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ID PMID Title PublicationDate abstract
33411607 Thoracic Manifestations of Rheumatoid Arthritis. 2021 Jan Rheumatoid arthritis (RA) is one of the most common chronic systemic inflammatory diseases and the most common chronic inflammatory arthritis. Classically a progressive symmetric polyarthritis, RA is characterized by inflammation, erosions, bone loss, and joint destruction. Up to half of patients with RA exhibit extra-articular manifestations (EAMs), which may precede articular disease and are more common in patients with seropositive RA (patients with detectable serum levels of rheumatoid factor and/or anticitrullinated peptide antibodies). Cardiovascular and pulmonary EAMs are the largest contributors to morbidity and mortality in RA and may be especially devastating. Imaging has a significant role in diagnosing these EAMs and assessing response to treatment. Although treatment with disease-modifying antirheumatic drugs has redefined the natural history of RA and helped many patients achieve low disease activity, patients are at risk for treatment-related complications, as well as infections. The clinical features of drug-induced lung disease and infection can overlap considerably with those of EAMs, presenting a diagnostic challenge. Radiologists, by recognizing the imaging characteristics and evolution of these various processes, are essential in diagnosing and distinguishing among EAMs, treatment-related complications, and unrelated processes and formulating an appropriate differential diagnosis. Moreover, recognizing these disease processes at imaging and contextualizing imaging findings with clinical information and laboratory and pathologic findings can facilitate definitive diagnosis and proper treatment. The authors review the articular and extra-articular thoracic imaging manifestations of RA, including cardiovascular, respiratory, and pleural diseases, as well as treatment-related complications and common infections. (©)RSNA, 2021.
34061447 LncRNA linc00152/NF-κB feedback loop promotes fibroblast-like synovial cells inflammation 2021 Sep INTRODUCTION: Overexpressed inflammatory cytokines are the main factors causing rheumatoid arthritis (RA) tissue damage and pathological deterioration, and lncRNAs has found to beinvolved in some autoinflammatory diseases. METHODS: We designed this study to investigate the effect of lncRNA linc00152 on rheumatoid arthritis inflammation and explore its molecular mechanism. RESULT: We found that linc00152 was not only up-regulated in rheumatoid arthritis fibroblast-like synoviocytes (RAFLS), but also stimulated by TNF-α/IL-1β in adose- and time-dependent manner in RAFLS and this expression depends on the NF-κB signaling pathway. Conversely, linc00152 promoted TNF-α/IL-1β expression in RAFLS induced by TNF-α/IL-1β. In addition, we found that linc00152 promoted TAK1 expression by targeting inhibition of miR-103a and activated TAK1-mediated NF-κB pathway. NF-kB indirectly promotes linc00152 expression by promoting the transcription activity of YY1, and YY1 directly promotes linc00152 expression by binding the promoter of linc00152. CONCLUSION: Our data suggested that the linc00152/NF-κB feedback loop promotes RAFLS inflammation via regulating miR-103a/TAK1 axis and YY1 expression. Thus, linc00152 acts as a switch to control this regulatory circuit and may serve as a diagnostic and therapeutic target for RA treatment.
34111674 Mixture of probiotics reduces inflammatory biomarkers and improves the oxidative/nitrosati 2021 Sep OBJECTIVES: Studies have demonstrated that the gut microbiota of people with rheumatoid arthritis (RA) is different from that of healthy individuals and could influence inflammation and oxidative stress. In this study, we sought to evaluate the effects of supplementation with a mixture of probiotics on cytokine plasma levels, inflammatory biomarkers, oxidative/nitrosative stress profile, and Disease Activity Score-28 in people with RA. METHODS: A randomized and double-blind placebo-controlled study was carried out with 42 participants with RA divided into two groups-the probiotic group (n = 21), who over 60 d took a daily ingestion of probiotics in a sachet containing 109 CFU/g each of five freeze-dried strains: Lactobacillus acidophilus La-14, Lactobacillus casei Lc-11, Lactococcus lactis Ll-23, Bifidobacterium lactis Bl-04 and B. bifidum Bb-06; and the placebo group (n = 21) who over 60 d took a daily ingestion of maltodextrin. RESULTS: The probiotic group showed a significant reduction in white blood cell count (P = 0.012) and tumor necrosis factor-α (P = 0.004) and interleukin 6 plasma levels (P = 0.039). However, no differences were observed in interleukin-10, adiponectin, C-reactive protein, erythrocyte sedimentation rate, ferritin, or Disease Activity Score-28 between the two groups. Regarding oxidative/nitrosative stress biomarkers, the probiotic group showed lower nitric oxide metabolites (P = 0.004) and higher sulfhydryl group (P = 0.028) and total radical-trapping antioxidant parameters (P = 0.019) than the placebo group. However, lipid hydroperoxide and protein carbonyl did not differ between groups (P > 0.05). CONCLUSIONS: The mixture of probiotics reduced inflammatory biomarkers and improved the oxidative/nitrosative profile in people with RA.
34688020 Systemic effects of IL-6 blockade in rheumatoid arthritis beyond the joints. 2022 Jan Interleukin (IL)-6 is produced locally in response to an inflammatory stimulus, and is able to induce systemic manifestations at distance from the site of inflammation. Its unique signaling mechanism, including classical and trans-signaling pathways, leads to a major expansion in the number of cell types responding to IL-6. This pleiotropic cytokine is a key factor in the pathogenesis of rheumatoid arthritis (RA) and is involved in many extra-articular manifestations that accompany the disease. Thus, IL-6 blockade is associated with various biological effects beyond the joints. In this review, the systemic effects of IL-6 in RA comorbidities and the consequences of its blockade will be discussed, including anemia of chronic disease, cardiovascular risks, bone and muscle functions, and neuro-psychological manifestations.
33386877 Reproducibility of total and regional body composition using dual-energy X-ray absorptiome 2021 May Several studies have reported changes in body composition in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Our study showed that body composition measurements obtained by absorptiometry were highly reproducible in patients suffering from these diseases. This study justifies the use of absorptiometry measurements in longitudinal studies in this population. PURPOSE: Our study aimed to assess the reproducibility of total and regional body composition in patients with rheumatoid arthritis (RA) and with ankylosing spondylitis (AS) and to compare them to healthy subjects. METHODS: The study enrolled 80 subjects including 32 healthy subjects, 31 RA patients, and 17 AS patients. Each subject had two scans in one day under the same standard conditions and none ate nor drunk before being repositioned on the table. The reproducibility was assessed through the coefficient of variation (CV), the least significant change (LSC), the intraclass correlation (ICC), and the smallest significant difference (SDD). RESULTS: Total body composition measurements obtained by dual-energy X-ray absorptiometry (DXA) were highly reproducible, and there was no statistically significant difference between reproducibility in healthy subjects, patients with RA, and patients with AS. For total body fat mass (FM), lean mass (LM), and bone mineral content (BMC) in the total population, CV values were 1.71%, 1.25%, and 1.74%, respectively; ICC values were 0.998, 0.996, and 0.993, respectively; LSC values were 4.88%, 3.7%, and 5.2%, respectively; and SDD values were ± 1.23 Kg, ± 1.47 Kg, and ± 126.0 g, respectively. For regional body FM, LM, and BMC in the total population, CV values in the arms were 8.46%, 4.17%, and 3.79%, respectively; in the legs 6.24%, 3.59%, and 2.04%, respectively, and in the trunk 5.02%, 2.92%, and 5.24%, respectively. CONCLUSION: Total body tissue mass, FM percentage, FM, LM, and BMC measurements obtained by DXA are highly reproducible in RA and AS.
33196874 Occupational mimics of rheumatoid arthritis: hair dye-induced arthritis. 2021 Apr Hair dye (HD) and its component para-phenylenediamine (PPD) are commonly used to enhance beauty and youth. HD is associated with allergic contact reactions and the development of autoimmune phenomena. A 28-year-old woman presented to us complaining of pain and swelling affecting the small joints of the hands bilaterally lasting for 7 weeks. Laboratory evaluation was remarkable only for an increase of acute-phase reactants, while the rest of laboratory tests including serological tests for viruses, as well as immunological tests were negative or within normal limits. She noticed a close correlation between the onset of symmetrical polyarthritis and the use of HD product. Thus, after excluding other possibilities of inflammatory arthritides, the diagnosis of HD-induced arthritis was made. The patient was treated with naproxen, and after 3 weeks, she had a complete clinical response with decrease of acute-phase reactants. Thus, we review and discuss the relevant literature of cases related with the use of HD and arthritis development. This is the first described case of HD-induced arthritis. Physicians must be aware and recognize these symptoms and signs of patients exposed to HD and treat them appropriately.
33385865 Health-related quality of life in early psoriatic arthritis compared with early rheumatoid 2021 Feb OBJECTIVE: Both psoriatic arthritis (PsA) and rheumatoid arthritis (RA) have a significant impact on quality of life, but few reports have compared the two diseases. The current study assessed health-related quality of life (HRQoL) in PsA at diagnosis and after five years compared with early rheumatoid arthritis (RA) and a matched general population. METHODS: Patients with early PsA and early RA included in two Swedish registries with HRQoL data measured by the Medical Outcomes Study Short Form 36 (SF-36) at baseline and at five years follow-up were included. Differences in SF-36 scores compared with the general population were calculated for each patient. Physical function, disease activity, the delay before diagnosis, pain, and general wellbeing were used as explanatory variables. Statistical tests included t-tests and univariate and multivariate linear regression. RESULTS: PsA (n = 166) and RA (n = 133) patients of both sexes had significantly reduced HRQoL at disease onset. After five years, PsA patients still had impairments in several domains of SF-36, whereas RA patients had an almost normalized HRQoL. The time from symptom onset to diagnosis, disease activity, and disability independently contributed to the reduced improvement in PsA. CONCLUSION: Both early PsA and RA are characterized by severely reduced HRQoL. Despite more severe disease at inclusion, normalization of HRQoL is seen in patients with RA but not PsA. This may be due to delay in the diagnosis of PsA or more powerful interventions in RA. Earlier detection, lifestyle intervention, and more aggressive management strategies may be needed for PsA.
34843223 Injectable Erythrocyte Gel Loaded with Bulleyaconitine A for the Treatment of Rheumatoid A 2021 Dec 13 Rheumatoid arthritis (RA) is a systemic autoimmune disease with clinical manifestations including joint cartilage, synovitis, and bone damage. Here we developed an injectable erythrocyte gel loaded with Bulleyaconitine A (BLA) for the treatment of RA and demonstrated its anti-inflammatory effects in vivo and in vitro. In vitro experiments showed that BLA could effectively down-regulate the expression of pro-inflammatory factor in activated macrophages through the nuclear factor-κB (NF-κB) pathway. In vivo experiments have shown that the injection of BLA@RBCs in the inflammatory joints of CIA mice increases the local concentration of BLA in a long time. Improved therapeutic outcomes and reduced toxicity of BLA are demonstrated in our work. Together, the developed BLA@RBCs drug delivery system provides an alternative strategy to treat RA joints and shows high potential in clinical RA treatment.
34733292 Emerging Role of Eosinophils in Resolution of Arthritis. 2021 Eosinophils are a minor component of circulating granulocytes, which are classically viewed as end-stage effector cells in host defense against helminth infection and promoting allergic responses. However, a growing body of evidence has emerged showing that eosinophils are versatile leukocytes acting as an orchestrator in the resolution of inflammation. Rheumatoid arthritis (RA) is the most common chronic inflammatory disease characterized by persistent synovitis that hardly resolves spontaneously. Noteworthy, a specific population of eosinophils, that is, regulatory eosinophils (rEos), was identified in the synovium of RA patients, especially in disease remission. Mechanistically, the rEos in the synovium display a unique pro-resolving signature that is distinct from their counterpart in the lung. Herein, we summarize the latest understanding of eosinophils and their emerging role in promoting the resolution of arthritis. This knowledge is crucial to the design of new approaches to rebalancing immune homeostasis in RA, considering that current therapies are centered on inhibiting pro-inflammatory cytokines and mediators rather than fostering the resolution of inflammation.
31977647 Risk of Toxicity After Initiating Immune Checkpoint Inhibitor Treatment in Patients With R 2021 Oct 1 INTRODUCTION: Immune checkpoint inhibitors (ICIs) are increasingly used to treat advanced cancer. Rheumatoid arthritis (RA) is associated with an increased risk of malignancies; however, patients with RA have been excluded from ICI trials. In this study, we evaluated risk of toxicity after initiation of ICI treatment in RA patients. METHODS: We conducted a single-institution, medical records review analysis to assess the incidence of immune-related adverse events (irAEs) and autoimmune disease (AID) flares among patients with AIDs treated with ICIs from 2011 to 2018. A subgroup analysis for RA patients was performed with frequencies of irAEs and AID flares reported. RESULTS: Twenty-two patients with RA who were treated with ICI for malignancy were identified. At the time of ICI initiation, 86% had inactive RA disease activity. Immune-related adverse events occurred in 7 (32%) of patients, with 2 (9%) developing grade 3 (i.e., severe) irAEs. Immune checkpoint inhibitors were temporarily discontinued because of irAEs in 5 patients (23%), and permanently in 1 patient. Rheumatoid arthritis flares occurred in 12 patients (55%). Of those, 10 (83%) received oral corticosteroids with an adequate treatment response. CONCLUSIONS: Our analysis suggests that irAEs following ICI treatment are not increased among RA patients compared with other cancer patients. Heightened RA disease activity during ICI treatment is common, but most adverse events are manageable with oral corticosteroids, and few require permanent ICI discontinuation. A close collaboration between the oncologist and rheumatologist is advisable when considering ICIs in patients with RA.
33021510 Clinical Feature and Prognosis of Sudden Sensorineural Hearing Loss With Rheumatoid Arthri 2021 Mar 1 OBJECTIVES: Recent publications reported that patients with rheumatoid arthritis (RA) experience an increased risk of suffering sudden sensorineural hearing loss (SSNHL), however, these cases are poorly understood. This study aims to explore the clinical presentations and hearing recovery of SSNHL patients with RA. STUDY DESIGN: Retrospective study. SETTING: Tertiary medical center. PATIENTS: Forty-seven SSNHL patients with RA (RA group) and 431 SSNHL patients without RA (non-RA group) were recruited between April 2015 and June 2019. INTERVENTIONS: In the non-RA group, all patients were administrated with oral steroids. In the RA group, 21 patients were treated with oral steroid (OS group) and 26 patients were administrated with intratympanic steroids plus oral steroids (IS+OS group). MAIN OUTCOME MEASURES: We explored the clinical features and hearing recovery of SSNHL patients with RA in comparison with patients without RA, we also evaluated the therapeutic effect of combined steroids in SSNHL patients with RA. RESULTS: RA group had higher initial hearing loss level (mean 68.5 dB), final hearing threshold (mean 52.3 dB), the rates of profound hearing loss (48.9%), and no recovery (48.9%) than non-RA group (mean 55.1 dB, mean 34.8 dB, 32.9 and 27.6%, all p < 0.05), however, had lower hearing gains (mean 16.1 dB) and the rate of partial recovery (12.8%) than non-RA group (mean 20.3 dB and 28.8%, all p < 0.05). Furthermore, IS+OS group had higher hearing gains (mean 21.1 dB) and lower rate of no recovery (30.8%) than in the OS group (mean 10.0 dB and 71.4%, all p < 0.05). CONCLUSIONS: SSNHL patients with RA experienced severe hearing loss and had poor hearing prognosis. IS+OS provide better hearing recovery than OS for this population.
34333094 A novel humanized model of rheumatoid arthritis associated lung disease. 2021 Sep Cigarette smoking has been implicated in the pathogenesis of seropositive rheumatoid arthritis (RA), as well as RA-associated lung disease. Fibrotic interstitial lung disease as well as emphysema occur in RA and cause substantial morbidity. We used arthritis-susceptible HLA-DQ8 transgenic mice to generate RA-associated lung disease. Mice were exposed to cigarette smoke (CS) prior to induction of arthritis, and subsequently injected with a low dose of bleomycin intra-tracheally to induce lung injury. Exposure of arthritic mice to both CS and bleomycin led to a significant reduction in lung compliance consistent with development of diffuse lung disease. Morphologic evaluation of the lung demonstrated areas of emphysematous change and co-existent fibrosis, consistent with a combined pattern of fibrosis and emphysema. These changes were accompanied by inflammatory cell infiltration and upregulation of fibrosis-associated genes. This humanized mouse model can serve as a valuable research tool to understand the pathogenesis of RA associated lung disease.
33470348 Acute corneal melting one week after an uncomplicated cataract surgery in a patient who pr 2021 Jan This is a rare case report of acute, paracentral corneal melting and perforation occurring 1 week after an uneventful cataract surgery, with discussions on possible pathogenetic mechanisms. Relevant literature was also reviewed. Herein, a case of an 86-year-old woman with acute, paracentral, and sterile corneal melting and perforation in her left eye at 1 week after an uncomplicated cataract extraction is described. This occurs at the base of ocular surface disorders due to previous radiation of her lower eyelid and cheeks for the treatment of cancer and previously undiagnosed rheumatoid arthritis. She underwent surgical treatment using Gundersen's conjunctival flap for the existing perforation due to low visual expectancies and reluctance to undergo corneal keratoplasty due to the risk of corneal graft rejection. The risk of coming across an acute corneal melting after an uncomplicated cataract surgery in the eyes with ocular surface disorders should always be considered.
34916676 [Effect of chemokines CXCL9 and CXCL10 on bone erosion in patients with rheumatoid arthrit 2021 Dec 18 OBJECTIVE: To detect the serum level of soluble chemokines CXCL9 and CXCL10 in patients with rheumatoid arthritis (RA), and to analyze their correlation with bone erosion, as well as the clinical significance in RA. METHODS: In the study, 105 cases of RA patients, 90 osteoarthritis (OA) patients and 25 healthy controls in Peking University People's Hospital were included. All the clinical information of the patients was collected, and the serum CXCL9 and CXCL10 levels of both patients and healthy controls were measured by enzyme-linked immune sorbent assay (ELISA). CXCL9 and CXCL10 levels among different groups were compared. The correlation between serum levels with clinical/laboratory parameters and the occurrence of bone erosion in RA were analyzed. Independent sample t test, Chi square test, Mann-Whitney U test, Spearman's rank correlation and Logistic regression were used for statistical analysis. RESULTS: The levels of CXCL9 and CXCL10 were significantly higher in the RA patients [250.02 (126.98, 484.29) ng/L, 108.43 (55.16, 197.17) ng/L] than in the OA patients [165.05 (75.89, 266.37) ng/L, 69.00 (33.25, 104.74) ng/L] and the health controls [79.47 (38.22, 140.63) ng/L, 55.44 (18.76, 95.86) ng/L] (all P < 0.01). Spearman's correlation analysis showed that the level of serum CXCL9 was positively correlated with swollen joints (SJC), rheumatoid factor (RF) and disease activity score 28 (DAS28) (r=0.302, 0.285, 0.289; P=0.009, 0.015, 0.013). The level of serum CXCL10 was positively correlated with tender joints (TJC), SJC, C-reactive protein (CRP), immunoglobulin (Ig) A, IgM, RF, anti-cyclic citrullinated peptide antibody (ACPA), and DAS28 (r=0.339, 0.402, 0.269, 0.266, 0.345, 0.570, 0.540, 0.364; P=0.010, 0.002, 0.043, 0.045, 0.009, < 0.001, < 0.001, 0.006). Serum CXCL9 and CXCL10 levels in the RA patients with bone erosion were extremely higher than those without bone erosion [306.84 (234.02, 460.55) ng/L vs. 149.90 (75.88, 257.72) ng/L, 153.74 (89.50, 209.59) ng/L vs. 54.53 (26.30, 83.69) ng/L, respectively] (all P < 0.01). Logistic regression analysis showed that disease duration, DAS28 and serum level of CXCL9 were correlated with bone erosion in the RA patients (P < 0.05). CONCLUSION: Serum levels of CXCL9 and CXCL10 were remarkably elevated in patients with RA, and correlated with disease activities and occurrence of bone erosion. Chemokines CXCL9 and CXCL10 might be involved in the pathogenesis and bone destruction in RA.
34017081 HLA-DRB1, IRF5, and CD28 gene polymorphisms in Egyptian patients with rheumatoid arthritis 2021 Jun This study was established to assess the effects of IRF5 rs10488631 and CD28 rs1980422 single-nucleotide polymorphisms (SNPs) and HLA-DRB1 shared epitope (SE) allele on the prognosis and disease activity of rheumatoid arthritis (RA) patients. A total of 150 RA patients and 150 healthy controls were genotyped for the selected SNPs by real-time PCR. HLA-DRB1 SE was determined using LAB Type SSO Class II DRB1 typing. Our results suggest that HLA-DRB1, CD28, and IRF5 significantly discriminated (p < 0.001) RA patients and healthy controls (OR of single HLA-DRB1 SE allele = 2.431, CI = 1.467-4.027, OR of two SE alleles = 11.152, CI = 2.479-50.159), (OR of CD28 risk allele C = 2.794, 95% CI = 1.973-3.956) and (OR of IRF5 risk allele C = 4.925, CI = 3.26-7.439). Rheumatoid factor (RF) seropositivity was associated with HLA-DRB1 SE (p < 0.001) and IRF5 risk allele (p < 0.001). ACPA was significantly associated only with IRF5 risk allele (p < 0.001). A better response to methotrexate therapy was found in HLA-DRB1 SE non-carriers, and CD28 TT patients. This study demonstrated associations of HLA-DRB1 SE, CD28, and IRF5 with the risk of RA. HLA-DRB1 SE and CD28 rs1980422 can be used as predictors of methotrexate therapy response.
34502386 Possible Roles of tRNA Fragments, as New Regulatory ncRNAs, in the Pathogenesis of Rheumat 2021 Aug 31 Understanding the pathophysiology of rheumatoid arthritis (RA) has led to the successful development of molecule-targeted drugs for the treatment of RA. However, some RA patients are refractory to these treatments, suggesting that the pathological mechanism of the disease is not entirely understood. Genome and transcriptome analysis is essential for understanding the unknown pathophysiology of human diseases. Rapid and more comprehensive gene analysis technologies have revealed notable changes in the expression of coding RNA and non-coding RNA in RA patients. This review focuses on the current state of non-coding RNA research in relation to RA, especially on tRNA fragments. Interestingly, it has been found that tRNA fragments repress translation and are antiapoptotic. The association between tRNA fragments and various diseases has been studied, and this article reviews the possible role of tRNA fragments in RA.
35016466 Efficacy and safety of methotrexate in the treatment of rheumatoid arthritis: a retrospect 2021 Dec BACKGROUND: The clinical efficacy and safety of leflunomide (LFN) at a dose of 10 mg/day in the treatment of patients with rheumatoid arthritis (RA) is still unclear. We conducted this retrospective study to identify its efficacy and safety in comparison with methotrexate (MTX) at a dose of 10 mg/week. METHODS: We enrolled RA patients who were treated in our hospital from January 2013 to December 2020, and the American College of Rheumatology (ACR) 1987 criteria were adopted. The following data was collected: age, duration of disease, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), cyclic citrullinated peptide (CCP) antibody, white blood cell (WBC), and hemoglobin (Hb) level. The primary outcomes included the changes of the above variables and the incidence of adverse events after treatment in both groups. RESULTS: From January 2013 to December 2020, a total of 612 patients with RA treated in our hospital were screened. After excluding cases that did not meet the inclusion criteria, 33 cases remained in LFN group, and there were 59 cases in the MTX group. The baseline characteristics were similar between the LFN and MTX groups. After 24 weeks of treatment, there were still no significant differences between the two groups in all of the above variables. The infection rate was slightly higher in patients treated with MTX than those treated with LFN, while diarrhea episodes were more common in the LFN group. CONCLUSIONS: Our data indicated that compared with MTX at a dose of 10 mg/week, a low dose of LFN at 10 mg/day might be a preferable treatment choice for RA patients.
33443606 Echocardiographic evaluation of pulmonary hypertension, right ventricular function, and ri 2021 Jul INTRODUCTION: Rheumatoid arthritis (RA) patients are at increased risk for developing cardiovascular disease, including right heart failure. The evaluation of right ventricle (RV) using the relationship between tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic pressure (RVSP) is of clinical prognostic relevance. Mild echocardiographic pulmonary hypertension (ePH) has been associated with worse RV function. The aim of this study was to evaluate RV function as measured by TAPSE to RVSP ratio in rheumatoid arthritis patients compared to matched healthy controls. METHOD: A case-control study with 67 RA patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and 45 matching controls was included. A transthoracic echocardiogram was performed to all patients. TAPSE was measured as the distance traveled from end-diastole to end-systole. RVSP was calculated using the modified Bernoulli equation. Comparisons were done using Chi-square and Mann-Whitney's U test or Student's t test. RESULTS: Patients with RA had significantly reduced ventricular function (TAPSE 23 [21-25] vs 25 [23-26], p = 0.033) and TAPSE/RVSP ratio was significantly lower in RA-patients than controls (TAPSE to RVSP ratio 0.809 [0.67-1.01] vs 0.933 [0.79-1.11], p = 0.009). RA-patients with mild ePH had similar RV function, evaluated by TAPSE, in comparison to RA-patients with normal RVSP. CONCLUSION: RA-patients had worse RV function measured by TAPSE and worse TAPSE/RVSP ratio than controls. Also, RA-patients with mild ePH had reduced right ventricular-pulmonary arterial coupling in comparison with patients with RA and normal RVSP. These echocardiographic findings could justify aggressive treatment for these patients and assess their evolution. Key Points • Right ventricular (RV) function and RV coupling with the pulmonary artery (RV-PA coupling) were worse in patients with RA in comparison to healthy controls. • Values of right ventricular systolic pressure (RVSP) were similar between RA-patients and non-RA controls. • Prevalence of normal RVSP, mild echocardiographic pulmonary hypertension (ePH), and pulmonary hypertension was similar between RA-patients and non-RA matched controls •Patients with RA and mild ePH had reduced RV-PA coupling in comparison with RA-patients with normal RVSP.
33250460 Long-term Use of Golimumab in Daily Practice for Patients with Rheumatoid Arthritis. 2021 May 1 Objective To evaluate the effectiveness and drug retention rate of golimumab (GLM) for long-term use in daily practice for patients with rheumatoid arthritis (RA). Methods Patients with RA who started GLM therapy with a minimum follow-up period of 52 weeks were included. The patients were divided into a biologic-naïve group and switch group. The disease activity score (DAS) 28-erythrocyte sedimentation rate (ESR) (DAS28-ESR), grip power, and Japanese version of the health assessment questionnaire (J-HAQ) score were assessed. In addition, the treatment continuation rate was evaluated at the final follow-up. Patients Sixty-five patients [58 women and 7 men; median (range) age, 69 (61-74) years; median (range) disease duration, 9 (5-16) years] were included. Twenty-eight patients were biologic-naïve (naïve group), and 37 were switched to biologics (switch group). Results The median (range) follow-up period was 134 (58-162) weeks. The DAS28-ESR improved from a median (range) of 4.31 (3.52-5.25) to 2.65 (2.28-3.77) in the naïve group and from 4.27 (3.19-4.89) to 2.89 (2.49-3.88) in the switch group. The grip power improved in both groups (p<0.01); however, the J-HAQ score showed no marked improvement in either group. The continuation rates were 22/28 (78.6%) in the naïve group, and 26/37 (70.3%) in the switch group at the final follow-up. Conclusion We herein report for the first time that the long-term use of GLM improves the grip power. Improving the grip power may help prevent sarcopenia and frailty in the future. Given the efficacy and high continuation rate, we suggest that GLM would be a well-tolerated treatment option for RA.
33058034 Investigating the safety and compliance of using csDMARDs in rheumatoid arthritis treatmen 2021 May Rheumatoid arthritis (RA) significantly impacts the health of Chinese patients. Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are used as the standard treatment for patients with RA. However, Chinese patients with RA have reported poor compliance with csDMARDs. This study aims to better understand the safety and compliance of using csDMARDs in RA treatment. Face-to-face interviews were conducted by questionnaires on safety and compliance of csDMARDs in 400 patients with RA and 100 rheumatologists from 13 cities in China. Rheumatologists were from Tier 3 Class A hospitals with independent rheumatology departments, who admitted more than 30 patients with RA per week. All patients were diagnosed for > 3 months before the survey and had been treated with csDMARDs for > 3 months. The incidence of adverse events (AEs) that attributed to csDMARDs estimated by rheumatologists was lower than that reported by patients for all four prescribed csDMARDs. Also, types of common AEs in rheumatologist's perception differed from those in the patient's report. Only 86% (116/135) of patients claimed they notified their rheumatologist about AEs, and 40.8% (150/368) of patients did not strictly adhere to their prescribed treatment. Reasons why patients were not compliant with their treatment, other than AEs, included symptoms being less severe, travel, and busy working life/business trips. This study revealed gaps in perceptions of csDMARDs-related AEs and medication adherence between rheumatologists and patients. These findings suggested adequate doctor-patient communications, and considerations of multiple real-world situations may improve adherence in the treatment of RA patients. Key Points • This study identified gaps in rheumatologists' perception of the prevalence and type of AEs experienced by their patients, which could potentially help them improve their patients' compliance with treatment.