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ID PMID Title PublicationDate abstract
31435753 Potential clinical utility of a novel optical tomographic imaging for the quantitative ass 2019 Dec Optical tomographic imaging (OTI) was reported to be a novel technique for the early diagnosis and disease activity assessment of rheumatoid arthritis (RA). This study aimed to evaluate the clinical utility of OTI for the detection of hand synovitis of RA patients. Manu-scan was used to perform imaging targeting the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints in 12 RA patients and three controls. The enrolled RA patients also underwent magnetic resonance imaging (MRI) and bone scintigraphy (BS) to provide reference images. Of the 181 joints feasible for OTI analysis, 140 joints (111 in RA patients and 29 in controls, 77.3%) in which the difference of the OTI indices in the two measurements was within 20% were evaluated. The OTI indices in RA joints were significantly lower than those in control joints (p < 0.001). Overall, the OTI indices in RA joints decreased as the synovitis grades on MRI or BS increased. Moreover, OTI was able to discriminate between RA and control joints (AUC = 0.815, 95% CI 0.739-0.891), even if RA joints were normal on physical examination (AUC = 0.714, 95% CI 0.594-0.834). OTI was in good agreement (kappa = 0.60) with MRI for evaluating synovitis in RA patients and showed positive results in 11.4% of clinically asymptomatic joints. OTI in this study showed the potential to be a supplementary imaging modality for the quantification of synovial inflammation in PIP and MCP joints of RA patients. Further large-scale trials are needed to confirm these findings.
31295689 Immunomodulatory effect of human umbilical cord mesenchymal stem cells on T lymphocytes in 2019 Sep Rheumatoid arthritis (RA) is an autoimmune disease which is lack of effective therapies. Abnormal activation, proliferation, and differentiation of T lymphocytes are closely related to RA. Mesenchymal stem cells (MSCs) can be used for RA treatment due to their immunoregulatory effects. However, the specific molecular mechanisms have not been fully elucidated and the therapeutic effect has been inconsistent. This study investigated the immunomodulatory effect of human umbilical cord MSCs (hUCMSCs) on T lymphocytes in collagen-induced arthritis (CIA) rats and RA patients to clarify the possible mechanism of hUCMSCs in RA treatment. The effects of hUCMSCs on arthritis index, radiological and synovial pathological changes, T lymphocyte proliferation and apoptosis, RORγt and Foxp3 expression, Th17 and Treg cell ratios, and IL-17 and TGF-β levels were assessed in CIA rats. Further, we verified the effect of hUCMSCs in RA patients, and compared the effect of hUCMSCs with that of hUCMSC derived extracellular vesicles (EVs). The results showed that hUCMSCs inhibited the proliferation and promoted apoptosis in T lymphocytes, downregulated RORγt mRNA and protein expression, decreased Th17 cell ratio, upregulated Foxp3 mRNA and protein expression, and increased Treg cell ratio in the spleen. Furthermore, they downregulated RORγt and Foxp3 expression in the joints, and inhibited IL-17 and promoted TGF-β expression in the serum, thereby improving arthritis, delaying radiological progression, and inhibiting synovial hyperplasia in CIA rats. In vitro the effects of hUCMSCs and EVs were consistent with those in vivo. Therefore, hUCMSCs may be expected to serve as a new therapy for RA.
31625435 Epidemiological characteristics of rheumatoid arthritis in Japan: Prevalence estimates usi 2020 Nov Objectives: To elucidate the epidemiological characteristics of patients with rheumatoid arthritis (RA) in Japan using data from the Comprehensive Survey of Living Conditions, a nationwide questionnaire survey conducted in 2016.Methods: In total, 222,365 men and 245,251 women aged ≥16 years were included in the study. RA patients were defined as those who reported 'currently receiving treatment for RA at hospitals, clinics, or a facility for Japanese traditional massage, acupuncture, moxibustion, or judo-orthopedics.' The number of RA patients was estimated from the age-specific prevalence and total Japanese population in 2016. Further, the prevalence of individuals experiencing difficulties in activities of daily living due to health problems and those with mental distress as evaluated by K6 Scale was examined.Results: The estimated number and prevalence of RA in Japan with 95% confidence interval was 822 (768-880) thousand and 0.75% (0.70-0.80%). The population peaked in the late 60s, and the prevalence continued increasing until the early 80s, regardless of sex. Compared with non-RA participants, RA patients were more likely to experience difficulties in activities and to be distressed.Conclusion: High prevalence of RA in older age and mental and physical burden among RA patients were confirmed.
30320976 Factors Associated With Hand and Upper Arm Functional Disability in People With Rheumatoid 2019 Nov OBJECTIVE: This original systematic review aimed to summarize evidence within observational studies on the factors associated with hand functional disability in adults with rheumatoid arthritis (RA). METHODS: A rigorous extensive systematic literature search was conducted in 6 medical databases for peer-reviewed English language observational studies that explore the factors associated with hand function for people with RA. Factors were critically classified under the domains of the International Classification of Functioning, Disability and Health (ICF) framework and health-related factors. The methodologic quality was determined using the appraisal tool for cross-sectional studies. Factors related to hand function that were investigated in ≥2 studies were explored using a best-evidence synthesis. RESULTS: Twenty articles from 1,271 citations met the inclusion criteria. All presented cross-sectional data (5 high-quality and 15 low-quality articles), resulting in limited evidence in the best-evidence synthesis. For the factors classified under the ICF domains, the best-evidence synthesis indicated that a diverse range of positive and negative factors were associated with hand function. However, key factors were hand strength, disease activity, and pain intensity. It is evident that few sociodemographic factors have been explored for the association with hand function. CONCLUSION: Although the level of evidence was limited, modifiable factors such as grip strength, disease activity, and pain were identified as the most influential factors on hand function in people with RA. The findings of the present review indicate that important sociodemographic factors that impact hand function in individuals with RA have not yet been considered or reported in clinical research.
31353807 A Neutrophil Activation Biomarker Panel in Prognosis and Monitoring of Patients With Rheum 2020 Jan OBJECTIVE: Exaggerated neutrophil activation and formation of neutrophil extracellular traps (NETs) are linked to inflammation and autoimmunity, including rheumatoid arthritis (RA). However, whether NETs are present in the circulation of RA patients and contribute to inflammation and disease progression has not been carefully addressed. We undertook this study to assess markers of neutrophil activation and NET formation in plasma samples, investigating whether they add clinical value in improving the determination of prognosis and monitoring in RA patients. METHODS: Markers of neutrophil activation (calprotectin) and cell death (NETs) were analyzed, using enzyme-linked immunosorbent assay, in serum and plasma obtained from patients in 3 cross-sectional RA cohorts and sex-matched healthy controls. A longitudinal inception cohort (n = 247), seen for a median follow-up of 8 years, was used for predictive analyses. RESULTS: Markers of neutrophil activation and cell death were increased in RA patients compared to healthy individuals (P < 0.0001). Calprotectin levels correlated with the Clinical Disease Activity Index (r = 0.53, P < 0.0001) and could be used to distinguish between patients with disease in remission and those with active disease, an observation not seen when examining C-reactive protein levels. A biomarker panel consisting of anti-citrullinated protein antibody and calprotectin could predict erosive disease (odds ratio [OR] 7.5, P < 0.0001) and joint space narrowing (OR 4.9, P = 0.001). NET levels were associated with markers of inflammation (P = 0.0002). Furthermore, NETs and a "neutrophil activation signature" biomarker panel had good predictive value in identifying patients who were developing extraarticular nodules (OR 5.6, P = 0.006). CONCLUSION: Neutrophils undergo marked activation and cell death in RA. Neutrophil biomarkers can provide added clinical value in the monitoring and prognosis of RA patients and may allow for early preventive treatment intervention.
31396235 Glucocorticoids-All-Rounders Tackling the Versatile Players of the Immune System. 2019 Glucocorticoids regulate fundamental processes of the human body and control cellular functions such as cell metabolism, growth, differentiation, and apoptosis. Moreover, endogenous glucocorticoids link the endocrine and immune system and ensure the correct function of inflammatory events during tissue repair, regeneration, and pathogen elimination via genomic and rapid non-genomic pathways. Due to their strong immunosuppressive, anti-inflammatory and anti-allergic effects on immune cells, tissues and organs, glucocorticoids significantly improve the quality of life of many patients suffering from diseases caused by a dysregulated immune system. Despite the multitude and seriousness of glucocorticoid-related adverse events including diabetes mellitus, osteoporosis and infections, these agents remain indispensable, representing the most powerful, and cost-effective drugs in the treatment of a wide range of rheumatic diseases. These include rheumatoid arthritis, vasculitis, and connective tissue diseases, as well as many other pathological conditions of the immune system. Depending on the therapeutically affected cell type, glucocorticoid actions strongly vary among different diseases. While immune responses always represent complex reactions involving different cells and cellular processes, specific immune cell populations with key responsibilities driving the pathological mechanisms can be identified for certain autoimmune diseases. In this review, we will focus on the mechanisms of action of glucocorticoids on various leukocyte populations, exemplarily portraying different autoimmune diseases as heterogeneous targets of glucocorticoid actions: (i) Abnormalities in the innate immune response play a crucial role in the initiation and perpetuation of giant cell arteritis (GCA). (ii) Specific types of CD4+ T helper (Th) lymphocytes, namely Th1 and Th17 cells, represent important players in the establishment and course of rheumatoid arthritis (RA), whereas (iii) B cells have emerged as central players in systemic lupus erythematosus (SLE). (iv) Allergic reactions are mainly triggered by several different cytokines released by activated Th2 lymphocytes. Using these examples, we aim to illustrate the versatile modulating effects of glucocorticoids on the immune system. In contrast, in the treatment of lymphoproliferative disorders the pro-apoptotic action of glucocorticoids prevails, but their mechanisms differ depending on the type of cancer. Therefore, we will also give a brief insight into the current knowledge of the mode of glucocorticoid action in oncological treatment focusing on leukemia.
30943146 Adherence in rheumatoid arthritis patients assessed with a validated Italian version of th 2019 Nov OBJECTIVES: The 5-item Compliance Questionnaire for Rheumatology (CQR5) proved reliability and validity in respect of identification of patients likely to be high adherers (HAs) to anti-rheumatic treatment, or low adherers (LAs), i.e. taking<80% of their medications correctly. The objective of the study was to validate an Italian version of CQR5 (I-CQR5) in rheumatoid arthritis (RA) patients and to investigate factors associated with high adherence. METHODS: RA patients, undergoing treatment with ≥1 self-administered conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) or biological DMARD (bDMARD), were enrolled. The cross-cultural adaptation and validation of I-CQR5 followed standardised guidelines. I-CQR5 was completed by patients on one occasion. Data were subjected to factor analysis and Partial Credit model Parametrisation (PCM) to assess construct validity of I-CQR5. Analysis of factors associated with high adherence included demographic, social, clinical and treatment information. Factors achieving a p<0.10 in univariate analysis were included in multivariable analysis. RESULTS: Among 604 RA patients, 274 patients were included in the validation and 328 in the analysis of factors associated with adherence. Factor analysis and PCM confirmed the construct validity and consistency of I-CQR5. HAs were found to be 109 (35.2%) of the patients. bDMARD treatment and employment were found to be independently associated with high adherence: OR 2.88 (1.36-6.1), p=0.006 and OR 2.36 (1.21-4.62), p=0.012, respectively. CONCLUSIONS: Only one-third of RA patients were HAs according to I-CQR5. bDMARDs and employment status increased by almost 3-fold the likelihood of being highly adherent to the anti-rheumatic treatment.
31455420 Exploration of shared genetic susceptibility loci between type 1 diabetes and rheumatoid a 2019 Aug 27 OBJECTIVE: Type 1 diabetes (T1D) and rheumatoid arthritis (RA) are autoimmune diseases. It is known that certain genetic loci and factors that increase the overall autoimmunity risk can be shared among different autoimmune diseases. We sought to replicate seven T1D-related SNPs (single nucleotide polymorphisms) that have been previously reported to be associated with RA susceptibility in a small set of mixed family-based and case-control Pakistani sample in a relatively large and independent RA case-control sample from the same population. Seven T1D-associated SNPs (GLIS3/rs7020673, BACH2/rs11755527, SKAP2/rs7804356, GDSMB/rs2290400, C6orf173/rs9388489, LOC399716/rs947474 and DLK1-MEG2/rs941576) were genotyped in a large Pakistani RA case-control sample (n = 1959) using TaqMan(®) SNP genotyping assays. RESULTS: None of the tested SNPs showed statistically significant association with RA susceptibility; however, one SNP (GLIS3/rs7020673) showed a trend for association (OR = 0.88, p = 7.99E-02). Our study has failed to replicate the previously reported association of seven T1D-associated SNPs with RA risk in a large sample from the same population. Thus, our results do not support a major role of these T1D SNPs in affecting RA susceptibility in the Pakistani population.
30945124 Can Disease-Modifying Anti-Rheumatic Drugs Reduce the Risk of Developing Dementia in Patie 2019 Jul Disease-modifying anti-rheumatic drugs (DMARDs) can reduce inflammation and slow progression of rheumatoid arthritis (RA). It remains unknown what impact DMARDs may have on dementia, where inflammation also plays a critical role in pathogenesis. Patients without a prior history of dementia who were newly diagnosed with RA between 2000 and 2005 were identified from Taiwan's National Health Insurance Research Database. The participants were stratified by age and gender. The outcome of interest was all-cause dementia, and Cox regression models were used to estimate the hazard ratio (HR) of dementia. The cumulative DMARD dosage was stratified by quartiles of defined daily doses. A total of 20,707 patients were diagnosed with RA, and 62,121 non-RA individuals aged 20 years or older were included. Cox proportional hazard regression analysis revealed that the RA cohort was 37% less likely to develop dementia compared with the non-RA cohort [adjusted HR 0.63, 95% confidence interval (CI) 0.55-0.72]. Further decreased risk was noted in DMARD users (adjusted HR 0.48, 95% CI 0.39-0.58) with dose-dependent effect. Subgroup analysis identified DMARD use as having a protective effect against developing dementia in female and younger patients. Also, in male and older patients, DMARD use further reduced the risk. These observations suggest that DMARDs may reduce the risk of developing dementia, and its effect is further increased at high cumulative dosages. These findings warrant further examination in randomized control trials.
31721330 Wogonin ameliorate complete Freund's adjuvant induced rheumatoid arthritis via targeting N 2020 Mar Rheumatoid arthritis (RA) is a chronic and accelerated autoimmune illness with proliferative and damaging synovitis, resulting in joint death and cartilage and bone erosion. This study focused on the potential therapeutic effect of wogonin on complete Freund's adjuvant (CFA) induced RA in rats and the underlying mechanisms. Arthritis was experimentally caused in rats by subcutaneously injecting 0.1 mL of CFA into the subplantar area of the left hind paw under moderate anesthesia on day zero. The regular oral doses of indomethacin/wogonin began on day zero and proceeded after injection to day 35. Wogonin reduced arthritic score considerably, enhanced body weight, and reduced paw thickness. Wogonin also boosted red blood cell considerably along with hemoglobin and reduced white blood cell count and erythrocyte sedimentation rate. Wogonin substantially improved an altered level of oxidative stress markers, antioxidant proteins, and inflammatory cytokines in a dose-dependent way. Wogonin inhibited p38 phosphorylation triggered by CFA and p65 nuclear translocation.
31555946 Prediction of recurrence and remission using superb microvascular imaging in rheumatoid ar 2020 Jan PURPOSE: Ultrasound is commonly used to assess the degree of synovitis in patients with rheumatoid arthritis (RA); however, it is unclear which joints are optimal for evaluating and predicting recurrence and remission. PATIENTS AND METHODS: In 293 RA patients enrolled in the KURAMA cohort, 28 joints were assessed by ultrasound. RESULTS: Results from patients in remission in both 2015 and 2017 (Group 1, n = 152) were compared with those from patients in remission in 2015 and non-remission in 2017 (Group 2, n = 60). The SMI scores for total (3.1 vs. 6.3, P = 0.004), MCP2-5 (1.1 vs. 2.4, P = 0.03), wrist (0.9 vs. 2.1, P = 0.0003), MTP2-5 (0.4 vs. 1.0, P = 0.03), and Lisfranc joints (0.07 vs. 0.25, P = 0.04) were significantly higher for Group 2. When those in non-remission in 2015 and remission in 2017 (Group 3, n = 27) were compared with those in remission in 2015 and non-remission in both 2015 and 2017 (Group 4, n = 54), the GS-SMI combined score (3.0 vs. 5.0, P = 0.04) and SMI score (1.5 vs. 2.9, P = 0.04) for MCP2-5 joints were significantly higher for Group 4. Multivariate logistic regression analysis identified "wrist SMI score ≧ 1" as an independent prognostic factor for recurrence (odds ratio 3.08, P = 0.001) and "MCP2-5 GS-SMI combined score ≦ 4" as an independent prognostic factor for remission (odds ratio 3.25, P = 0.048). CONCLUSION: We identified the optimal joint cut-off scores for predicting recurrence and remission in RA patients. Risk-stratification therapy based on the ultrasound scores may improve outcome and quality of life for patients with RA.
31185289 Frailty and risk of osteoporotic fractures in patients with rheumatoid arthritis: Data fro 2019 Oct The evidence assessing the relationship between frailty and risk of adverse health outcomes in patients with rheumatoid arthritis (RA) remains limited and sparse in the literature. Data from the Ontario Best Practices Research Initiative (OBRI), a clinical registry of patients with RA, were used to explore the relationship between frailty and fracture risk in patients with RA. Patients were referred to OBRI by their participating rheumatologist, and contacted by OBRI trained interviewers. Primary outcome was time to first incident osteoporotic fractures during follow-up that led to a hospitalization or emergency room visit. Frailty was measured by a Rockwood-type frailty index (FI) of deficit accumulation that consisted of 32 health-related deficits. To quantify the relationship between frailty and risk of fracture, we used Cox proportional hazards models with hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) reported. We included 2923 patients (mean age 57.7 standard deviation [SD]: 12.7; 78% female,) for analyses. During a mean follow-up of 3.7 years, there were 125 (4.3%) incident fractures reported. The FI was significantly higher in patients with a fracture compared to controls (0.24 vs. 0.20, p = 0.02). The FI was found to be significantly related to increased risk of fracture in the fully-adjusted models, with a HR of 1.04 (95% CI: 1.02-1.06, p < 0.001) and 1.58 (95% CI: 1.32-1.89, p < 0.001) for per-0.01 and per-SD increase in the FI respectively. In summary, our study demonstrates that higher frailty status is significantly related to increased risk of osteoporotic fractures in patients with RA. Quantifying the frailty status as a research tool may aid in fracture risk assessment, management and decision-making in RA.
31363338 QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS - A PRELIMINARY STUDY. 2019 Mar The most severe effects of rheumatoid arthritis (RA) are loss of physical function and chronic pain, which may have a major impact on different areas of the person's existence. The aim of this study was to get an insight into the quality of life (QOL) in subjects with RA in connection with pain perception and functional ability. The following instruments were used: the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), Short Form Health Survey (SF-36), Health Assessment Questionnaire Disability Index (HAQ-DI) and Visual Analog Scale for Pain (VAS Pain). The results indicated that there was no statistical difference in the QOL between subjects with RA and healthy population according to SF-36 Croatian norms. Also, the results showed that stronger pain experience was significantly associated with poorer social functioning assessment (SF36SF, Spearman's rho=-0.463, p<0.05), poorer general health perception (SF36GH, Spearman's rho=-0.432, p<0.05) and poorer physical functioning (WHOPH, Spearman's rho=-0.688, p<0.01). Furthermore, the subjects evaluating their general functional state worse were found to have worse physical functioning (SF36PF, Spearman's rho=-0.699 and WHOPH, Spearman's rho=-0.769), poorer social functioning (SF36SF, Spearman's rho=-0.580) and experienced greater pain intensity (SF36BP, Spearman's rho=-0.652). Therefore, additional efforts should be invested to define a holistic and integrative model of treatment and rehabilitation of people with RA, focused on pain relief, improvement of functional ability, encouraging social interaction and supporting positive emotional responses.
31280277 The relationship between anthropometric status and rheumatoid arthritis. Exploring the rol 2019 Apr OBJECTIVE: The aim of this study was to explore the anthropometric status of rheumatoid arthritis (RA) patients, as well as two controversial adipokines, namely nesfatin-1 and asymmetric dimethylarginine (ADMA), to reveal the possible relationships between them and RA. METHODS: This study included RA patients who fulfilled the American college of rheumatology classification criteria. Anthropometric parameters including height, weight, and waist circumference (WC) were measured and body mass index (BMI) was calculated. Disease activity was assessed by 28 joints disease activity score (DAS28). Fasting plasma samples were collected and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), nesfatin-1 and asymmetric dimethylarginine (ADMA) were determined using commercial kits. Statistical analyses were done using the BMI SPSS Statistics. RESULTS: A total of 77 patients including 63 females, with an average age of 48.45±11.26 and disease duration of 9.99±5.80 years participated the study, 62% of whom were overweight or obese. Disease activity was significantly higher in obese patients. In addition, BMI and WC were correlated with CRP and ESR, indicating higher level of inflammation in obese patients. DAS28 was also found to be correlated with CRP, ESR and ADMA (r=0.38, 0.61, 0.21 respectively). Higher protein intake was accompanied with higher CRP and ESR and higher carbohydrate intake was related to higher CRP and lower nesfatin-1. CONCLUSIONS: Weight, BMI, and WC were correlated with the activity of RA and the concentrations of CRP and ESR went up in tandem with BMI. In addition, ADMA, but not nesfatin-1, was associated with BMI and disease activity in RA patients.
31228581 Potential therapeutic applications of exosomes in different autoimmune diseases. 2019 Aug Autoimmune diseases are caused by self-immune responses to autoantigens, which damage body tissues and severely affect the patient's quality of life. Therapeutic drugs are associated with adverse side effects and their beneficial effects are limited to specific populations. Evidence indicates that exosomes which are small vesicles secreted by most cell types and body fluids, and may play roles in both immune stimulation and tolerance since they are involved in many processes such as immune signaling, inflammation and angiogenesis. Exosomes have also emerged as promising tools for therapeutic delivery, given their intrinsic features such as stability, biocompatibility and a capacity for stealth. In this review, we summarize existing literature regarding the production, efficacy, action mechanism, and potential therapeutic uses of exosomes in the contexts of autoimmune diseases such as type 1 diabetes mellitus, multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome.
30871994 A Novel Pharmacokinetic Bridging Strategy to Support a Change in the Route of Administrati 2019 Jul Determination of appropriate pharmacokinetic end point to bridge different dosing regimens is often a challenge when developing a new route of administration. Trough concentrations (C(trough)) are often considered the most relevant PK end point to predict efficacy (ACR20/DAS28) in the treatment of rheumatoid arthritis for biologics. However, no systematic research has been conducted to evaluate this approach. We developed a novel strategy to predict the most relevant PK variables that may be used to support a change in the route of administration for biological products. Our analysis indicated that matching only C(trough) when switching from intravenous dosing to subcutaneous dosing with decreasing dosing interval may result in a lower treatment response. If only average concentration (C(ave)) is considered as the relevant variable, our analysis showed that treatment response may be worsened when switching from subcutaneous dosing to intravenous dosing with increasing dosing interval. The study results demonstrated that matching a single pharmacokinetic end point (C(trough) or C(ave)) may not be sufficient to ensure efficacy when switching between intravenous dosing and subcutaneous dosing. A practical novel pharmacokinetic bridging approach is provided to support a change in the route of administration for biological products.
31242930 Hepatic methotrexate-associated lymphoproliferative disorders identified by multiple liver 2019 Jun 27 BACKGROUND: Methotrexate, an immunosuppressant, is widely used as the standard therapeutic drug for rheumatoid arthritis. With the increasing frequency of use of methotrexate, adverse effects of methotrexate have been reported, one of which is known as methotrexate-associated lymphoproliferative disorders. The etiology of hepatic methotrexate-associated lymphoproliferative disorders remains largely unknown. To date, there have only been ten cases of hepatic methotrexate-associated lymphoproliferative disorders reported in the English literature and a case report is very rare. CASE PRESENTATION: An 82-year-old Japanese man with rheumatoid arthritis treated with methotrexate presented with fever. Contrast-enhanced computed tomography showed multiple hypovascular nodules in his liver, spleen, and lung, and para-aortic lesions. Endoscopic ultrasound-guided fine-needle aspiration biopsy for liver tumors was performed, and pathological results identified cluster of differentiation 20-positive lymphocytes. Discontinuance of methotrexate led to regression of the nodules and a final definitive diagnosis of methotrexate-associated lymphoproliferative disorders was made. CONCLUSIONS: We review 11 reported cases of hepatic methotrexate-associated lymphoproliferative disorders including the present case. Physicians should discontinue methotrexate in patients with rheumatoid arthritis treated with methotrexate when elevated soluble interleukin-2 receptor and hypovascular lesions in contrast-enhanced computed tomography are confirmed considering the possibility of methotrexate-associated lymphoproliferative disorders.
29856128 Incidence and Risk of Glucocorticoid-Associated Adverse Effects in Patients With Rheumatoi 2019 Apr OBJECTIVE: Using the UK Clinical Practice Research Datalink, we examined the incidence of glucocorticoid (GC)-related serious adverse events (SAEs) in rheumatoid arthritis (RA) and non-RA patients and quantified the risk of SAEs in patients with RA. METHODS: We matched incident patients with RA to an age- and sex-matched, non-RA comparison group of equal size. In a cohort analysis, we estimated incidence rates (IRs) and IR ratios (IRRs) for GC-related AEs (i.e., diabetes mellitus [DM], osteoporosis, fractures, glaucoma, hypertension, gastrointestinal [GI] perforation or bleeding, thrombotic stroke or myocardial infarction [MI], or death), stratified by GC use. We conducted a series of nested case-control analyses among patients with RA, evaluating the effects of increasing cumulative and average daily GC dose. Cases of each outcome were matched to controls for age, sex, and general practice. We calculated adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) for each outcome. RESULTS: Patients with RA had a higher incidence for all investigated SAEs except glaucoma, compared to non-RA patients. IRRs were greater in those patients prescribed a GC than in those without. In patients with RA, GCs were associated with an elevated risk of DM (adjusted OR 1.33 [95% CI 1.14-1.56]), osteoporosis (adjusted OR 1.41 [95% CI 1.25-1.59]), thrombotic stroke or MI (adjusted OR 1.28 [95% CI 1.07-1.52]), serious infection (adjusted OR 1.28 [95% CI 1.11-1.48]), and death (adjusted OR 1.33 [95% CI 1.19-1.48]). There was a trend of increasing risk with increasing cumulative and average daily GC dose for all outcomes other than glaucoma, hypertension, and GI perforations or bleeding (P < 0.05). CONCLUSION: Patients with RA had an increased incidence of GC-related AEs. Increasing cumulative and average daily GC doses were found to be associated with an increasing risk of developing an AE.
31482155 Conventional and functional imaging in the evaluation of temporomandibular joint rheumatoi 2019 OBJECTIVES: To evaluate the efficacy of diagnostic imaging for temporomandibular joint rheumatoid arthritis (TMJ RA). Inflammation of the TMJ has a high correlation (> 17%) with the late stages of RA. Clinical recognition of TMJ RA using diagnostic imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and cone beam computed tomography (CBCT), is limited to osseous and soft tissue components of the TMJ. Positron emission tomography (PET) and positron emission tomography/CT (PET/CT) are novel technologies that have shown increasing relevance in the detection and management of TMJ RA. METHOD AND MATERIALS: Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA, 2009) guidelines, and using databases such as PubMed, Ovid Medline, Google Scholar, Web of Science, Scopus, and EBSCOhost, 94 publications were identified, and 27 studies were selected for this systematic review. A flowchart of the comprehensive study selection was generated. Quality assessment and data extraction were performed independently by three reviewers. RESULTS: It was noted that two-dimensional radiographs, CBCT, multidetector CT, and MRI are the most commonly used methods in TMJ RA assessment, although they are not useful for determination of active disease. MRI has excellent contrast resolution and can acquire dynamic imaging for demonstration of the functionality of the TMJ. CT and ultrasound imaging also have specific indication in imaging the TMJ. PET used in conjunction with CT is the only imaging modality that can quantify TMJ RA in active disease. CONCLUSIONS: PET/CT images provide unique quantitative information that cannot be obtained from any other imaging modalities.
31559763 Prevalence of Metabolic Syndrome in Rheumatoid Arthritis Patients: A Case Control Study fr 2019 Jul BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Along with traditional cardiovascular risk factors and systemic inflammation, metabolic syndrome (MetS) contributes to CVD and increased mortality in patients with RA. In this study we determine the prevalence of MetS in RA patients presenting to a tertiary care centre in north India. METHODS: This is a case control study involving 114 patients of RA with disease duration of ≥1 year and 114 healthy controls who are age and sex matched. Components of MetS were assessed in all the subjects and disease activity of RA was determined by DAS28-ESR. MetS was defined according to modified ATP-III criteria and consensus definition of metabolic syndrome for adult Asian Indians. RESULTS: Women constituted 81.6% in RA group and 80.5% in control group. Mean age of subjects was 44.81±12.7 years in RA group and 43.27±12.6 years in control group. According to modified ATP-III criteria, 36 (31.6%) RA subjects and 17 (14.9%) controls had MetS (p=0.03). According to the consensus definition of metabolic syndrome for adult Asian Indian criteria, 40 (35.1%) RA subjects and 18 (15.8%) controls had MetS (P=0.01). There was no significant difference in disease activity between subjects of RA with or without MetS (p=0.276). CONCLUSION: The prevalence of MetS was higher in RA subjects compared to controls. There is no association of MetS with disease activity in our cohort. Larger studies are needed to determine the relation between MetS and disease activity.