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ID PMID Title PublicationDate abstract
34910427 Cryptococcal Meningitis in a Patient with Sjogren's Syndrome: a Case Report. 2021 Dec 1 BACKGROUND: Cryptococcal meningitis (CM) is a life-threatening infectious disease and causes high morbidity and mortality. No information about Cryptococcal meningitis in populations with Sjogren's syndrome (SS) was available. METHODS: This report details the first case of Cryptococcal meningitis in a 75-year-old female patient with 10-years history of Sjogren's syndrome. RESULTS: Detailed findings of C. neoformans from CSF examinations, including routine examination, India ink stain, immunological test, culturing, mass spectrum analysis and molecular biology identification were all delineated in this case, which facilitated understanding of detection methods in C. neoformans infection. The etiological exploration was initiated from a positive finding of yeast cells in routine examination of unstained CSF in the present case. Morphology description of C. neoformans in unstained CSF was depicted for the first time. CONCLUSIONS: Clinicians should consider the possible complication of Cryptococcal meningitis when patients with Sjogren's syndrome show neurological symptoms. Importance of screening yeast cells from unstained CSF for routine examination was emphasized, which may reduce errors in cell counting and trigger further etiological ex-ploration of C. neoformans infection in laboratory and clinical practice.
34748096 The effects of resistance training in patients with primary Sjogren's syndrome. 2022 Apr INTRODUCTION: Resistance training (RT) is well tolerated and has shown promise for decreasing fatigue. However, the effects of RT have never been examined in primary Sjogren's syndrome (pSS). OBJECTIVE: To assess the feasibility, effectiveness, and safety of a resistance exercise program on fatigue in patients with pSS. METHODS: This is a parallel, single-blind randomized trial. Women aged 18 years or older, diagnosed with pSS according to the American-European criteria, were included. We randomized 59 participants to a resistance training group (RT) or a control group (CG). Participants in the RT group performed a 16-week resistance exercise program. The sessions consisted of three sets of resistance exercises (10 repetitions each) at 60 to 80% of 1 repetition maximum, designed to improve whole-body strength. The participants in the CG received their usual pharmacological treatment and instructions regarding disease control, pain management, sleep hygiene, and activities of daily living. To compare intergroup and intragroup variability, a one-factor repeated-measures analysis of variance (ANOVA) was used. RESULTS: RT effectively improved fatigue, pain, functional capacity, emotional aspects, vitality, and subjective perception of disease activity by the patient. No between-group differences were found in the ESSPRI mental score, ESSDAI, SF-36-Physical Aspects, SF-36-General Health, SF-36-Social aspects, and SF-36-Mental Health after the training period. CONCLUSION: An RT program was safe and effective in improving fatigue, pain, functional capacity, emotional aspects, vitality, and subjective perception of disease activity by the patient in women with pSS. Key Points • This is the first study to evaluate the effects of a resistance training program on fatigue in patients with primary Sjogren's syndrome. • A resistance training program was shown to be effective in improving fatigue in patients with primary Sjogren's syndrome. • A resistance training program is well-tolerated, has good compliance, and is not associated with serious adverse effects in patients with primary Sjogren's syndrome.
34663471 Cerebellar degeneration in primary Sjögren syndrome: a case report. 2021 Oct 19 BACKGROUND: Cerebellar degeneration is a rare and severe presentation of primary Sjögren syndrome. There are few case reports of cerebellar degeneration associated with different autoimmune diseases, especially with systemic lupus erythematosus and neuro-Behcet's disease. There are only six patients reported worldwide to be affected by cerebellar atrophy associated with primary Sjögren syndrome. In this report, we describe a patient with primary Sjögren syndrome who presented with ataxia due to cerebellar degeneration. CASE PRESENTATION: We report the case of a 37-year-old Chinese woman with primary Sjögren syndrome who presented with ataxia over 3 months associated with tremor of the limbs. Magnetic resonance imaging of the brain revealed bilateral cerebellar atrophy. Based on the presence of cerebellar signs with magnetic resonance imaging brain findings, she was diagnosed as cerebellar degeneration secondary to primary Sjögren syndrome. She was treated with methylprednisolone, hydroxychloroquine, and two cycles of monthly intravenous cyclophosphamide. Subsequently, she refused further treatment, and her neurological symptoms remained the same upon the last clinic review. Primary cerebellar degeneration is rarely associated with primary Sjögren syndrome. The pathogenesis of the neurological manifestations in primary Sjögren syndrome is unclear. Treatment involves corticosteroids and immunosuppressive agents with no consensus of a specific therapy for the management of primary Sjögren syndrome with central nervous system involvement. CONCLUSIONS: Cerebellar degeneration is a rare presentation of primary Sjögren syndrome. Early diagnosis and treatment of this condition is needed to ensure a good outcome.
34116201 Coexistence of immune-mediated diseases in sarcoidosis. Frequency and clinical significanc 2021 Dec OBJECTIVE: To analyze whether immune-mediated diseases (IMDs) occurs in sarcoidosis more commonly than expected in the general population, and how concomitant IMDs influence the clinical presentation of the disease. METHODS: We searched for coexisting IMDs in patients included in the SARCOGEAS-cohort, a multicenter nationwide database of consecutive patients diagnosed according to the ATS/ESC/WASOG criteria. Comparisons were made considering the presence or absence of IMD clustering, and odds ratios (OR) and their 95% confidence intervals (CI) were calculated as the ratio of observed cases of every IMD in the sarcoidosis cohort to the observed cases in the general population. RESULTS: Among 1737 patients with sarcoidosis, 283 (16%) patients presented at least one associated IMD. These patients were more commonly female (OR: 1.98, 95% CI: 1.49-2.62) and were diagnosed with sarcoidosis at an older age (49.6 vs. 47.5years, P<0.05). The frequency of IMDs in patients with sarcoidosis was nearly 2-fold higher than the frequency observed in the general population (OR: 1.64, 95% CI: 1.44-1.86). Significant associations were identified in 17 individual IMDs. In comparison with the general population, the IMDs with the strongest strength of association with sarcoidosis (OR>5) were common variable immunodeficiency (CVID) (OR: 431.8), familial Mediterranean fever (OR 33.9), primary biliary cholangitis (OR: 16.57), haemolytic anemia (OR: 12.17), autoimmune hepatitis (OR: 9.01), antiphospholipid syndrome (OR: 8.70), immune thrombocytopenia (OR: 8.43), Sjögren syndrome (OR: 6.98), systemic sclerosis (OR: 5.71), ankylosing spondylitis (OR: 5.49), IgA deficiency (OR: 5.07) and psoriatic arthritis (OR: 5.06). Sex-adjusted ORs were considerably higher than crude ORs for eosinophilic digestive disease in women, and for immune thrombocytopenia, systemic sclerosis and autoimmune hepatitis in men. CONCLUSION: We found coexisting IMDs in 1 out of 6 patients with sarcoidosis. The strongest associations were found for immunodeficiencies and some systemic, rheumatic, hepatic and hematological autoimmune diseases.
34902604 The autoimmune aetiology of unexplained chronic pain. 2022 Mar Chronic pain is the leading cause of life years lived with disability worldwide. The aetiology of most chronic pain conditions has remained poorly understood and there is a dearth of effective therapies. The WHO ICD-11 has categorised unexplained chronic pain states as 'chronic primary pains' (CPP), which are further defined by their association with significant distress and/or dysfunction. The new mechanistic term, 'nociplasticic pain' has been developed to illustrate their presumed generation by a structurally intact, but abnormally functioning nociceptive system. Recently, researchers have unravelled the surprising, ubiquitous presence of pain-sensitising autoantibodies in four investigated CPP indicating autoimmune causation. In persistent complex regional pain syndrome, fibromyalgia syndrome, chronic post-traumatic limb pain, and non-inflammatory joint pain associated with rheumatoid arthritis, passive transfer experiments have shown that either IgG or IgM antibodies from patient-donors cause symptoms upon injection to rodents that closely resemble those of the clinical disorders. Targets of antibody-binding and downstream effects vary between conditions, and more research is needed to elucidate the molecular and cellular details. The central nervous system appears largely unaffected by antibody binding, suggesting that the clinically evident CNS symptoms associated with CPP might arise downstream of peripheral processes. In this narrative review pertinent findings are described, and it is suggested that additional symptom-based disorders might be examined for the contribution of antibody-mediated autoimmune mechanisms.
33987854 Is Sjogren's syndrome a risk factor/contraindication for dental implants? An umbrella revi 2021 Jul INTRODUCTION: There have been concerns that longstanding oral dryness secondary to Sjogren's syndrome may increase the risk of failure of dental implants. AIMS: The aim of the present study was to determine the level of methodological quality of systematic reviews that evaluated the effectiveness of dental implants in patients diagnosed with Sjogren's syndrome. METHODS AND RESULTS: Databases of PubMed/Medline, LILACS, Science Direct and Dare Cochrane to October 2020 were evaluated. A total of 833 articles were initially identified but following use of appropriate inclusion and exclusion criteria 4 papers were identified for detailed analysis. An eventual study sample comprised 722 implants placed in 189 patients with a 95.22% success rate, the minimum follow-up time was 45.2 ± 23.8 months and the maximum 125.5 months. The studies were assessed for their methodological quality by the AMSTAR 2 tool, in which 3 had critically low quality and one low quality. CONCLUSION: Oral rehabilitation with dental implants in patients with Sjogren's syndrome seems to have a high success rate; however, the low quality of relevant reports highlights the need for primary and secondary studies with better methodological design in order to reduce bias and provide reassurance for this treatment option.
34565210 Anti-TRIM21 antibody is associated with aberrant B-cell function and type I interferon pro 2021 Nov BACKGROUND: TRIM21 is a member of the tripartite motif family proteins and is one of the autoantigens which react with anti-SS-A antibody (Ab) present in sera of patients with systemic lupus erythematosus (SLE) and Sjögren's syndrome. Previous studies have shown that TRIM21 dysfunction promotes aberrant B-cell differentiation and Ab production in SLE, and anti-TRIM21 Ab may be related to the TRIM21 dysfunction in human SLE pathogenesis. Here, we examined the relationship between anti-TRIM21 Ab and clinical and immunological characteristics in SLE patients. METHODS: Twenty-seven patients with SLE (23 women and four men) before immunosuppressive therapies, who fulfilled the revised 1997 American College of Rheumatology criteria for SLE, and four healthy controls (3 women and one man) were enrolled in the study. SLE patients were divided into two groups according to the seropositivity for anti-TRIM21 Ab. Serum anti-TRIM21 Ab levels were measured using enzyme-linked immunosorbent assays. The serum levels of cytokines and immunoglobulins were measured by cytometer beads arrays. The expression levels of TRIM21 protein in peripheral mononuclear cells (PBMCs) from SLE patients were evaluated by Western blotting. RESULTS: Sixteen and 9 patients showed seronegativity and seropositivity for anti-TRIM21 Ab, respectively. There were no significant differences in the background parameters, including female ratio, age, disease duration, SLE activity, and laboratory data between the two groups. The serum levels of interferon (IFN)-β were significantly higher in patients with anti-TRIM21 Ab as compared with those without anti-TRIM21 Ab (P = .043). The levels of IgG1 and IgA were significantly higher in SLE patients with anti-TRIM21 Ab as compared with those without anti-TRIM21 Ab (P = .0022 and .032, respectively). The PBMCs of patients with anti-TRIM21 Ab showed a significantly lower expression of TRIM21 protein as compared with those of patients without anti-TRIM21 Ab (P = .014). CONCLUSIONS: Anti-TRIM21 Ab seropositivity was related to B-cell abnormalities and type I IFN overproduction in SLE patients. These findings suggest that anti-TRIM21 Ab may have an inhibitory effect on TRIM21 functions and be a novel biomarker for the level of dependence on type I IFN overproduction and B-cell abnormalities.
32623648 Systemic immune-inflammation index combined with ferritin can serve as a reliable assessme 2021 Feb OBJECTIVE: The diagnosis of adult-onset Still's disease (AOSD) is based on nonspecific symptoms and laboratory data, and several infectious, autoimmune, and malignant diseases must be ruled out. This study aimed to elucidate the value of various laboratory inflammatory scores, including the systemic immune-inflammation index (SII), C-reactive protein/albumin ratio (CAR), albumin/globulin ratio (AGR), prognostic nutritional index (PNI), and ferritin/erythrocyte sedimentation rate ratio (FER) as assessment factors for diagnosis and evaluation of disease activity in AOSD. METHODS: The medical records of patients suspected of AOSD between January 1999 and June 2019 were examined. The inflammatory scores were compared between AOSD and non-AOSD groups, and receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic utility. RESULTS: A total of 164 patients diagnosed with AOSD had higher values of SII, CAR, and FER, as well as lower values of AGR and PNI, than non-AOSD patients (n = 61). For an AOSD diagnosis, the area under the receiver operating characteristic curve (AUC) was 0.859 (95% confidence interval [CI], 0.806-0.911) for the SII, 0.769 (95% CI, 0.702-0.837) for the CAR, 0.749 (95% CI, 0.615-0.782) for the AGR, 0.699 (95% CI, 0.675-0.823) for the PNI, and 0.764 (95% CI, 0.693-0.834) for the FER, with optimal cut-off values of 2195.7, 1.8, 1.38, 48.8, and 17, respectively. The SII had the largest AUC and the highest specificity (91.5%). In further analysis, the AUC for the combination of SII and ferritin was 0.904 (95% CI, 0.863-0.945), with a cut-off value of 2615.4. CONCLUSIONS: Laboratory inflammatory scores can be used as a practical tool for diagnosing AOSD. The SII and ferritin combination proved to be the most powerful assessment tool. Key Points • The systemic immune-inflammation index (SII), C-reactive protein/albumin ratio (CAR), ferritin/erythrocyte sedimentation rate ratio (FER), prognostic nutritional index (PNI), and albumin/globulin ratio (AGR) can be used as initial assessment scores for AOSD. • SII combined with ferritin (AUC = 0.904; 95% CI, 0.863-0.945) appears to be the most effective and valuable assessment score for AOSD.
34635300 Unique Aspects of Pediatric Sjögren Disease. 2021 Nov Sjögren disease increasingly is recognized in pediatric patients. Clinical features, primarily parotitis and sicca symptoms, and results of diagnostic tests may be different from those in adult disease. Adult criteria fail to capture most pediatric patients. Pediatric-specific criteria are urgently needed to define the natural history of the disease, identify risk and prognostic factors, and evaluate the impact of therapeutics and other interventions on disease course in young patients.
33030565 Publication activity in the field of Sjögren's syndrome: a ten-year Web of Science based 2021 Apr Bibliometric analysis is widely utilized to evaluate global research productivity in different research topics. However, to date, there has been no assessment of worldwide research productivity associated with Sjögren's syndrome. Therefore, the aim of this study was to evaluate the global research productivity in the field of Sjögren's syndrome using bibliometric analysis. The Web of Science database was scanned with the search terms 'Sjögren's syndrome' and 'Sjögren syndrome' for publications in the period 2010-2019. Original articles and reviews were selected for analysis. The most active countries were determined, and the number of articles, citations, research productivity adjusted by population and gross domestic product were analyzed. A total of 3856 articles were identified from 65 different countries. A statistically significant trend was observed in the direction of increase (in terms of the number of articles; from 282 to 461) in the 10-year period. A total of 3004 (77.90%) articles were from high-income countries. The five most productive countries were the United States (n = 714, 18.51%), China (n = 428, 11.09%), Japan (n = 308, 7.98%), Italy (n = 299, 7.75%) and France (n = 249, 6.45%). When the number of articles was adjusted according to population, Norway was the most productive country, followed by Greece and the Netherlands. In analysis according to gross domestic product, Greece was the leading country, followed by Norway and the Netherlands. The results of this study demonstrated a remarkable growth in global research productivity on Sjögren's syndrome between 2010 and 2019. More than three quarters of the articles were from high-income countries. When population and gross domestic product were considered, relatively small European countries came to the fore.
32934126 Elevated Granulocyte Colony-stimulating Factor Levels in Patients With Active Phase of Adu 2021 May OBJECTIVE: Neutrophilia is a hallmark of adult-onset Still disease (AOSD). We aimed to investigate the levels of granulocyte colony-stimulating factor (G-CSF), an essential regulator of neutrophil production and function, in the pathogenesis of AOSD. METHODS: Sera were collected from 70 patients with AOSD and 20 healthy controls (HCs). The levels of G-CSF were determined by ELISA. Low-density granulocytes (LDGs) were quantified by flow cytometry. Correlations between G-CSF levels and disease activity, laboratory variables, and LDG levels in patients with AOSD were analyzed by Spearman correlation test. RESULTS: Patients with active AOSD presented significantly higher levels of G-CSF compared to inactive AOSD patients (P < 0.001) and HCs (P < 0.0001). The G-CSF levels were significantly decreased after active AOSD patients achieved disease remission (P = 0.0015). The G-CSF levels were significantly correlated with C-reactive protein, erythrocyte sedimentation rate, ferritin, and systemic score in AOSD (P < 0.0001). Significant correlations between the levels of G-CSF and circulating neutrophils (P < 0.0001), neutrophil-to-lymphocyte ratio (P < 0.0001), percentages of LDGs in the peripheral blood mononuclear cells (P = 0.004), as well as absolute numbers of circulating LDGs (P = 0.018) were identified. Patients with fever, evanescent rash, sore throat, arthralgia, myalgia, lymphadenopathy, or hepatomegaly/elevated liver enzymes displayed significantly higher levels of G-CSF compared to patients without these manifestations (P < 0.05). CONCLUSION: Our findings indicate that G-CSF is implicated in the pathogenesis of AOSD, and targeting G-CSF may have therapeutic potential for AOSD. In addition, introducing circulating G-CSF levels into the clinical assessment system may help to monitor disease activity.
34923222 Balance between Interleukin-18 and Interleukin-18 binding protein in auto-inflammatory dis 2022 Feb Interleukin (IL)-18 is a member of the IL-1 family of cytokines with pleiotropic and potent pro-inflammatory activities that are tightly controlled at the level of production and in the extracellular space. Indeed, IL-18 is translated as a leaderless biologically inert pro-peptide that is cleaved by caspase-1 in its N-terminus domain to become active. Mature Il-18 is then released out of the cells via a phenomenon of inflammatory cell death termed pyroptosis. The biological activity of IL-18 is also regulated by a naturally-occurring soluble inhibitor, IL-18 binding protein (IL-18BP) that binds IL-18 and forms high affinity complexes, thus preventing IL-18 to signal through its cell surface receptors. IL-18BP is present in high amount in the circulation, thus unbound free Il-18 is virtually absent in normal and most pathological conditions. Recent findings showed that IL-18 is present in remarkably high concentrations in some autoinflammatory diseases, including adult-onset Still's disease, systemic juvenile idiopathic arthritis and in various conditions associated with hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Furthermore, elevated levels of free IL-18 are present in correlation with clinical and biological signs of disease activity. Most importantly, some patients with these diseases responded remarkably well to the administration of recombinant human IL-18BP, further indicating the pathogenic role of Il-18 and providing a strong rational for the use of IL-18 inhibitors in some of these difficult to treat auto-inflammatory diseases.
34363247 Adverse post-operative events of salivary gland biopsies: A systematic review and meta-an 2022 Feb OBJECTIVES: The study aimed to perform a systematic review and meta-analysis of the complications following major and minor salivary gland biopsy. MATERIALS AND METHODS: Observational studies assessing postoperative complications of minor salivary gland biopsy and indexed at Medline/PubMed, EMBASE, Cinahl, LILACS, or Scopus were selected. This review was registered under the protocol number: CRD42020211169. The level of significance considered was 0.05, and the R software (The R Foundation) was used for the meta-analysis. RESULTS: Twenty-seven studies reporting 3208 patients were included in this review. The combined prevalence of postsurgical complications was 11% (95% CI, 8 to 13%, p = 0.01). The percentage of the combined prevalence of neurological complications was 3% (95% CI, 1-6%, p = 0.01). The surgical technique did not influence the frequency of overall and neurological complications. CONCLUSION: Minor salivary gland biopsies are a safe and predictable procedure that should be performed on the lower lip. Postoperative complications are more common than previously reported, but permanent complaints are uncommon.
33479487 Work productivity among Sjögren's Syndrome and non-Sjögren's dry eye patients: a systema 2021 Dec BACKGROUND: Dry eye disease (DED) is one of the most common conditions presenting to eye care providers and is increasingly recognized to have poor outcomes on quality of life, activities of daily living, and social and emotional well-being. Here, we aim to understand the association between dry eye symptoms and workplace productivity experienced by patients with non-Sjögren's dry eye and Sjögren's Syndrome. METHODS: MEDLINE, PubMed, Embase, Cochrane Library, CINAHL, Healthstar, and PsycINFO were searched from inception to May 2019. RESULTS: Thirty-one studies consisting of 50,446 study participants from 14 countries were included in this systematic review. Among non-Sjögren's dry eye patients, there was significant absenteeism (ES = 0.19; 95% CI: [0.04, 0.35]), presenteeism (ES = 0.25; 95% CI: [0.15. 0.35]), productivity impairment (ES = 0.24; 95% CI: [0.20, 0.27]), activity impairment (ES = 0.30; 95% CI: [0.21, 0.38]), and subjective difficulties at work (ES = 0.58; 95% CI: [0.40, 0.75]). Patients with Sjögren's Syndrome demonstrated significant absenteeism (ES = 0.13, 95% CI: [0.10, 0.17]), presenteeism (ES = 0.28, 95% CI: [0.24, 0.32]), productivity impairment (ES = 0.31, 95% CI: [0.27, 0.35]), and activity impairment (ES = 0.39, 95% CI: [0.32, 0.47]) in the workplace. In addition, patients with Sjögren's Syndrome demonstrated significantly lower employment rate (ES = 0.42, 95% CI: [0.34, 0.50]), decreased number of hours worked (SMD = -0.21, 95% CI: [-0.39, -0.02]), and increased work disability (ES = 0.18; 95% CI: [0.09, 0.27]). CONCLUSIONS: This is the first systematic review and meta-analysis to demonstrate the negative association between DED and several work productivity measures.
35005593 Autoimmune rheumatic diseases: One or many diseases? 2021 Until the etiopathogenic factor(s) of autoimmune and autoinflammatory rheumatic disorders will be identified, their classification into entities will continue. However, their similar clinical manifestations, overlapping syndromes, evolution from one entity into another, as well as common autoantibody responses, suggest that autoimmune and autoinflammatory disorders may constitute distinct pathophysiologic processes on the basis of a different genetic background. Prognosis and effective therapeutic regimens are mostly based on the clinico-pathologic severity of the involved tissues or organs and not on the disease label.
34804405 The dilemma: scleroderma renal crisis vs lupus nephritis in a patient with mixed connectiv 2021 INTRODUCTION: Mixed connective tissue disorder (MCTD) is a rare connective tissue disorder characterized by features of systemic lupus erythematosus, dermatomyositis, systemic sclerosis, and rheumatoid arthritis. MCTD is associated with an elevated antibody titer to U1 small nuclear ribonucleoprotein. CASE DESCRIPTION: A 49-year-old man presented to the emergency department for evaluation of worsening shortness of breath with associated for bilateral hand pain and swelling associated with morning stiffness which was initially thought to be related to systemic lupus erythematous (SLE). He was also found to have a positive autoantibody, and he was later diagnosed with MCTD complicated by scleroderma renal crisis. CONCLUSION: MCTD is a rare connective tissue disorder with overlapping features of SLE, dermatomyositis, systemic sclerosis, and rheumatoid arthritis. The diagnosis of MCTD requires a high index of suspicion and careful workup. Immunosuppressive therapy is the mainstay of treatment that improves patient outcomes.
34639346 Association of Decreased Physical Activity with Rheumatoid Mid-Hindfoot Deformity/Destruct 2021 Sep 24 Foot/ankle problems remain important issues in rheumatoid arthritis (RA) patients. Although forefoot deformity generally takes a major place in surgical treatment, concomitant mid-hindfoot deformity is also commonly seen. In this situation, it can be easy to overlook that mid-hindfoot deformity can also induce or exacerbate clinical problems behind the forefoot events. Thus, the relationship between mid-hindfoot deformity/destruction and physical activity/ADL was investigated. Radiographic findings of 101 lower limbs (59 patients) were retrospectively evaluated. Alignment parameters in the lower extremity and joint destruction grade (Larsen grade) were measured. The timed-up-and-go (TUG) test, modified health assessment questionnaire (mHAQ), pain, self-reported scores for the foot and ankle (SAFE-Q), and RA disease activity were investigated to assess clinical status. The relationships among these parameters were evaluated. Subtalar joint destruction was correlated with TUG time (r = 0.329), mHAQ score (r = 0.338), and SAFE-Q: social functioning (r = 0.332). TUG time was correlated with the HKA (r = -0.527), talo-1st metatarsal angle (r = 0.64), calcaneal pitch angle (r = -0.433), M1-M5A (r = -0.345), and M2-M5A (r = -0.475). On multivariable linear regression analysis, TUG time had a relatively strong correlation with the talo-1st metatarsal angle (β = 0.452), and was negatively correlated with calcaneal pitch angle (β = -0.326). Ankle joint destruction was also correlated with TUG time (β = 0.214). Development of structural problems or conditions in mid-hindfoot, especially flatfoot deformity, were related with decreased physical activity in RA patients. Wearing an insole (arch support) as a preventative measure and short foot exercise should be considered from the early phase of deformity/destruction in the mid-hindfoot in the management of RA.
33604457 The study of gp130/the inflammatory factors regulating osteoclast differentiation in rheum 2021 Jul Rheumatoid arthritis (RA) is a chronic immune disease characterized by synovitis and bone destruction. The osteoclasts play a critical role in pathologic bone loss during inflammatory arthritis. In this paper, we report that Interleukin (IL)-6, IL-6Rα/gp130, IL-11, IL-27, and Matrix Metallo Proteinases (MMP)-9 expression results in serum of the RA group were significantly higher than that of the control group. The gp130 positive cells in peripheral blood mononuclear cell (PBMC) and osteoclast-like cells (OLC) which had been induced with receptor activator of nuclear factor κB ligand (RANKL) in RA group were also higher than that in the control group. In addition, after OLC in RA group is cultured with anti-gp130 Monoclonal antibody (McAb), the IL-6 and MMP-9 expression in osteoclast supernatant insignificantly decreased. Meanwhile, the expression results of Tartrate Resistant Acid Phosphatase (TRAP)-positive cells and osteoclasts were also decreased significantly. Our study suggests that regulating gp130 receptor can be used to control the differentiation and formation of osteoclasts, which provides a new clinical strategy for RA patients in the future.
35035700 Value of combination of 25-(OH)-D3, IL-6, and cyclic peptide containing citrulline antibod 2021 OBJECTIVE: To determine the value of a combination of 25-hydroxyvitamin D3 (25-(OH)-D3), interleukin-6 (IL-6), and cyclic peptide containing citrulline (CCP) antibodies in the acute stage and remission stage of patients with rheumatoid arthritis (RA). METHODS: A retrospective analysis was made on 80 RA patients who received treatment in Wenjiang District People's Hospital of Chengdu from February 2017 to February 2020. According to their condition, they were identified as acute-stage patients (n=48) or remission-stage patients (n=32). In addition, 40 healthy individuals who received physical examination in our hospital during the same period were enrolled in a control group. Serum 25-(OH)-D3, IL-6, and CCP antibodies in all enrolled participants were quantified, and their levels were compared between RA patients at the acute stage and those at the remission stage before therapy, and also between patients with different efficacy after 3 months of therapy. The correlations of serum 25-(OH)-D3, IL-6, and CCP antibodies with disease activity score in 28 joints (DAS-28) were analyzed. A corresponding joint receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of the combination of 25-(OH)-D3, IL-6, and CCP antibodies in the staging of RA patients, and logistic regression was used to establish an efficacy risk model. RESULTS: The highest serum 25-(OH)-D3 level was found in the control group, followed by the remission-stage patients and then acute-stage patients from high to low (all P<0.05), and the lowest levels of serum IL-6 and CCP antibodies were also found in the control group, followed by the remission-stage patients and then the acute-stage patients from low to high (all P<0.05). The Pearson's test revealed a negative correlation of 25-(OH)-D3 with DAS-28 and a positive correlation of IL-6 and CCP antibodies with DAS-28. According to ROC curve-based analysis, the area under the joint curve of 25-(OH)-D3, IL-6, and CCP antibodies was >0.9. After therapy, patients showed an increase in 25-(OH)-D3 and decreases in IL-6 and CCP antibodies (all P<0.05). The logistic model confirmed that the area under the ROC curve of RA affecting the efficacy on patients was >0.8. CONCLUSION: A combination of 25-(OH)-D3, IL-6, and CCP antibodies can be adopted as a diagnostic indicator in acute and remission stages of RA. A risk factor model of clinical efficacy in RA patients can help us effectively identify high-risk patients before therapy and take intervention measures early.
34943529 Early Myocardial Changes in Patients with Rheumatoid Arthritis without Known Cardiovascula 2021 Dec 7 Clinically silent cardiac disease is frequently observed in rheumatoid arthritis (RA), and cardiovascular complications are the leading cause of mortality in RA. We sought to evaluate the myocardium of young RA patients without known cardiac disease using cardiac magnetic resonance (CMR), including T1/T2 mapping sequences. Eighteen RA patients (median age 41 years, 83% females) mainly with low disease activity or in remission and without any known cardiovascular disease were prospectively included to undergo CMR. A control group consisted of 10 sex- and age-matched patients without RA or any known structural cardiovascular disease. Heart chambers size and left/right ventricular systolic function were similar in patients with RA and controls. Signs of myocardial oedema were present in up to 39% of RA patients, including T2 time above cut-off value in 7 patients (39%) in comparison to none of the controls (p = 0.003) and T2 signal intensity ratio above the cut-off value in 6 patients (33%) and in none of the controls (p = 0.06). Extracellular volume was similar in both groups signifying a lack of diffuse fibrosis in studied group of RA patients. There were also no signs of late gadolinium enhancement (LGE) in either group except for one patient with RA who was found to have prior silent myocardial infarction. No correlation was found between markers of disease severity and markers of oedema observed on CMR in patients with RA. Nevertheless, patients with increased T2 time (≥50 ms) were more likely to have X-ray erosions (p = 0.02) and a longer duration between symptom onset and diagnosis (p = 0.02). Finally, there were no significant arrhythmias on 24-h ECG Holter monitoring in RA patients. CMR features of myocardial oedema without signs of myocardial fibrosis were found in 39% of young RA patients without known heart disease or cardiac symptoms. Presence of myocardial oedema was associated with X-ray erosions and a longer duration between symptom onset and diagnosis. The clinical significance of the observed early myocardial changes accompanying RA requires additional studies.