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ID PMID Title PublicationDate abstract
33011090 Current status of imaging of Sjogren's syndrome. 2020 Dec Primary Sjögren's syndrome (pSS) is an autoimmune disease, which involves salivary glands (SG) and extra glandular organs. Today, Sjögren's patients' diagnosis is based on classification criteria taking into account five objective tests, including histology, immunology, two ophthalmological tests, and salivary flow evaluation. To date, the challenge is to find the right imaging tool for diagnosis, follow up, and prognosis of pSS. The objective of this review is to describe as to what are these imaging modalities and particularly the place and validity of salivary glands ultrasonography (SGUS) in the diagnosis and follow-up strategy of patients with suspected pSS. Moreover, new noninvasive tools are emerging, including elastography, a new ultrasonography technique that provides an estimate of tissue elasticity, MRI, MR sialography, and (18) fluorodeoxyglucose-positron emission tomography. Although new imaging opportunities are available, SGUS should be the first-line choice in pSS because of its accessibility, feasibility over time, and sensitivity to change.
32618170 Impact of Sjögren's syndrome on oral health and quality of life: an observational cross-s 2020 May Sjögren's Syndrome is a complex disease, due to an autoimmune physiopathology, that strongly impacts both patients' primary needs (nutrition and speaking), and patients' relationship life related factors (psychological health and quality of life). In Literature, few studies had investigated oral health status in Sjögren's syndrome and its impact on patients' quality of life, so the aim of this study was to analyse that issue. 30 patients were enrolled, within the Department of Rheumatology (University of Pisa), both first diagnosis patients' and both patients who had been diagnosed with Sjögren's syndrome in the past. For each patient, a medical record was filled out together with the compilation of the Oral Health Impact Profile questionnaire. Then, during a specialistic rheumatologic visit, Sjögren's Syndrome Disease Damage Index Score (SSDDI) was determined. Results showed a direct proportion between years from diagnosis and severity of oral health issues. It was found that these issues were related to soft tissue damage and an overall worse, reported quality of life and psychological health.
32455849 Sicca Symptoms, Oral Health Conditions, Salivary Flow and Oral Candida in Sjögren's Syndr 2020 May 21 This study aimed to investigate the relationships among sicca symptoms, oral health conditions, salivary profiles and oral Candida in Sjögren's syndrome (SS) patients. Eighty-five SS patients (mean age = 50.5) and 40 healthy non-SS individuals (mean age = 51.4) were recruited. They self-completed the Sicca Symptoms Inventory (SSI). Decayed, missing and filled surface (DMFS) scores, salivary flow rates, pH and oral Candida colonization were determined. Mean SSI summary scores of SS patients and non-SS individuals were 11.1 and 5.4 respectively (p < 0.001). The most prevalent sicca symptoms in SS patients were eye irritation (93%), dry throat or nose (88%) and need of fluid for mouth wetting (88%). SS patients had significantly lower whole salivary flow rates than the non-SS individuals. Candida strains were isolated from over 60% of SS patients but not in non-SS patients. C. albicans was the predominant species. SSI summary score was negatively correlated to salivary flow rates while SSI summary and domain scores were positively correlated to the number of filled surfaces (FS) and DMFS scores and oral Candida counts. In conclusion, SS patients had more severe sicca symptoms than non-SS individuals. SSI scores were negatively correlated to the salivary flow rates but positively correlated to caries experience and oral Candida colonization.
32855647 Inhibition of Rheumatoid Arthritis Using Bark, Leaf, and Male Flower Extracts of Eucommia 2020 Eucommia ulmoides Oliv., a native Chinese plant species, has been used as a traditional Chinese medicine formulation to treat rheumatoid arthritis (RA), strengthen bones and muscles, and lower blood pressure. Various parts of this plant such as the bark, leaves, and flowers have been found to have anti-inflammatory properties. E. ulmoides has potential applications as a therapeutic agent against bone disorders, which were investigated in this study. In vitro, RA joint fibroblast-like synoviocytes (RA-FLS) were treated with different concentrations (0, 25, 50, 100, 200, 400, 800, and 1000 μg/mL) of E. ulmoides bark, leaf, and male flower alcoholic extracts (EB, EL, and EF, respectively) to determine their potential cytotoxicity. Tumor necrosis factor- (TNF-) α and nitric oxide (NO) levels in RA-FLS were quantified using enzyme-linked immunosorbent assay (ELISA). Furthermore, collagen-induced arthritis (CIA) rats were treated with EB, EL, EF, Tripterygium wilfordii polyglycoside (TG) or the normal control (Nor), and then ankle joint pathology, bone morphology, and serum and spleen inflammatory cytokine levels were evaluated. The results showed that, in RA-FLS, EB, EL, and EF were not cytotoxic; EB and EF reduced TNF-α supernatant levels; and EB, EL, and EF reduced NO levels. The results of in vivo experiments showed that EB, EL, and EF alleviated ankle swelling and joint inflammation, while all extracts diminished inflammatory cell infiltration, pannus and bone destruction, and bone erosion. All tested extracts inhibited interleukin- (IL-) 6, IL-17, and TNF-α mRNA in the spleen of CIA rats, while EB most effectively reduced osteoclasts and inhibited bone erosion. EF showed the most obvious inhibition of inflammatory factors and pannus. Thus, EB, EL, and EF may alleviate bone destruction by inhibiting inflammation.
31745587 Retraction Note: Urinary Cross-linked N-telopeptides of Type I Collagen Levels in Patients 2020 Feb The Editors-in-Chief have retracted this article [1]. Serious concerns have been raised about the data presented [2], and after careful consideration and additional investigation the Editors-in-Chief no longer have confidence in this article. All authors were contacted and did not respond to correspondence about this retraction.
31745586 Retraction Note: Forearm Bone Mineral Density in Postmenopausal Women with Rheumatoid Arth 2020 Feb The Editors-in-Chief have retracted this article [1]. Serious concerns have been raised about the data presented [2], and after careful consideration and additional investigation the Editors-in-Chief no longer have confidence in this article.
33178279 Evaluation of Oral Health Status and Oral Care of Patients with Rheumatoid Arthritis. 2020 OBJECTIVE: Rheumatoid arthritis (RA) and periodontal disease (PD) are common chronic, immunoinflammatory, destructive, and progressive diseases; however, the correlations between those two are not yet widely discussed. The purpose of this study was to evaluate the relationship between the selected demographic and clinical parameters of RA patients and oral health status parameters, on the basis of self-assessment. MATERIALS AND METHODS: Three hundred patients under treatment were included in the study. Questionnaires were completed by 164 out of 300 patients. RESULTS: A total of 100 females and 64 males took part in the study, with a mean age of 65 ± 11.1 years. In younger patients, the disease activity score (DAS28) was higher, and it was associated with pain or discomfort in the oral cavity and with difficulties in toothbrushing. Discomfort or pain in the oral cavity was to a significant extent associated with the poor gingival state, gingival bleeding, and difficulties in biting or chewing. CONCLUSIONS: In RA patients, difficulties in biting or chewing, discomfort or pain in oral cavity, feeling of the presence of movable teeth, and gingival bleeding are indications of periodontal infection. Maintaining awareness of oral health and RA is a key issue in the simultaneous management of proper oral care and RA due to the mutual influence of those two factors.
33152108 Checkpoints controlling the induction of B cell mediated autoimmunity in human autoimmune 2020 Dec B cell targeting therapies are effective in various autoimmune diseases, among others rheumatoid arthritis, pemphigus vulgaris, and systemic lupus erythematosus. Given these successes, it is evident that B cells are central orchestrators in the processes leading to the signs and symptoms hallmarking many human autoimmune diseases. The pathways provoking the generation of such autoreactive B cells or mechanisms preventing their induction in health are, however, poorly explored. Nevertheless, such information is crucial for the development of preventative/curative interventions aiming to permanently deplete- or prohibit the emergence of autoreactive B cells. Hence, this review will focus on how B cell tolerance might be breached, and which checkpoints are at play preventing the arousal of autoreactive B cells in human. Especially antigen presentation by follicular dendritic cells, somatic hypermutation, and cross-reactivity to the microbiome/environment could operate as actors playing pivotal roles in the induction of B cell-mediated humoral autoimmunity. Moreover, we highlight the human autoimmune disease rheumatoid arthritis as a prototype where autoreactive B cells combine several mechanisms to overcome peripheral B cell checkpoints.
33138320 A Population-Based Study on the Association between Periodontal Disease and Major Lifestyl 2020 Oct 29 This study determined the association between periodontal disease (PD) and major lifestyle-related comorbidities (LCs) using the database of the nationwide population-based National Health Insurance Service-Elderly Cohort 2002-2015. A nationwide representative sample comprising 558,147 participants, aged 60 years, was analyzed. Univariate and multivariate logistic regression analyses adjusted for sociodemographic and economic factors (sex, age, household income, insurance status, health status, and living area) and major LCs (hypertension, diabetes mellitus, rheumatoid arthritis, osteoporosis, cerebral infarction, angina pectoris, myocardial infarction, erectile dysfunction, lipoprotein disorder, and obesity) were used to determine the association between PD and major LCs. Elderly participants with PD had a higher risk of major LCs (hypertension: odds ratio (OR) = 1.40, diabetes mellitus: OR = 1.22, rheumatoid arthritis: OR = 1.16, osteoporosis: OR = 1.37, erectile dysfunction: OR = 1.73, lipoprotein disorder: OR = 1.50, and obesity: OR = 1.59). Our longitudinal cohort study provided evidence that PD was significantly associated with major LCs in elderly participants. In particular, the association between PD and erectile dysfunction had the highest OR in the multivariate analyses.
32971792 Adenosine Signaling in Autoimmune Disorders. 2020 Sep 22 The molecular components of the purinergic system (i.e., receptors, metabolizing enzymes and membrane transporters) are widely expressed in the cells of the immune system. Additionally, high concentrations of adenosine are generated from the hydrolysis of ATP in any "danger" condition, when oxygen and energy availability dramatically drops. Therefore, adenosine acts as a retaliatory metabolite to counteract the nucleotide-mediated boost of the immune reaction. Based on this observation, it can be foreseen that the recruitment with selective agonists of the receptors involved in the immunomodulatory effect of adenosine might represent an innovative anti-inflammatory approach with potential exploitation in autoimmune disorders. Quite surprisingly, pro-inflammatory activity exerted by some adenosine receptors has been also identified, thus paving the way for the hypothesis that at least some autoimmune disorders may be caused by a derailment of adenosine signaling. In this review article, we provide a general overview of the roles played by adenosine on immune cells with a specific focus on the development of adenosine-based therapies for autoimmune disorders, as demonstrated by the exciting data from concluded and ongoing clinical trials.
32373945 LncRNA H19 inhibitor represses synovial cell proliferation and apoptosis in rats with rheu 2020 Apr OBJECTIVE: To study the roles and underlying mechanisms of long non-coding ribonucleic acid (lncRNA) H19 in the synovial cell proliferation and apoptosis in rats with rheumatoid arthritis (RA). MATERIALS AND METHODS: A total of 30 Sprague-Dawley rats were randomly divided into Control group and Model group. The rat model of RA was induced by using type II collagen in Model group. The primary synovial cells were isolated from the synovial tissues of the rats and were assigned into Control group, Model group, and lncRNA H19 inhibitor intervention group. 5-Ethynyl-2'-deoxyuridine (EdU) staining was applied to detect cell proliferation in each group. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining was employed to determine the cell apoptosis in each group. Western blotting assay was adopted to measure the expression levels of Notch1 and hairy/enhancer of split-1 (Hes1) in each group of cells. RESULTS: The RA score of the Model group was higher than that of the Control group. Compared to the Control group, the expression of lncRNA H19, Notch, and Hes1 of the synovial cells in the Model group were significantly elevated. Besides, the cell proliferation rate of the Model was also increased, while the cell apoptosis rate was decreased compared with those in the Control group. Moreover, in comparison with Model group, lncRNA H19 inhibitor intervention group exhibited a lowered lncRNA H19 level, remarkably reduced cell proliferation rate and protein levels of Notch1 and Hes1, as well as notably raised cell apoptosis rate. CONCLUSIONS: Our results indicated that lncRNA H19 inhibitor could repress the proliferation and promote the apoptosis of synovial cells in RA rats, which might be attributed to the inhibition of the Notch signaling pathway.
32272789 Peripheral Blood Lymphocyte Phenotype Differentiates Secondary Antibody Deficiency in Rheu 2020 Apr 7 The phenotype of primary immunodeficiency disorders (PID), and especially common variable immunodeficiency (CVID), may be dominated by symptoms of autoimmune disorders. Furthermore, autoimmunity may be the first manifestation of PID, frequently preceding infections and the diagnosis of hypogammaglobulinemia, which occurs later on. In this case, distinguishing PID from hypogammaglobulinemia secondary to anti-inflammatory treatment of autoimmunity may become challenging. The aim of this study was to evaluate the diagnostic accuracy of peripheral blood lymphocyte phenotyping in resolving the diagnostic dilemma between primary and secondary hypogammaglobulinemia. Comparison of B and T cell subsets from patients with PID and patients with rheumatic disease, who developed hypogammaglobulinemia as a consequence of anti-inflammatory regimes, revealed significant differences in proportion of naïve B cells, class-switched memory B cells and CD21(low) B cells among B cells as well as in CD4(+) memory T cells and CD4(+) T follicular cells among CD4(+) T cells. Identified differences in B cell and T cell subsets, and especially in the proportion of class-switched memory B cells and CD4(+) T follicular cells, display a considerable diagnostic efficacy in distinguishing PID from secondary hypogammaglobulinemia due to anti-inflammatory regimens for rheumatic disease.
31768328 Effect of an orthosis on foot center of pressure translation for treatment of hallux valgu 2020 Jan OBJECTIVES: We aimed to investigate the change in the center of pressure (COP) path and distribution with or without orthosis for hallux valgus (HV) in patients with rheumatoid arthritis (RA). METHODS: In total, 17 patients and 21 feet were enrolled. We measured the COP path using the COP path measurement device (F-Scan II system). The HV angle (HVA); the anteroposterior COP path length, which was measured as a percentage of the foot length (%Long); transverse width of the COP path which was measured from the most medial to the most lateral point and expressed as a percentage of maximum foot width (%Trans); and the final site of the walking locus were analyzed by comparing patients with RA with and without orthosis. RESULTS: Testing without and with the orthosis showed that the HVAs were 31.8° ± 9.3° and 25.2° ± 6.8° (p < 0.001), the %Long values were 61.1% ± 5.5% and 69.2% ± 5.9% (p < 0.001), and the %Trans values were 28.0% ± 9.1% and 30.1% ± 8.3% (p = 0.108). The final site of the walking locus for the 1st interphalangeal joint without and with orthosis were 8 feet (38.1%) and 15 feet (71.4%) (p = 0.020), respectively. CONCLUSIONS: The results indicated that the orthosis for HV improved the walking path and should be considered as a therapeutic option in nonpharmacological treatment of RA.
32083088 The Supply of Rheumatology Specialist Care in Real Life. Results of a Nationwide Survey an 2020 Objectives: To study the balance between the supply and need for rheumatology care in Austria. In addition, to investigate rheumatologists' work-hours, the amount of time rheumatologists dedicate to care for patients with rheumatic and musculoskeletal diseases (RMD), with non-RMD problems, and other professional activities such as research, teaching, and administration. Methods: A questionnaire covering aspects of professional activities was sent to all 215 rheumatologists registered with the Austrian Medical Association. The data collected was set in relation to the need calculated on the basis of recommendations put forward by the German society of rheumatology. Results: 149 of the 215 rheumatologists (69.0%) responded. Median weekly working time was 50 h (IQR 45-60). 47.4% of the working time was spent for care of patients with RMD. The remaining time was dedicated to patients with non-rheumatic diseases (19.6%), research and teaching (8.4%), and administration (24.5%). The number of full-time equivalents (FTE, based on a 40-h work-week) available for rheumatology care, thus, was calculated to be 178.5. Based on disease prevalence/incidence estimates and on the time allocation results of this survey, our study resulted in a need of 4.29 rheumatologists per 100.000 adult inhabitants (301.79 for an adult population of 7.03 × 10(6)). Conclusion: The study demonstrated a substantial mismatch between the available supply and the need for rheumatology care. The results of our study are a conservative estimate, which should be taken into consideration for future healthcare workforce planning. In particular, the rising need for rheumatologists should be met by increasing the numbers of those specialists.
31976312 Metabonomic-Transcriptome Integration Analysis on Osteoarthritis and Rheumatoid Arthritis. 2020 PURPOSE: This study is aimed at exploring the potential metabolite/gene biomarkers, as well as the differences between the molecular mechanisms, of osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: Transcriptome dataset GSE100786 was downloaded to explore the differentially expressed genes (DEGs) between OA samples and RA samples. Meanwhile, metabolomic dataset MTBLS564 was downloaded and preprocessed to obtain metabolites. Then, the principal component analysis (PCA) and linear models were used to reveal DEG-metabolite relations. Finally, metabolic pathway enrichment analysis was performed to investigate the differences between the molecular mechanisms of OA and RA. RESULTS: A total of 976 DEGs and 171 metabolites were explored between OA samples and RA samples. The PCA and linear module analysis investigated 186 DEG-metabolite interactions including Glycogenin 1- (GYG1-) asparagine_54, hedgehog acyltransferase- (HHAT-) glucose_70, and TNF receptor-associated factor 3- (TRAF3-) acetoacetate_35. Finally, the KEGG pathway analysis showed that these metabolites were mainly enriched in pathways like gap junction, phagosome, NF-kappa B, and IL-17 pathway. CONCLUSIONS: Genes such as HHAT, GYG1, and TRAF3, as well as metabolites including glucose, asparagine, and acetoacetate, might be implicated in the pathogenesis of OA and RA. Metabolites like ethanol and tyrosine might participate differentially in OA and RA progression via the gap junction pathway and phagosome pathway, respectively. TRAF3-acetoacetate interaction may be involved in regulating inflammation in OA and RA by the NF-kappa B and IL-17 pathway.
31922473 Effects of biologic drugs on the prognosis of rheumatoid arthritis among patients with poo 2020 Apr OBJECTIVE: To investigate the effects of biological disease-modifying antirheumatic drugs (bDMARDs) on diabetes control among patients with rheumatoid arthritis (RA). METHODS: A total of 296 patients with RA were included in the study. The following background factors were investigated: age, gender, bDMARD type, methotrexate and prednisolone (PSL) dosages, glycated hemoglobin (HbA1c), C-reactive protein, and matrix metalloproteinase-3. We used the simplified disease activity index (SDAI) to evaluate the RA disease activity. Poor diabetes mellitus (DM) control was defined as a HbA1c of 6.0; accordingly, the patients were divided into good and poor DM control groups. SDAI and PSL dosage were the primary endpoints, respectively, 1 year later. RESULTS: HbA1c ranged from 6.6±0.68 to 6.5±0.82 and 5.1±0.29 to 5.4±0.34 in the poor and good DM control groups, respectively. Although the intergroup difference was significant (p=0.000), there was no significant intergroup difference during the treatment period (p=0.084). The SDAI ranged from 27.7±15.6 to 7.1±8.0 in the group with a poor DM control (n=83) and from 22.9±14.0 to 6.3±7.6 in the group with a good DM control (n=213). CONCLUSION: The bDMARD therapy reduced the RA disease activity regardless of a good or poor DM control.
32695560 Primary Central Nervous System Methotrexate-associated Lymphoproliferative Disorder in a P 2020 Jul Methotrexate (MTX) is an immunosuppressor that is widely used to treat autoimmune diseases, including rheumatoid arthritis (RA). However, it can have serious adverse effects including a lymphoma: MTX-associated lymphoproliferative disorder (MTX-LPD). Extranodal lesions are common in MTX-LPD patients. However, MTX-LPD in the central nervous system (CNS) is extremely rare with few reported cases. Here, we describe a case of primary CNS MTX-LPD in a patient with RA, with a review of the literature. A 68-year-old woman who had received MTX for her RA for more than 10 years was referred to our hospital. Head magnetic resonance imaging (MRI) showed multiple lesions with heterogeneous contrast enhancement scattered throughout both hemispheres. As immunosuppression caused by MTX was suspected, MTX was discontinued, based on a working diagnosis of MTX-LPD. We performed an open biopsy of her right temporal lesion. Histopathologic examination showed atypical CD20+ lymphoid cells, leading to a definitive diagnosis of diffuse large B-cell lymphoma (DLBCL). In situ hybridization of an Epstein-Barr virus-encoded small RNA (EBER) was positive. Sanger sequencing confirmed that both MYD88 L265 and CD79B Y196 mutations were absent. The LPD regressed after stopping MTX. Follow-up head MRI at 8 months after surgery showed no evidence of recurrence. Although primary CNS MTX-LPD is extremely rare, it should be included in the differential diagnosis when a patient receiving MTX develops CNS lesions. Diagnosis by biopsy and MTX discontinuation are required as soon as possible.
32374019 Increased risk of endometriosis in patients with endometritis - a nationwide cohort study 2020 OBJECTIVES: To evaluate the incidence of endometriosis among endometritis patients and its association with confounding comorbidities. MATERIAL AND METHODS: A population-based, retrospective cohort study of women aged between 20 to 55 years, who were newly diagnosed with endometritis between 2000 to 2013. A total of 16,830 endometritis patients and 67,230 non-endometritis individuals were enrolled by accessing data from the National Health Insurance Research Database of Taiwan. The comorbidities accessed were uterine leiomyoma, rheumatoid arthritis, ovarian cancer, infertility and allergic diseases. RESULTS: The mean follow-up period was 9.15 years for the non-endometritis cohort and 9.13 years for the endometritis cohort. There were significantly higher percentages of uterine leiomyoma, rheumatoid arthritis, infertility, ovarian cancer and allergic diseases in the endometritis cohort than in the non-endometritis cohort. Patients with endometritis had a 1.5-fold increased risk of their condition advancing to endometriosis (HR 1.58, 95% CI 1.48-1.68). CONCLUSIONS: Our results suggest that patients with endometritis exhibited a positive correlation in developing endometriosis.
32530139 Recombinant Soluble TNF-α Receptor Fusion Protein Therapy Reduces Insulin Resistance in N 2020 Jul OBJECTIVE: Current evidence highlights a link between insulin resistance (IR) and disease activity in rheumatoid arthritis (RA), suggesting that insulin sensitivity can be improved by treating patients with TNF-α blockers. Although reduced IR has been shown in RA patients who receive monoclonal antibody treatment, the efficacy remains to be elucidated when using recombinant soluble receptor fusion proteins. In particular, etanercept (ETA) is capable of blocking lymphotoxin-α, a cytokine-related to IR-associated disease status. METHODS: A prospective study was carried out in nondiabetic active RA patients receiving a 25-mg subcutaneous ETA injection twice weekly. RESULTS: Thirty patients aged 31 to 73 years (50.9 ± 10.6), naïve to biological and targeted synthetic disease-modifying antirheumatic drugs with DAS28 scores of 5.17 to 7.49 (6.11 ± 0.66), were classified into high-IR and low-IR groups based on their baseline homeostatic model assessment (HOMA)-IR levels. No differences were found between the two groups in terms of age, sex, weight, body mass index, seropositivity, and medication profiles before the injection. After a 24-week therapeutic period, there were reduced HOMA-IR levels in all patients in the high-IR group (3.390 ± 0.636 to 2.234 ± 0.870, P < 0.001). A greater decrease in DAS28 values was found in patients with reduced IR than those without a reduction (2.54 ± 0.67 versus 1.46 ± 0.46, P = 0.006) in the low-IR group. CONCLUSION: We observed an improvement in insulin sensitivity in nondiabetic active RA patients following 24-week recombinant soluble TNF-α receptor fusion protein therapy.
33086974 Case with long-standing gout showing various ultrasonographic features caused by monosodiu 2020 Jan Gout, which is characterized by the deposition of monosodium urate monohydrate (MSU) in the synovial fluid and other tissues, is the most common form of inflammatory arthritis. Unlike the easily recognized acute and monoarticular gouty arthritis, advanced gout induces multiple finger joint disorders and may sometimes mimic rheumatoid arthritis (RA) or vice versa. The gold standard for gout diagnosis is the identification of MSU crystals via aspiration in the symptomatic joints or nodules; however, its feasibility and specificity may be inadequate. Recently, there have been important advances in imaging techniques, assisting in the non-invasive diagnosis of gout. Ultrasonography (US) has been known to have the ability to detect deposition of MSU crystals in patients with gout. Herein, we report an evocative case of long-standing gout with precisely detected specific US features indicating MSU crystal deposition and inflammation in multiple joints. Comprehensive US assessment included the bone, hyaline cartilage, soft tissue, subcutaneous nodules and tendon; we also discriminated gouty arthritis from RA.