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ID PMID Title PublicationDate abstract
30424703 Targeting primary Sjögren's syndrome. 2019 Jan Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease that is estimated to affect 35 million people worldwide. Hallmarks of the disease are a loss of salivary and lacrimal gland function as well as lymphocytic infiltration, elevated proinflammatory cytokines, and circulating autoantibodies. Patients often experience significant fatigue and a decrease in their quality of life. Approximately 30-50% of pSS patients develop extra-glandular manifestations including malignant lymphoma. Although therapeutic approaches for pSS target both dryness and systemic manifestations, effective treatments are limited. However, new therapies targeting specific immune pathways associated with pSS are being developed. This review describes current and future targeted therapies against pSS.
31370688 Psychological status and disease activity were major predictors of body image disturbances 2020 Jun Sjögren's syndrome (SS) often leads to disease-related body defects and functional impairments, which may result in the body image disturbances (BID) of patients. The aim of this study was to investigate the severity and predictors of BID among SS patients. Two hundred and thirty-one SS patients [mean (IQR) age: 51 (42-58); females: 94.4%] and 224 age and sex-matched healthy controls were included in this cross-sectional study. Questionnaires were applied: body image disturbance questionnaire (BIDQ), the hospital anxiety and depression scale (HADS), fatigue severity scale (FSS), the 10-cm pain Visual Analog Scale (VAS), the oral health impact profile-14 (OHIP-14), the ocular surface disease index (OSDI), the social support rate scale (SSRS). Independent sample t-test, Mann-Whitney U-test, Chi-square test, spearman rank correlation, and stepwise linear regression were performed by SPSS version 20.0 to analyze these data. In 231 SS patients, the mean of the overall BIDQ score was 1.80 ± 1.21, and SS patients had significantly higher scores in each domain of BIDQ compared with healthy controls (p < 0.05). The stepwise multiple linear regression analysis revealed that high BIDQ score was predicted by severe anxiety (β = 0.081; p < 0.001), high disease activity (β = 0.038; p < 0.001) and poor oral health (β = 0.017; p = 0.007) in SS patients. Patients with SS suffer from severe BID and it is necessary for rheumatologists to pay more attention to SS patients' body image disturbance, especially those with high disease activity, severe anxiety, and poor oral health to improve patients' quality of life.
31282141 Splenic artery aneurysm in Sjögren's syndrome. 2019 Jul 8 A 40-year-old female presented with cough, exertional dyspnea, abdominal pain with distention, fatigue, dry eyes and dry mouth. Past history revealed asthma. Physical examination was normal except for tachypnea. We found leukocytosis, azygos fissure on chest X-ray along with normal pulmonary function tests and arterial blood gases.  Thorax computed tomography (CT) revealed bronchiectasis and ground glass opacities in both lungs. Abdominal CT demonstrated thrombosed proximal splenic artery aneurysm. Further diagnostic procedures were done and according to the positive Schirmer test and compatible histopathologic findings of the salivary gland, diagnosis of primary Sjögren's syndrome was established. Splenic artery aneurysm is rare occurring in less than 1% of the population that usually appears as an incidental finding. This is the first case in literature that introduces Sjögren's syndrome as a risk factor for splenic artery aneurysm. The silent presentation of the splenic artery aneurysm should previse the clinicians that such an occurrence may cause a significant diagnostic dilemma.
31700729 Infective Endocarditis Masquerading as Rheumatoid Arthritis. 2019 Sep 11 Infective endocarditis (IE) is associated with high inflammatory markers including rheumatoid factor (RF). Diagnosis can be difficult when it presents with musculoskeletal symptoms, and a raised RF titer as it points towards an autoimmune joint disease. It is imperative to rule out IE by echocardiography and blood cultures. A 42-year-old male with type two diabetes mellitus presented to our hospital with severe back pain, hemoptysis, mild pain in multiple joints, and low-grade fever for three months. He was previously seen by a rheumatologist and was clinically diagnosed with rheumatoid arthritis along with a RF level of 505.3 IU/mL. After an extensive investigation, transthoracic echocardiography (TTE) showed vegetations on the ventricular side of the aortic valve. Transesophageal echocardiography (TEE) confirmed vegetations on the aortic valve and also detected anterior mitral valve leaflet perforation with regurgitation. He was treated with ceftriaxone and gentamycin for six and two weeks, respectively. High RF is associated with IE possibly due to an intense immune response generated by a chronic intravascular infection. Echocardiography should be performed in a suspected case as a prompt diagnosis is related to better outcomes.
30552512 [The rich diversity of Whipple's disease]. 2019 Feb Whipple's disease (WD) is a rare, chronic multiorgan disease which can caused by Tropheryma whipplei, a ubiquitous gram positive bacterium. Detection of T. whipplei is mostly performed histologically using periodic acid-Schiff (PAS) staining in affected tissues to visualize characteristic PAS-positive macrophages and by the polymerase chain reaction (PCR). Clinically, WD is often characterized by gastrointestinal symptoms (diarrhea, colic-like abdominal pain and weight loss). Arthritis is a common presentation of WS, often leading to a misdiagnosis of seronegative rheumatoid arthritis and as a consequence to immunosuppressive therapy. The clinical presentation of WD is highly polymorphic affecting different organ systems (e. g. cardiac or neurological manifestation) and making an appropriate clinical diagnosis and even the diagnostic process itself difficult. This article reports on three cases presenting with completely different leading symptoms (initially misdiagnosed as seronegative rheumatoid arthritis, spondyloarthritis and adult onset of Still's disease, respectively) that illustrate the rich diversity of WD. The cases were chosen to draw attention to the fact that although WD is mainly associated with the field of gastroenterology and gastrointestinal (GI) involvement is common, it may appear without GI symptoms. In cases of a clinical suspicion of WD, diagnostic efforts should be made to detect the bacterium in the affected organ. The German S2k guidelines on GI infections and WD published in January 2015 summarized the current state of the art for WD. The currently recommended primary treatment is antibiotics that can infiltrate the cerebrospinal fluid, e. g. ceftriaxone, followed by cotrimoxazole, which should be maintained over several months.
30897958 Evaluation of the antirheumatic effects of isoflavone-free soy protein isolate and etanerc 2019 May In view of the partial clinical benefit and significant toxicity of traditional rheumatoid arthritis (RA) treatments, there is a growing trend to use complementary therapy. The antiarthritic activity of soy is related to the effect of soy isoflavones. However, little is known about the antiarthritic activity of soy protein itself. This study demonstrates that soy protein isolate (SPI) and etanercept (ETN), a tumor necrosis factor-α (TNF-α) inhibitor, protect rats against the effects of adjuvant-induced arthritis (AIA) by reducing inflammation (TNF-α and matrix metalloproteinase-3), autoantibody production (anticyclic citrullinated peptide), and lipid peroxidation (malondialdehyde). Only SPI improved dyslipidemia accompanied by RA, giving it the advantage of reducing cardiovascular risk. Additionally, the severity of arthritis-induced pathology, including inflammatory infiltrates, synovial hyperplasia, pannus formation, synovial vascularity, and cartilage erosions, was reduced by both SPI and ETN. This research ascertains the possible antiarthritic effect of SPI, making it a recommended alternative therapy for RA.
31698794 Folate Receptor-Targeting and Reactive Oxygen Species-Responsive Liposomal Formulation of 2019 Nov 6 Multifunctional nanomedicines with active targeting and stimuli-responsive drug release function utilizing pathophysiological features of the disease are regarded as an effective strategy for treatment of rheumatoid arthritis (RA). Under the inflammatory environment of RA, activated macrophages revealed increased expression of folate receptor and elevated intracellular reactive oxygen species (ROS) level. In this study, we successfully conjugated folate to polyethylene glycol 100 monostearate as film-forming material and further prepared methotrexate (MTX) and catalase (CAT) co-encapsulated liposomes, herein, shortened to FOL-MTX&CAT-L, that could actively target to activated macrophages. Thereafter, elevated intracellular hydrogen peroxide, the main source of ROS, diffused into liposomes and encapsulated CAT catalyzed the decomposition of hydrogen peroxide into oxygen and water. Continuous oxygen-generation inside liposomes would eventually disorganize its structure and release the encapsulated MTX. We characterized the in vitro drug release, cellular uptake and cytotoxicity studies as well as in vivo pharmacokinetics, biodistribution, therapeutic efficacy and safety studies of FOL-MTX&CAT-L. In vitro results revealed that FOL-MTX&CAT-L possessed sufficient ROS-sensitive drug release, displayed an improved cellular uptake through folate-mediated endocytosis and exhibited a higher cytotoxic effect on activated RAW264.7 cells. Moreover, in vivo results showed prolonged blood circulation time of PEGylated liposomes, enhanced accumulation of MTX in inflamed joints of collagen-induced arthritis (CIA) mice, reinforced therapeutic efficacy and minimal toxicity toward major organs. These results imply that FOL-MTX&CAT-L may be used as an effective nanomedicine system for RA treatment.
31254222 Real-Life Tolerability and Effectiveness of Adalimumab Biosimilar in Rheumatoid Arthritis: 2019 Sep INTRODUCTION: The TNF-α blocker adalimumab is a well-proven therapy for rheumatoid arthritis (RA). A biosimilar adalimumab (ZRC-3197; Exemptia™), a 'fingerprint match' to reference adalimumab, has been approved for prescription in India since 2014. Here, we report on the effectiveness and tolerability of this biosimilar adalimumab (bADA) from the Adalimumab Biosimilar Patient Registry [ASPIRE; ISRCTN16838474], which contains data from real-life RA patients from India. METHODS: ASPIRE is a post-marketing, observational registry that evaluates real-world experience across multiple centres in India. Patients with moderate to severe RA who were prescribed bADA 40 mg subcutaneously every fortnight were enrolled. Patients with complete data available until 24 weeks of bADA treatment were extracted and analyzed for standard disease activity measures and reported adverse events. RESULTS: The registry included 149 patients with RA who had a median age of 41 (22-67) years; 65% of the patients were female. Disease outcome measures, i.e. ESR, DAS-ESR and VAS-pain scores, showed gradual and significant decreases (p < 0.0001 for all) in 73 analyzable patients who received 24 weeks of bADA therapy. ACR20, ACR50 and ACR70 responses were achieved in 48%, 48% and 34% of patients after 24 weeks of therapy, respectively, and about 58% and 15% of patients were moderate and good EULAR responders, respectively. Physician and patient ratings for the overall global assessment of efficacy and tolerability were 'good' to 'excellent' for the majority of the patients (≥ 96%). No new safety signals were observed when analyzing this registry data. CONCLUSION: Real-life data from this post-marketing observational analysis demonstrate the clinical effectiveness and tolerability of 24 weeks of adalimumab biosimilar therapy in Indian patients with RA. This report also reflects upon the treatment strategies and prescription patterns for such therapies in Indian clinical practice. TRIAL REGISTRATION: ISRCTN16838474. FUNDING: Cadila Healthcare Limited, India.
31659680 Physical and Emotional Burden of Rheumatoid Arthritis: Data from RA Matters, a Web-Based S 2019 Dec INTRODUCTION: This survey assessed the impact of rheumatoid arthritis (RA) on the lives of patients based on the perceptions of both patients and healthcare professionals (HCPs). METHODS: This is a cross-sectional survey of patients with RA. Data were collected from patients and HCPs who manage RA using a structured, closed-ended questionnaire in their local language. Respondents for the survey were recruited from survey panels of verified unique responses. The survey focused on the impact of disease on four domains: daily activities, relationships, work and aspirations. RESULTS: Overall, 1231 adult patients with RA and 270 rheumatologists or other HCPs were surveyed between November 2016 and February 2017. Almost one in three patients believed that the impact of RA is not well understood by people without the disease. Fifty-eight percent [95% confidence interval (CI) 55-61%] of patients felt frustrated when they were unable to undertake or complete daily activities because of their disease. Fifty-seven percent (95% CI 54-60%) of patients wished to be able to accept their life with RA. Forty-three percent (95% CI 40-46%) of patients hoped that the physical impact of RA will be better understood in future. Forty percent (95% CI 37-43%) of patients were forced to take long-term leave/retirement or experienced slow career progression since being diagnosed with RA. Twenty-three percent (95% CI 21-25%) of patients had difficulties in taking care of personal grooming, whereas 8% (95% CI 6-10%) of patients reported that RA ruined their life. Similar responses were observed among HCPs. CONCLUSION: Patients and HCPs feel that the physical and emotional impact of RA is not well understood by people without the disease. In RA treatment decisions, patients' personal goals and patient-reported outcomes should be taken into consideration along with clinical targets. FUNDING: Eli Lilly and Company (Indianapolis, IN, USA).
31041173 Effect of Boswellia Serrata Extract on Acute Inflammatory Parameters and Tumor Necrosis Fa 2019 Apr CONTEXT: The worldwide prevalence of rheumatoid arthritis (RA) is about 1%, whereas in India, it is approximately 0.75%. The current therapy for RA includes nonsteroidal anti-inflammatory drugs corticosteroids, disease-modifying anti-rheumatic drugs and some recently developed biologic agents, but all of these are associated with adverse effects. Some herbal drugs, such as Boswellia serrata, have been reported to possess anti-inflammatory activity. AIMS: The aim of this study is to evaluate the anti-arthritic activity of Boswellia serrata extract (BSE) in complete Freund's adjuvant (CFA)-induced arthritis in rats. MATERIALS AND METHODS: Thirty-six Wistar rats were divided into six equal groups. RA was induced by intradermal injection of 0.1 ml CFA in hind paw. Body weight, ankle diameter, paw volume, arthritic index, tumor necrosis factor-α (TNF-α), and histopathological examination were assessed. The experimental data were statistically assessed by one-way analysis of variance (ANOVA). STATISTICAL ANALYSIS USED: The recorded data were analyzed using paired t-test and ANOVA test using SPSS. The data were analyzed and represented as mean difference. Value of P < 0.05 was considered statistically significant. RESULTS: BSE at dose 180 mg/kg showed statistically significant improvement in body weight and decrease in ankle diameter and arthritic index (P < 0.05); however, there was insignificant change in paw volume (P = 0.056). This improvement was comparable with Indomethacin. The level of TNF-α did not show any statistically significant change (P = 0.076). Histopathological results also exhibited a reduction in inflammatory parameters. CONCLUSIONS: BSE might have usefulness as an adjunct to conventional therapy of RA.
31882343 Treat-to-target strategy in patients with rheumatoid arthritis: Audit of adherence from re 2021 Apr INTRODUCTION: The current paradigm of the management of rheumatoid arthritis (RA) recommends achieving a state of remission or low disease activity through the treat-to-target strategy. Our study assesses adherence to this strategy. METHOD: Patients with RA (ACR-EULAR 2010 criteria) were included. From each centre, 19 patients were randomly selected. Clinical histories (CH) were assessed by independent auditors, checking compliance with predefined quality criteria. The study was approved by ethics committees. RESULTS: We included 856 patients (mean age 54 years; 71% women). The use of a combined index (CI) was recorded in 61% of cases. Visits were recorded every 4 weeks using a CI in 4% of CH while attempts were made to achieve remission. Monitoring of disease activity every 6-8 months after reaching the target was recorded in 73% of cases. CONCLUSIONS: The implementation of the treat-to-target strategy is barely recorded in patients with RA in routine clinical practice.
31749869 Modulator role of infliximab and methotrexate through the transient receptor potential mel 2019 Oct INTRODUCTION: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease causing symmetric polyarthritis. In this study, we aimed to investigate the effects of infliximab (INF) and methotrexate (MTX) on apoptosis, oxidative stress, and calcium signaling in the neutrophils of RA patients. MATERIAL AND METHODS: Neutrophils were isolated from 10 patients with newly diagnosed RA and 10 healthy controls. They were divided into four groups (control, RA, RA + MTX, RA + INF) and incubated with MTX and INF. In the cell viability (MTT) test, the ideal non-toxic dose and incubation time of MTX were found to be 0.1 mM and 1 h, respectively. The neutrophils were also incubated with the TRPM2 channel blocker N-(p-amylcinnamoyl) anthranilic acid (ACA). RESULTS: Intracellular free Ca(2+) concentration, intracellular reactive oxygen species (ROS) production, mitochondrial depolarization, lipid peroxidation, apoptosis, and caspase 3 and caspase 9 activities were found to be significantly higher in the neutrophils of RA patients compared to controls. MTT, reduced glutathione (GSH) level, and glutathione peroxidase (GSHPx) activity were significantly lower in the neutrophils of RA patients. However, MTT, GSH and GSHPx values were detected to be significantly increased with INF and MTX therapies. The Ca(2+) concentrations were further decreased by the ACA therapy. CONCLUSIONS: Our results suggest that INF and MTX are useful antagonists in apoptosis and mitochondrial oxidative stress in the neutrophils of RA patients. INF and MTX decreased the Ca(2+) concentration through inhibition of the TRPM2 channel in the neutrophils of RA patients. It may be a new pathway in the mechanisms of anti-rheumatic drugs.
31285841 Noninvasive imaging methods for evaluating cardiovascular involvement in patients with rhe 2019 Jun 13 AIM: To use 2D speckle-tracking echocardiography, and conventional and tissue Doppler echocardiography to detect subclinical left ventricular myocardial dysfunction in patients with rheumatoid arthritis (RA). METHODS: Thirty RA outpatients were assessed before and after 18 months of treatment with anti-TNF drugs, along with 30 healthy controls. Cardiovascular risk was assessed by means of ultrasound carotid assessment and comprehensive echocardiographic evaluation (conventional and speckle-tracking calculation). RESULTS: The speckle-tracking analyses were significantly different between the two groups, with global longitudinal strain deformation in the apical four-chamber view being significantly lower in the RA patients (median: 18.78%, interquartile range [IQR]: 15.80-20.82% vs 20.16%, IQR: 19.03-21.89%; [p < 0.05]). After 18 months of biological treatment, global longitudinal strain showed a significant improvement (18.78%, IQR: 15.80-20.82 vs 19.24%, IQR: 18.23-19.98; [p < 0.01]), such as for DAS28 (4.80, IQR: 4.65-5.22 vs 2.78; IQR: 2.52-2.99; [p < 0.01]). CONCLUSION: Speckle-tracking echocardiography showed that left ventricular myocardial longitudinal strain was impaired in the RA patients.
31673179 Outcomes of Balloon Kyphoplasty for the Treatment of Osteoporotic Vertebral Compression Fr 2019 Nov BACKGROUND: Patients with rheumatoid arthritis (RA) have higher rate of osteoporosis and vertebral fracture than individuals without RA. This study aimed to compare the outcomes of balloon kyphoplasty (KP) performed to treat osteoporotic vertebral compression fracture (OVCF) in RA patients with the outcomes in non-RA patients. MATERIALS AND METHODS: The patients who received KP for OVCF and could be followed up at least 1 year were included in the study. These patients were divided into RA group and non-RA group. For clinical outcomes, the visual analog scale for back pain (VAS-BP) and Korean version of the Oswestry Disability Index (K-ODI) were assessed before and after the procedure and at the 1-year followup. For radiological outcomes, the anterior vertebral height and change in local kyphotic angle were measured. Complications were also examined. RESULTS: Twenty three RA patients (31 vertebral bodies) and 107 non-RA patients (124 vertebral bodies) were analyzed. In two groups, postoperative VAS-BP and K-ODI decreased significantly to similar extents. There was a similar recovery of vertebral height and kyphotic angle in two groups. However, in terms of complications, adjacent segment fracture and recollapse were more frequent in the RA group than in the non-RA group. CONCLUSIONS: The use of KP to treat OVCF in RA group exhibited similar outcomes to non-RA group in terms of pain reduction, vertebral height restoration, and kyphosis correction. However, RA group had significantly higher rate of complications involving adjacent segment fracture and recollapse. Therefore, careful followup after KP in patients with RA is required to monitor for high complication rate.
31497761 Association of Interleukin-17F 7488A/G and 7383A/G Polymorphisms With Rheumatoid Arthritis 2019 Jun OBJECTIVES: This meta-analysis aims to summarize and estimate the relationship between rheumatoid arthritis (RA) susceptibility and two polymorphisms of interleukin-17F (IL-17F) 7488A/G and 7383A/G. MATERIALS AND METHODS: PubMed, Embase and Web of Science were searched up to 01 July 2017. Case-control studies with genotype frequencies data for 7488A/G and 7383A/G were included. The pooled effects were calculated by fixed-effect model or random effects model. RESULTS: A total of seven publications with 1,409 RA patients and 1,303 controls were included in the present meta-analysis. The results indicated that 7488A/G was significantly associated with increased susceptibility to RA (GA vs. AA: odds ratio [OR]=1.43, 95% confidence interval [CI]: 1.07-1.90, p=0.02; GG vs. AA: OR=3.22, 95% CI: 1.54-6.74, p=0.002; GA+GG vs. AA: OR=1.57, 95% CI: 1.02-2.42, p=0.04; GG vs. GA+AA: OR=3.05, 95% CI: 1.46-6.39, p=0.003). In subgroup analysis, 7488A/G was a strong risk factor in Europeans but not in Americans or Africans. No significant association was found between 7383A/G and RA in overall population or ethnic subgroups by all genetic model comparisons. CONCLUSION: This meta-analysis provided evidence that IL-17F 7488A/G polymorphism is associated with increased RA susceptibility, while no clear correlation was found between 7383A/G and RA.
31192227 Significance of Crescentic Glomeruli in Acute Kidney Injury with Rheumatoid Arthritis. 2019 Jan Crescentic glomerulonephritis (GN) without immune reactants or deposits (referred to as pauci-immune) is typically characterized by the presence of anti-neutrophilic cytoplasmic antibodies (ANCA). While ANCA-negative patients might be expected to have a more benign course, they often have poor renal outcomes, especially without treatment with steroids and immune-modulating therapy. Pauci-immune crescentic GN can also co-exist with other autoimmune conditions, including rheumatoid arthritis (RA). Here, we describe an ANCA-negative patient with RA who developed dialysis-requiring acute kidney injury (AKI) with findings consistent with focal pauci-immune crescentic GN (i.e., no IgG or immune complex on kidney biopsy). Coexistent conditions included Klebsiella sepsis attributed to pneumonia, rhabdomyolysis, leukocytoclastic immune-mediated skin vasculitis, and positive ANA. He had spontaneous improvement in renal function without immunosuppressive therapy. This crescentic GN was not associated with poor renal outcome as AKI resolved with supportive care and treatment of his infection. The AKI was likely multifactorial with co-existing acute tubular necrosis in the setting of Kebsiella sepsis and rhabdomyolysis, and the crescentic GN was felt more likely to be related to the infection rather than having a primary role. This case highlights the importance of viewing crescentic GN in the context of the clinical picture, as it may not always lead to the need of aggressive immune suppression and is not a universally poor prognostic kidney finding. However, these cases do warrant close follow-up as our patient had recurrent RA disease manifestations over the next 2 years that eventually led to his death from severe pulmonary hypertension.
30854695 MicroRNA-19a-3p promotes rheumatoid arthritis fibroblast-like synoviocytes via targeting S 2019 Mar 10 Rheumatoid arthritis (RA) is a common chronic autoimmune disease and effective treatment for RA is still lacking. In this study, the regulatory role of miR-19a-3p in RA was investigated. Quantitative polymerase chain reaction analysis of human blood samples showed that the level of miR-19a-3p was significantly lower in the RA patients compared with that in healthy patients (P < 0.05). In RA fibroblast-like synoviocytes (RAFLS), miR-19a-3p and suppressor of cytokine signaling 3 (SOCS3) were also downregulated and upregulated, respectively, compared with those of normal FLS. Transfection of miR-19a-3p mimic in RAFLS inhibited cell proliferation and promoted cell apoptosis. TargetScan identified SOCS3 as a target of miR-19a-3p, which was confirmed by dual-luciferase assay. Western blot indicated that SOCS3 protein level was significantly decreased after miR-19a-3p overexpression. Moreover, SOCS3 silencing through siRNA transfection also enhanced cell proliferation, meanwhile inhibiting RAFLS apoptosis. In addition, SOCS3 overexpression abrogated the effects of miR-19a-3p overexpression on cell proliferation and apoptosis, corroborating that SOCS3 acts as a downstream effector in the miR-19a-3p-mediated function of RAFLS. These findings suggest that miR-19a-3p plays an important role in RA, and the miR-19a-3p/SOCS3 axis may become a potential therapeutic target for RA.
30788278 Skin inflammatory reactions to capsaicin in rheumatoid arthritis patients compared to heal 2019 Jan OBJECTIVE: Previous studies have examined the role of sensory nerves and neural mediators in symmetrical joint inflammation and autoimmunity in rheumatoid arthritis (RA). In this study, we sought to examine the association between capsaicin skin test and disease activity in RA patients. MATERIALS AND METHODS: Eighty RA patients (case group) and 20 healthy volunteers were enrolled in this experiment. The subjects in case group were calcified to newly diagnosed patients and those previously diagnosed with RA. A topical solution of capsaicin (0.075%) was applied on the volar forearm during the skin test, and evaluations were done after 5, 10, and 20 min. The parameters recorded in capsaicin skin test were time to tingling, area of induration (cm(2)), and area of redness (cm(2)). RESULTS: A faster capsaicin skin reaction was observed in healthy controls compared to the case group (p=0.02). Newly diagnosed and previously diagnosed RA patients were not significantly different in terms of reaction latency (p=0.06). The redness area after 15 (p=0.04) and 20 (p=0.001) min was significantly larger in previously diagnosed RA patients than in newly diagnosed ones. The ​​area of redness and time to tingling did not show any difference between active and inactive RA patients, but after 15 and 20 min, the area of redness was significantly greater in inactive RA patients compared to active RA patients (p=0.01 and p=0.03, respectively). CONCLUSION: This study suggested that capsaicin skin test is not an efficient tool for the examination of synovial inflammation and disease activity in RA.
30652022 Switching of biological therapies in Brazilian patients with rheumatoid arthritis. 2019 Jan AIM: To assess drug switching, rates of remission and disease activity in Brazilian patients with rheumatoid arthritis (RA) treated with biologic agents. MATERIALS & METHODS: Using a retrospective method, a total of 94 adult patients were included. RESULTS: Anti-TNF was the first choice therapy in 85 (90.4%) patients. After an average of 8 years of follow-up, 55 (59%) patients were taking anti-TNF, 18 (19%) abatacept, eight (9%) tocilizumab and 13 (14%) rituximab. In this period, 99 switches of biological therapy were registered in 55 patients. CONCLUSION: After 8 years of follow-up, 54% of the RA patients on biological therapy were still experiencing high or moderate activity despite established treatment, including switching between different biologic agents.
32043773 In Reply. 2020 Feb This letter to the editor is in response to the letter from Brugu's and colleagues regarding the Warner et al. study of sicca syndrome induced by immune checkpoint inhibitor therapy.