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ID PMID Title PublicationDate abstract
32637924 The Validity and Sensitivity of Rheumatoid Arthritis Pain Scale on a Different Ethnic Grou 2020 Mar OBJECTIVES: This study aims to assess pain in rheumatoid arthritis (RA) patients by using Rheumatoid Arthritis Pain Scale (RAPS) and to find its correlation with Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI). PATIENTS AND METHODS: The study included 100 RA patients (23 males, 77 females; mean age 43.22 years; range, 19 to 72 years) who were subjected to RAPS questionnaire for pain assessment and DAS28 and CDAI for disease activity assessment. Spearman's correlation coefficient was measured to assess the correlation of RAPS with DAS28 and CDAI. Cronbach's alpha (α) was also measured for each scale to assess reliability. RESULTS: The study group had a female to male ratio of 3.34:1. Mean values for RAPS, DAS28 and CDAI were 62.91, 5.59, and 25.24, respectively. RAPS was correlated with DAS28 and CDAI with correlation coefficients of 0.811 and 0.770, respectively. Cronbach's α for RAPS, DAS28 and CDAI were 0.892, 0.814, and 0.833, respectively. CONCLUSION: Rheumatoid Arthritis Pain Scale had a strong positive correlation with disease activity measures of DAS28 and CDAI. RAPS also showed good correlation with core data set measures hence merits its place in clinical practice.
31728237 Rheumatoid Vasculitis: Is It Always a Late Manifestation of Rheumatoid Arthritis? 2019 Sep 28 Rheumatoid vasculitis (RV) is an infrequent complication of longstanding severe rheumatoid arthritis (RA). The active vasculitis associated with rheumatoid disease occurs in about 1%-5% of the patient population. RV is a manifestation of "extra-articular" rheumatoid arthritis and involves the small- and medium-sized arteries in the body. Newer RA treatments, including biologic therapies, offer a broader array of potential therapeutic options, although no controlled trials exist to guide treatment. In general, following tissue confirmation of the diagnosis, the severity of organ involvement and disease manifestations can guide treatment decisions. We want to alert clinicians of this unique yet severe complication of RA which has high morbidity and mortality. We describe a thought-provoking case of a 44-year-old male with past medical history (PMH) of hypertension who presented with over three-month history of lower extremity (LE) swelling, discoloration, and ulceration. Arthralgias with constitutional symptoms (fatigue, weight loss), large pericardial effusion, was found to have leukocytoclastic vasculitis along with rheumatoid factor (RF) >650, and anti-cyclic citrullinated peptide (anti-CCP) antibodies >300, low C4 and normal C3. Pericardial fluid appeared serous, exudative, showed histiocytes, multinucleated giant cells and necrotic debris consistent with rheumatoid effusion. Skin, right shin, punch biopsy showed epidermal necrosis from underlying occlusive vasculopathy. Skin, left lower back, punch biopsy showed focal leukocytoclastic vasculitis. The patient was started on high dose steroids with marked improvement in the symptoms, Rituximab was planned awaiting QuantiFERON to be negative. Pan-CT angiography of the whole body was negative for any vascular changes ruling out polyarteritis nodosa (PAN).
31708781 Targeting Macrophages: Friends or Foes in Disease? 2019 Macrophages occupy a prominent position during immune responses. They are considered the final effectors of any given immune response since they can be activated by a wide range of surface ligands and cytokines to acquire a continuum of functional states. Macrophages are involved in tissue homeostasis and in the promotion or resolution of inflammatory responses, causing tissue damage or helping in tissue repair. Knowledge in macrophage polarization has significantly increased in the last decade. Biomarkers, functions, and metabolic states associated with macrophage polarization status have been defined both in murine and human models. Moreover, a large body of evidence demonstrated that macrophage status is a dynamic process that can be modified. Macrophages orchestrate virtually all major diseases-sepsis, infection, chronic inflammatory diseases (rheumatoid arthritis), neurodegenerative disease, and cancer-and thus they represent attractive therapeutic targets. In fact, the possibility to "reprogram" macrophage status is considered as a promising strategy for designing novel therapies. Here, we will review the role of different tissue macrophage populations in the instauration and progression of inflammatory and non-inflammatory pathologies, as exemplified by rheumatoid arthritis, osteoporosis, glioblastoma, and tumor metastasis. We will analyze: 1) the potential as therapeutic targets of recently described macrophage populations, such as osteomacs, reported to play an important role in bone formation and homeostasis or metastasis-associated macrophages (MAMs), key players in the generation of premetastatic niche; 2) the current and potential future approaches to target monocytes/macrophages and their inflammation-causing products in rheumatoid arthritis; and 3) the development of novel intervention strategies using oncolytic viruses, immunomodulatory agents, and checkpoint inhibitors aiming to boost M1-associated anti-tumor immunity. In this review, we will focus on the potential of macrophages as therapeutic targets and discuss their involvement in state-of-the-art strategies to modulate prevalent pathologies of aging societies.
30987068 Research of Pathogenesis and Novel Therapeutics in Arthritis. 2019 Apr 2 Arthritis has a high prevalence globally and includes over 100 types, the most common of which are rheumatoid arthritis, osteoarthritis, psoriatic arthritis and inflammatory arthritis. The exact etiology of arthritis remains unclear and no cure exists. Anti-inflammatory drugs are commonly used in the treatment of arthritis, but are associated with significant side effects. Novel modes of therapy and additional prognostic biomarkers are urgently needed for these patients. In this editorial, the twenty articles published in the Special Issue Research of Pathogenesis and Novel Therapeutics in Arthritis 2019 are summarized and discussed as part of the global picture of the current understanding of arthritis.
34754908 Felty's syndrome - a rare case of febrile neutropenia. 2019 Felty's syndrome (rheumatoid arthritis with neutropenia and splenomegaly) is a rare condition with poor long-term prognosis, mainly as a result of severe infection risk. An effective treatment strategy has not been developed so far and current treatment options are based upon case reports, small series and clinical experience since no randomized clinical trials are available. The authors describe the case of a 53-year-old female patient with a 14-year history of rheumatoid arthritis presenting with fever, neutropenia and splenomegaly. Broad-spectrum antibiotics and granulocyte colony-stimulating factor were administered with good clinical outcome and low dose methotrexate for disease control was successfully initiated after discharge. We would like to highlight the importance of being aware of this syndrome in the differential diagnosis of long term rheumatoid arthritis patients presenting with febrile neutropenia.
32185360 Pneumocystis Jirovecii Pneumonia after Initiation of Tofacitinib Therapy in Rheumatoid Art 2019 Sep The use of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs) in rheumatic diseases is constantly increasing during the last decade. Tofacitinib is a new oral Janus Kinase (JAK) inhibitor, approved for rheumatoid arthritis (RA), psoriatic arthritis and ulcerative colitis. Safety data of tofacitinib derived from randomized controlled trials and long-term extension studies has demonstrated a moderate increase in the risk for common serious infections. We describe a case of Pneumocystis jirovecii pneumonia (PJP) in a woman on tofacitinib therapy for RA. Although tofacitinib use has been associated with the development of opportunistic infections, PJP has been rarely reported. PJP should be included in the differential diagnosis of patients with autoimmune disorders under newer oral JAK inhibitors therapy who present with fever, hypoxia and pulmonary infiltrates.
31312346 Co-culture with synovial tissue in patients with rheumatoid arthritis suppress cell prolif 2019 There is growing evidence that synovial tissue affects osteoblasts although the mechanisms behind the aberrant bone metabolism in rheumatoid arthritis (RA) are unclear. The aim of this study is to preliminarily establish a co-culture system of rheumatoid arthritis-derived synovial tissue (RAS) and osteoblasts in vitro and to investigate the potential mechanism of RAS on osteoblasts. A consistent volume of approximately 85 mm(3) of RAS was cultured isolated and co-cultured with Hfob1.19 cells for up to 21 days. Equal volume of normal synovial tissue (NS) was co-cultured as a control group. Cell proliferation, cell cycle and bone markers were valued and the mechanisms underlying MAPK pathway have been fully delineated. Our findings suggested that co-cultures with RAS exhibited decreased proliferation of Hfob1.19 cells. Moreover, gene and protein expressions of GLUT3 in cells were suppressed, and the cell cycle was also down-regulated. The expressions of related proteins of MAPKs (JNK and p38) signaling pathway were found to be inhibited. Rescue experiments demonstrated that co-cultures with RAS could decrease the growth and cell cycle of Hfob1.19 cells, which were reversed by p-JNK and p-p38 over expression. In conclusion, this study suggested that synovial tissue in patients with RA may negatively regulate osteoblasts proliferation by declining MAPK pathway.
31435152 Design of novel JAK3 Inhibitors towards Rheumatoid Arthritis using molecular docking analy 2019 Multiple cytokines play a pivotal role in the pathogenesis of Rheumatoid Arthritis by inducing intracellular signaling and it is known that the members of the Janus kinase (JAK) family are essential for such signal transduction. Janus kinase 3 is a tyrosine kinase that belongs to the Janus family of kinases. Drugs targeting JAK3 in the treatment of Rheumatoid arthritis is relevant. Therefore, it is of interest to design suitable inhibitors for JAK3 dimer using molecular docking with Molegro Virtual Docker. The compound possessing the highest affinity score is subjected to virtual screening to retrieve inhibitors. The compound SCHEMBL19100243 (PubChem CID- 76749591) displays a high affinity with the target protein. The affinity scores of this compound are more than known drugs. ADMET analysis and BOILED Egg plot provide insights into this compound as a potent inhibitor of JAK3.
31523110 Alopecia Universalis in a Case of Rheumatoid Arthritis after Treatment with Etanercept. 2019 Jul Alopecia universalis (AU) is a condition which causes generalized hair loss of the body. It is postulated that autoimmunity plays an important role in its pathogenesis. It is characterized by the involvement of multiple inflammatory cytokines such as tumor necrosis factor-alpha and multiple interferons. Hence, biologics like tumor necrosis factor alpha (TNF-α) antagonist may be used to block this inflammatory process. It is not very commonly appreciated that the use of biologics can lead to alopecia areata. Here, we report a case of severe alopecia areata which progressed to AU after etanercept administration. We here describe a 23-year-old unmarried female who was a known case of rheumatoid arthritis who developed AU after 6 months of continuous treatment with etanercept. TNF-α antagonist may not play a sufficient role in the treatment of alopecia areata. There exists a strong and significant connection between TNF-α blockers and development of alopecia and specifically AU and their role in the pathophysiology of the disease should be called into question if our findings are observed again.
33458669 Tofacitinib Induced Psoriasiform Lesion in a Patient With Rheumatoid Arthritis. 2020 Sep Paradoxical psoriasis or psoriasiform lesion is an adverse effect, represented by the occurrence of a psoriasiform lesion or exacerbation of psoriasis caused by the drugs normally used for the management of psoriasis. In this article, we present the first case of a 45-year-old male patient with rheumatoid arthritis who developed psoriasiform lesions following treatment with tofacitinib, and highlight the possible pathogenetic mechanisms involved in such an occurrence.
31001277 Osteoimmunology of Bone Loss in Inflammatory Rheumatic Diseases. 2019 Over the past two decades, the field of osteoimmunology has emerged in response to a range of evidence demonstrating the reciprocal relationship between the immune system and bone. In particular, localized bone loss, in the form of joint erosions and periarticular osteopenia, as well as systemic osteoporosis, caused by inflammatory rheumatic diseases including rheumatoid arthritis, the prototype of inflammatory arthritis has highlighted the importance of this interplay. Osteoclast-mediated resorption at the interface between synovium and bone is responsible for the joint erosion seen in patients suffering from inflammatory arthritis. Clinical studies have helped to validate the impact of several pathways on osteoclast formation and activity. Essentially, the expression of pro-inflammatory cytokines as well as Receptor Activator of Nuclear factor κB Ligand (RANKL) is, both directly and indirectly, increased by T cells, stimulating osteoclastogenesis and resorption through a crucial regulator of immunity, the Nuclear factor of activated T-cells, cytoplasmic 1 (NFATc1). Furthermore, in rheumatoid arthritis, autoantibodies, which are accurate predictors both of the disease and associated structural damage, have been shown to stimulate the differentiation of osteoclasts, resulting in localized bone resorption. It is now also evident that osteoblast-mediated bone formation is impaired by inflammation both in joints and the skeleton in rheumatoid arthritis. This review summarizes the substantial progress that has been made in understanding the pathophysiology of bone loss in inflammatory rheumatic disease and highlights therapeutic targets potentially important for the cure or at least an alleviation of this destructive process.
31723390 Vasculitic neuropathy associated with Rheumatoid Arthritis, a case report. 2019 Rheumatoid vasculitis which affects small-to-medium-sized vessels is a rare and late complication of rheumatoid arthritis. It is defined histologically as immune complex deposition in venules, capillaries and arterioles.(1) Vasculitis in the vasa nervorum leads to infarction of peripheral nerves which leads to neuropathy. We present a case of mononeuritis multiplex due to rheumatoid vasculitis.
31909370 Associations of Handgrip Strength with Prevalence of Rheumatoid Arthritis and Diabetes Mel 2019 Dec BACKGROUND: The purpose of this study was to investigate the association between handgrip strength and prevalence of rheumatoid arthritis and diabetes in older adults. METHODS: A total of 4,186 participants 65 years of age and older was included in the study, which utilized data from the fifth Korea National Health and Nutrition Examination Survey. Pearson's chi-square tests were used to explore the relationship between frequency of participation in physical activity and handgrip strength. The relationships between handgrip strength and prevalence of rheumatoid arthritis and diabetes were determined by logistic regression. RESULTS: Older adults with higher handgrip strength participated more frequently in walking (right hand, 3.71 day/wk; left hand, 3.80 day/wk), strength (right hand, 1.40 day/wk; left hand, 1.43 day/wk), and flexibility exercises (both hands, 2.08 day/wk) than those with lower handgrip strength (right hand, 2.83 day/wk and left hand, 2.81 day/wk for walking; right hand, 0.18 day/wk and left hand, 0.22 day/wk for strength; right hand, 1.17 day/wk and left hand, 1.24 day/wk for flexibility). Higher handgrip strength was associated with reduced prevalence of rheumatoid arthritis (right hand: odds ratio [OR], 0.29; 95% confidence interval [CI], 0.16-0.52; P<0.05; left hand: OR, 0.20; 95% CI, 0.10-0.38; P<0.05) and diabetes (right hand: OR, 0.71; 95% CI, 0.57-0.89; P<0.05; left hand: OR, 0.71; 95% CI, 0.58-0.88; P<0.05). CONCLUSION: Enhanced handgrip strength was significantly associated with lower prevalence of rheumatoid arthritis and diabetes in older adults. Participating in physical activity should be recommended to older adults for maintaining handgrip strength.
31454946 Rheumatoid Arthritis-Associated Mechanisms of Porphyromonas gingivalis and Aggregatibacter 2019 Aug 26 Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology characterized by immune-mediated damage of synovial joints and antibodies to citrullinated antigens. Periodontal disease, a bacterial-induced inflammatory disease of the periodontium, is commonly observed in RA and has implicated periodontal pathogens as potential triggers of the disease. In particular, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans have gained interest as microbial candidates involved in RA pathogenesis by inducing the production of citrullinated antigens. Here, we will discuss the clinical and mechanistic evidence surrounding the role of these periodontal bacteria in RA pathogenesis, which highlights a key area for the treatment and preventive interventions in RA.
31024773 Patient-reported fatigue in patients with rheumatoid arthritis who commence biologic thera 2019 AIMS AND OBJECTIVES: To examine changes in patient-reported fatigue, over a twelve month period, in rheumatoid arthritis patients who commence biologic treatment, and to identify possible predictors for such changes. BACKGROUND: Fatigue is a burdensome symptom for patients with rheumatoid arthritis. Despite biologics being effective in reducing disease activity, patients still report fatigue. DESIGN: A longitudinal observational study. METHODS: A total of 48 patients were enrolled in the study. Fatigue was measured by the Fatigue Severity Scale. Independent samples T-tests were used to test gender differences, and paired samples T-tests were used to measure differences between repeated measures. Bivariate and multiple regression analyses were used to examine potential predictors for changes in fatigue, such as age, sex, Disease Activity Score 28, pain and physical and emotional well-being. RESULTS: Forty-seven patients completed the study. From baseline to 12-month follow-up, fatigue decreased significantly in both women and men. Analyses of predictors were performed step-wise, and the final model included sex and physical well-being. The results from this final step showed that female sex was the only significant predictor for changes in fatigue. CONCLUSION: Patients commencing biologic therapy reported a significant reduction in fatigue. Female sex was a significant predictor of changes in fatigue. RELEVANCE TO CLINICAL PRACTICE: Despite improvements in pharmacological treatment, patients with rheumatoid arthritis still report fatigue. This is a multifaceted health problem encompassing personal and emotional factors in addition to the clinical factors directly connected to the disease.
30479211 Nanotherapeutics for the Treatment of Cancer and Arthritis. 2019 BACKGROUND: Nanotechnology is gaining significant attention worldwide for the treatment of complex diseases such as AIDS (acquired immune deficiency syndrome), cancer and rheumatoid arthritis. Nanomedicine is the application of nanotechnology used for diagnosis and treatment for the disease that includes the preservation and improvement of human health by covering an area such as drug delivery using nanocarriers, nanotheranostics and nanovaccinology. The present article provides an insight into several aspects of nanomedicine such as usages of multiple types of nanocarriers, their status, advantages and disadvantages with reference to cancer and rheumatoid arthritis. METHODS: An extensive search was performed on the bibliographic database for research article on nanotechnology and nanomedicine along with looking deeply into the aspects of these diseases, and how all of them are co-related. We further combined all the necessary information from various published articles and briefed to provide the current status. RESULTS: Nanomedicine confers a unique technology against complex diseases which includes early diagnosis, prevention, and personalized therapy. The most common nanocarriers used globally are liposomes, polymeric nanoparticles, dendrimers, metallic nanoparticles, magnetic nanoparticles, solid lipid nanoparticles, polymeric micelles and nanotubes among others. CONCLUSION: Nanocarriers are used to deliver drugs and biomolecules like proteins, antibody fragments, DNA fragments, and RNA fragments as the base of cancer biomarkers.
31384691 Liposomal glutathione as a promising candidate for immunological rheumatoid arthritis ther 2019 Jul Nano-medicine can passively accumulate in chronic inflammatory tissues via the enhanced permeability and retention phenomenon, or by being conjugated with a ligand that can bind to receptors over expressed by cells inside chronic inflammatory tissues, contributing to reduced systemic side-effects and increased efficacy. This article highlights the utilization of nanomedicine for potential treatment of rheumatoid arthritis. Rheumatoid arthritis was induced in rat model via 2 weeks intradermal injection of pristane at the base of the tail in a daily dose of 150 μl. Susceptible rat strains developed severe arthritis with a sudden onset 3 weeks post pristane injection. Three weeks post pristane administration; rats were treated intravenously with glutathione or liposomal-glutathione in a dose of 5 mg/kg daily for 30 days. Concomitant supplementation with the aforementioned antioxidants effect on proinflammatory marker C-reactive protein (CRP) was assessed. On the other hand, oxidative stress biomarker malondialdehyde (MDA) and rheumatoid factor (RF) compared with pristane treated group was also investigated. The results elucidated that glutathione and liposomal -glutathione significantly reduced rheumatoid factor, malondialdehyde and C-reactive protein levels with the superiority of liposomal -glutathione in this side reflecting its pronounced effect as anti-rheumatoid agent.
31453131 A novel bioavailable hydrogenated curcuminoids formulation (CuroWhite™) improves symptom 2019 Oct Rheumatoid arthritis (RA) is an inflammatory disease that cause chronic pain, disability and joint destruction. The present placebo controlled randomized study aimed to evaluate the efficacy of a novel hydrogenated curcuminoid formulation-CuroWhite™, in rheumatoid arthritis (RA) patients. Twenty four RA patients were randomized in 1:1:1 ratio to receive 250 mg, 500 mg CuroWhite or placebo as one capsule a day, over a period of three months. Improvement in the ACR response, changes in disease activity assessed using the DAS 28 score, change in physical function assessed on change in ESR, CRP, RF values were evaluated before and after the study. Results suggested that patients who received CuroWhite both low and high doses reported statistically significant changes in their clinical symptoms towards end of the study when compared with placebo. There were significant changes in DAS28 (50-64%) VAS (63-72%) ESR (88-89%), CRP (31-45%) RF (80-84%) values and ACR response for CuroWhite groups in comparison with placebo. Thus, CuroWhite acts as the analgesic and anti-inflammatory product for management of RA by the reduction of the inflammatory action which was confirmed by improvement in ESR, CRP, VAS, RF, DAS-28 and ACR responses. CuroWhite was significantly effective against RA with highly safe without serious side effects and well tolerated.
31642045 Efficacy of Abatacept and Adalimumab in Patients with Early Rheumatoid Arthritis With Mult 2019 Dec INTRODUCTION: Patients with rheumatoid arthritis (RA) with poor prognostic factors, such as seropositivity for anti-citrullinated protein antibodies and early erosions, may benefit from early intensive treatment. However, information to guide physicians on the best choice of therapy in these patients is limited. The objective of this study was to describe the efficacy of subcutaneous abatacept versus adalimumab over 2 years in patients with seropositive, erosive early RA in the AMPLE study. METHODS: This exploratory post hoc analysis compared clinical, functional and radiographic outcomes in two subsets of patients: patients with early RA (≤ 6 months' disease duration) who were seropositive for rheumatoid factor and/or anti-citrullinated protein antibodies and had > 1 radiographic erosion (Cohort 1); and patients with RA and absence of ≥ 1 of these inclusion criteria (Cohort    2). RESULTS: Of the 646 randomized patients, Cohort 1 included 38 patients receiving abatacept and 45 receiving adalimumab, and Cohort 2 included 280 patients receiving abatacept and 283 receiving adalimumab. Baseline demographics and disease characteristics were generally similar between treatment groups in both cohorts. Over 2 years, in Cohort 1, the adjusted mean change from baseline in the Disease Activity Score in 28 joints (using C-reactive protein) was numerically greater for abatacept than for adalimumab (mean difference at day 365 was 0.9, 95% confidence interval - 1.47 to - 0.33). Similar patterns of improvement were observed for other disease activity measures and physical function, but not for radiographic outcomes. No treatment-related differences were observed in Cohort 2. CONCLUSION: This analysis indicates a trend towards improved disease activity and physical function with abatacept versus adalimumab in patients with seropositive, erosive early RA. TRIAL REGISTRATION: ClinicalTrials.gov NCT00929864. FUNDING: Bristol-Myers Squibb.
31449627 A giant fibrinoid pericardial mass in a patient with rheumatoid arthritis: a case report. 2019 Jun 1 BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints, which may extend to extra-articular organs. Extra-articular manifestations have been considered as prognostic features in RA, and pericardial disease is one of the most frequent occurrences. Rheumatoid arthritis pericarditis is usually asymptomatic and is frequently found on echocardiography as pericardial thickening with or without mild effusion. Severe and symptomatic cases are rare, but pericardial masses are even rarer. We report a patient with erosive, nodular seropositive RA, and progressive functional deterioration owing to a giant pericardial mass compressing the right cardiac chambers. CASE SUMMARY: The patient was a 79-year-old man. Cardiac magnetic resonance imaging revealed a pericardial lesion measuring 10 × 9 × 6 cm with complex structures in its interior, which had compressive effects on the right atrium and right ventricle, severely limiting diastole. Late gadolinium enhancement of the lesion walls and pericardium suggested pericarditis. Surgical resection was performed, and a soft mass with liquid content was extracted. The patient recovered well with improvements in symptoms and the functional status. Histopathological studies ruled out neoplasm, vasculitis, and infection, and the entire mass showed fibrinoid material associated with fibrinoid pericarditis. DISCUSSION: Symptomatic RA pericarditis is a rare cardiac manifestation of RA, whilst associated significant haemodynamic compromise is even rarer. The condition could manifest with a giant compressive pericardial mass composed of fibrinous material, with particular involvement of the right ventricle. Exclusion of other conditions, such as neoplasms and infections, is necessary.