insurance, and race/ethnicity. We used standardized response means and linear mixed-effects models to evaluate the responsiveness of the PF10a to longitudinal changes in the Clinical Disease Activity Index (CDAI) across population subgroups. RESULTS: We included 595 patients in a cross-sectional analysis of validity and 341 patients in longitudinal responsiveness analyses of the PF10a. The PF10a had acceptable floor and ceiling effects and was successfully implemented. We observed good construct validity and responsiveness to changes in CDAI among white subjects, English speakers, and privately insured patients. However, constructs evaluated by the PF10a were less correlated with clinical measures among Chinese speakers and Hispanic subjects, and less sensitive to clinical improvements among Medicaid patients and Spanish speakers. CONCLUSION: While the PF10a has good measurement properties and is both practical and acceptable for implementation in routine clinical practice, we also found important differences across racial/ethnic groups and those with limited English proficiency that warrant further investigation.
30968534 Association between use of Chinese herbal medicine and depression risk in patients with rh 2019 Jun AIM: Depression is a common mental disorder in rheumatoid arthritis (RA) patients and may provoke the onset of poor clinical prognoses. In view of this, whether or not the use of Chinese herbal medicines (CHMs) can alleviate the risk of depression still remains unclear. We conducted a longitudinal cohort study to evaluate the association between CHMs us and depression risk among RA patients. METHOD: Using claims data from the National Health Insurance of Taiwan, we identified 6609 newly diagnosed RA patients aged 20 years or older between 1998 and 2010. From this sample, we recruited 3386 CHM users and randomly selected 3223 controls using propensity scores matching from the remaining cases as the non-CHMs users. They were followed until the end of 2012 to record depression incidence. A Cox proportional hazards regression model was used to compute the hazard ratio (HR) of depression with regard to the use of CHMs. RESULTS: During the 15-year follow-up, 249 CHM users and 314 non-CHM users developed depression, representing an incidence rate of 9.33 and 14.98, respectively, per 1000 person-years. We found that use of CHMs was associated with lower risk of depression by 38% (95% confidence interval 0.54-0.76). The most predominant effect was observed in those receiving CHMs for over 2 years (adjusted HR 0.34). Seven commonly prescribed CHMs could lessen the risk of depression: Chuan-niu-xi, Jie-geng, San-qi, Jia-wei-xia-yao-san, Dang-gui-nian-tong-tang, Zhi-gan-cao-tang, and Suan-zao-ren-tang. CONCLUSION: This study supports that adding CHMs into conventional therapy may prevent subsequent depression risk for RA patients.
29742922 Diagnostic accuracy of simplified ultrasound hand examination protocols for detection of i 2019 Jan BACKGROUND: There is no consensus regarding the minimum number of joints that should be included in an ultrasound (US) scoring system to reliably assess for disease activity in rheumatoid arthritis (RA). PURPOSE: To assess whether simplified US protocols for hand examination are as informative as the examination of 22 joints in patients with RA, and to correlate the US parameters with disease activity (DAS-28). MATERIAL AND METHODS: This is a cross-sectional study of 224 RA patients stratified based on their DAS-28 scores and assessed using eight preselected US examination protocols, including 22, 18, 16, 14, ten, eight, and two different combinations of four joints, respectively. RESULTS: We found a significant difference between US hand scores regarding their ability to detect active inflammation and erosions. DAS-28 scores correlated very well with the power Doppler (PD) scores generated by all eight US examination protocols (r = 0.89-1, P < 0.05), irrespective of patients' disease activity. Simplified US scores missed information on presence of PD in 20.6-40.2% patients ( P < 0.05) and misdiagnosed non-erosive hand RA in 12-38.4% patients ( P < 0.05), depending on the number of joints excluded from US hand examination. CONCLUSION: Preselected simplified US scores are less reliable in appreciating the disease burden when compared with an extended protocol for 22 joint US examination, raising clinicians' awareness regarding the need to comprehensively assess multiple hand joints to reliably rule out subclinical inflammation.
31135239 Predictors of sick leave and improved worker productivity after 52 weeks of intensive trea 2019 Jul Objective: To identify predictors of sick leave and improved worker productivity in patients with early rheumatoid arthritis (RA) treated for 52 weeks with intensive combination strategies. Methods: Patients with early RA were included in the COmbinatietherapie Bij Reumatoïde Artritis (COBRA)-light trial and followed for 52 weeks. As the COBRA-light strategy proved to be non-inferior to the COBRA strategy, all patients were pooled. Predictors for sick leave and improved worker productivity were assessed through a 3 month time-lag multivariable logistic generalized estimating equations model. Results: At baseline, 97 patients had a paid job, 59 had no job, and for six patients the work status was unknown. During the trial, 13 patients stopped working (8%) and six started working (4%). Only sick leave in the past 3 months predicted sick leave. By excluding this variable, patient global assessment and actual hours of sick leave became predictors. Increased worker productivity was predicted by higher patient global assessment levels, Sharp van der Heijde score ≥ 1, actual hours on sick leave, and higher worker productivity in the past 3 months. Conclusion: Sick leave and improved worker productivity were mainly predicted by non-disease-specific variables. Both outcomes can be predicted on a 3 month basis, using the outcome over the past 3 months for the next 3 months. By applying this model in daily practice, decisions for therapy change could be based not solely on disease activity but also taking into account a possible high risk for sick leave in the upcoming 3 months.
30285585 Predictive factors for radiographic progression of large joint damage in patients with rhe 2019 Nov Objectives: Little information is available regarding long-term follow-up of radiographic progression of damage (RPD) to large joints during treatment of rheumatoid arthritis (RA) with biological disease-modifying antirheumatic drugs (bDMARDs). We evaluated 3- to 4-year follow-up results and the associations between RPD and patient background and Larsen grade (LG) of joints.Methods: Seventy-one RA patients receiving bDMARDs for 3 to 4 years or who achieved bDMARD-free status were included. The mean age and disease duration at the start of bDMARDs were 62.4 years and 10.8 years, respectively. A total of 314 joints, including shoulders, elbows, hips, knees, and ankles, were evaluated to determine whether RPD was present by comparing radiographs before and after treatment.Results: RPD was observed in 24 patients (33.8%) and 34 joints (10.8%). Joints with an LG of III or higher had significantly higher rates of RPD than those with LGs I and II. Multivariate logistic regression analysis revealed that stage and health assessment questionnaire (HAQ) score at 18-months were independent risk factors for RPD (cut-off value: 2.5, odds ratio: 7.222 for stage; cut-off value: 0.9375, odds ratio: 6.278 for HAQ at 18-months).Conclusion: Stage, HAQ at 18-months, and LG at the start of bDMARDs were predictive of RPD after 3 to 4 years. bDMARDs should be started before both stage and LG exceed III and the therapeutic strategy should be determined so that HAQ does not exceed 1.0 during treatment.