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ID PMID Title PublicationDate abstract
35636630 Development of pH-sensitive dextran-based methotrexate nanodrug for rheumatoid arthritis t 2022 May 27 Rheumatoid arthritis (RA) is a chronic and symmetrical autoimmune disease that primarily characterized with articular synovial hyperplasia, joint swelling, cartilage and bone destruction. The in-depth understanding of the role of immune signaling pathway inhibitors provides inspiration for the construction of new and more effective strategy for RA therapy. In this study, by loading methotrexate (MTX) into an acetalated dextran biopolymer, AcDEX, we developed a pH-sensitive, MTX-loaded and molecularly targeted nanodrug MTX@pH-AcDEX NPs) to decrease the toxicity of MTX and simultaneously enhance its therapeutic effect. The resultant MTX@pH-AcDEX NPs showed the spherical morphology and notable pH-responsiveness with high drug loading of 88.32%. As demonstrated in vitro and in vivo, the reduced cytotoxicity of both RAW264.7 cells and LPS-activated RAW264.7 cells treated with MTX@pH-AcDEX NPs was found compared to free MTX. Upon intravenous administration into adjuvant-induced arthritis (AIA) rat model, the nanodrug had potent pharmacokinetic and pharmacodynamic profiles, which can accumulate in RA lesions and release MTX inhibitors for regulating the JAK-STAT pathways. As a result, the MTX@pH-AcDEX NPs achieved the cartilage and bone protective and a better anti-inflammatory effect with negligible systemic toxicity, suggesting the strong potential of safe and effective nanodrug for RA therapy as well as other autoimmune diseases.
35476502 Emerging proteoglycans and proteoglycan-targeted therapies in rheumatoid arthritis. 2022 Jun 1 Rheumatoid arthritis (RA) is a common autoimmune disease that causes inflammation of the joints and damage to the cartilage and bone. The pathogenesis of RA is characterized in many patients by the presence of antibodies against citrullinated proteins. Proteoglycans are key structural elements of extracellular matrix in the joint articular cartilage and synovium and are secreted as lubricants in the synovial fluid. Alterations of proteoglycans contribute to RA pathogenesis. Proteoglycans such as aggrecan can be citrullinated and become potential targets of the rheumatoid autoimmune response. Proteoglycans are also upregulated in RA joints and/or undergo alterations of their regulatory functions over cytokines and chemokines, which promotes inflammation and bone damage. Recent studies have aimed to not only clarify these mechanisms but also develop novel proteoglycan-modulating therapeutics. These include agents altering the function and signaling of proteoglycans as well as tolerizing agents targeting citrullinated aggrecan. This mini-review summarizes the most recent findings regarding the dysregulation of proteoglycans that contributes to RA pathogenesis and the potential for proteoglycan-modulating agents to improve upon current RA therapy.
30247840 Naproxen. 2022 Jan Naproxen is FDA-approved for treating acute gout, ankylosing spondylitis, bursitis, polyarticular juvenile idiopathic arthritis, osteoarthritis, tendonitis, rheumatoid arthritis, pain, and primary dysmenorrhea. It is the first-line treatment for acute gouty arthritis, osteoarthritis, musculoskeletal pain, inflammation, and dysmenorrhea. While naproxen and other NSAIDs are approved for the treatment of inflammatory arthropathies such as rheumatoid arthritis and ankylosing spondylitis, they do not alter the course of the disease, nor do they prevent joint and soft tissue destruction that are common sequelae of these diseases. This activity outlines the indications, mechanism of action, methods of administration, significant adverse effects, contraindications, monitoring, and toxicity of naproxen, so providers can direct patient therapy to optimal outcomes when pain relief is needed.
35460244 Stress Fractures in the Forefoot After Arthrodesis of the Hindfoot in a Patient with Rheum 2022 Apr 23 Rheumatoid arthritis (RA) is an autoimmune disease that attacks multiple joints throughout the body. Ankle arthrodesis (AA) has been the gold standard surgery for end-stage ankle arthritis in patients with RA. Here, we report the case of a 67-year-old woman with RA who had displacement and loosening of total ankle arthroplasty (TAA). The ankle was converted to AA using a metal spacer and an intramedullary nail. The patient had no complications in perioperative terms of arthrodesis. However, multiple fractures were found in the metatarsal bones at the routine 3-year follow-up. Although the patient did not remember any symptoms, the clinical outcome deteriorated compared to that a year before. The hindfoot in this case report was fixed completely by an intramedullary nail, while the midfoot had already involved ankylosis because of severe joint destruction present before the surgery. As a result, the range of motion in the joints of the midfoot and hindfoot was lost, and it is probable that an excessive load was applied to the forefoot during push-off by the toes, resulting in a stress fracture. Patients with RA remain at risk of future progressive joint destruction in every joint of their body. Therefore, surgeons should choose a surgery that preserves ankle motion to decrease the rate of adjacent joint degeneration for severe ankle arthropathy in patients with RA.
35499177 Sauvé-Kapandji and Darrach Salvage Procedure Rates and Perioperative Parameters for Dista 2022 May 2 BACKGROUND: Distal radioulnar joint (DRUJ) instability and arthritis are often painful and functionally limiting pathologies. Two common salvage procedures for DRUJ dysfunction are the Darrach and Sauvé-Kapandji (S-K) procedures. This study aims to provide an analysis of national Darrach and S-K procedure utilization rates and patient demographics. METHODS: A national ambulatory surgery database, the 2018 Nationwide Ambulatory Surgery Sample, was filtered for Darrach and S-K procedure encounters. Data related to patient demographics and medical history, indications for DRUJ salvage, and concurrent hand/wrist procedures were collected. RESULTS: Database analysis revealed 1044 Darrach and 223 S-K procedure encounters. Patients undergoing Darrach procedures were older (60 vs 57, P = .002) and more likely to be women (66.1% vs 54.6%, P < .05). Patients aged <35 years underwent S-K procedures at greater rates compared with Darrach (13.9% vs 8.6%, P < .05). Primary osteoarthritis proved to be the most common indication for DRUJ salvage (64.8%) compared with rheumatoid arthritis (23.2%) and post-traumatic osteoarthritis (12.0%). Darrach and S-K procedures were accompanied by a secondary procedure at rates of 64% and 41%, respectively. The most common secondary procedures were tendon transfer, implant removal, neuroplasty, nerve resections, and wrist arthroscopy. CONCLUSIONS: Patient age and sex are associated with DRUJ salvage procedure selection. Sauvé-Kapandji procedures are used in higher rates in male and younger patient populations. Furthermore, primary osteoarthritis and rheumatoid arthritis are the main underlying pathologies for Darrach and S-K procedures.
35280253 Notoginsenoside R1 (NG-R1) Promoted Lymphatic Drainage Function to Ameliorating Rheumatoid 2021 Rheumatoid arthritis (RA) is a chronic autoimmune disease that is primarily characterized by synovial inflammation. Our previous studies demonstrated that the lymphatic system is critical for the development and maintenance of RA disease, and sufficient lymph drainage helps to improve joint inflammation. In this study, we found that NG-R1, the main active component in the traditional Chinese medicinal herb Sanchi, activating lymphatic function can attenuate synovial inflammation. According to histopathological staining of ankle sections, NG-R1 significantly decreased the area of inflammation and reduced bone destruction of ankle joints in TNF-Tg mice. Near infrared-indocyanine green (NIR-ICG) lymphatic imaging system has shown that NG-R1 significantly improved the lymphatic drainage function. However, the molecular mechanism of its activity is not properly understood. Our in-depth study demonstrates that NG-R1 reduced the inflammatory cytokine production of lymphatic endothelial cells (LECs) stimulated by TNF-α, and the mechanism ameliorated the phosphorylation of IKKα/β and p65, and the translocation of p65 into the nucleus. In summary, this study proved that NG-R1 promoted lymphatic drainage function to ameliorating rheumatoid arthritis in TNF-Tg mice by suppressing NF-κB signaling pathway.
35261706 Long-term effect of tocilizumab on left ventricular hypertrophy and systolic dysfunction i 2022 Mar Because cardiac involvement of amyloid A (AA) is not frequent, little is known about the effects of tocilizumab (TCZ; a humanized monoclonal anti-interleukin-6 receptor antibody). We present the case of a 77-year-old man with cardiac AA amyloidosis due to rheumatoid arthritis (RA). He was admitted to our hospital because of gastrointestinal bleeding. Upon admission, chest radiography and electrocardiogram showed progression of cardiomegaly and atrioventricular conduction delay, respectively. Echocardiography showed diffuse left ventricular (LV) hypertrophy with reduced LV contraction. AA amyloid deposits in the myocardium were identified by Congo red staining and immunohistochemical staining with anti-AA antibody, suggesting cardiac AA amyloidosis. After starting treatment with TCZ, his condition improved. Hypertrophic LV mass was significantly reduced, and impaired LV contraction was restored after 10 months of TCZ treatment. The effects of TCZ were sustained for 2 years. Plasma N terminal pro-B-type natriuretic peptide level decreased from 2947 pg/mL (reference level, <125 pg/mL) on admission to 325 pg/mL after 2 years of TCZ treatment. The present case supports that cardiac biopsy is very important to diagnose cardiac AA amyloidosis in patients with RA complicating unexplained cardiac hypertrophy and/or dysfunction and TCZ should be administered if applicable. .
35536604 Surgical Intervention for Patients With Rheumatoid Arthritis is Declining Except for Foot 2022 May 10 OBJECTIVE: A global downward trend in the number of rheumatoid arthritis (RA)-related surgeries has been reported. The purpose of our study was to investigate the latest trends in RA-related surgeries in a single-center Japanese RA cohort. METHODS: This study was a retrospective analysis of RA-related surgeries between 2001 and 2020 in the Institute of Rheumatology Rheumatoid Arthritis cohort. An average of 4,944 patients per semiannual survey was included in the study. The primary goal was to analyze the half-year period prevalence proportion (HPP) of RA-related surgeries in a 20-year period, and the secondary goal was to analyze the HPP of surgeries by site or by categories of disease activity. RESULTS: There has been a downward trend in the HPP of RA-related surgeries in the 20-year study period. The total HPP of RA-related surgeries decreased by 50.3% during the 20-year study period. There was a significant decrease in knee, hip, shoulder/elbow, and hand procedures. Only foot/ankle joint surgeries significantly increased in volume during this period (p=0.001). The HPP of RA-related surgeries remained unchanged in patients with remission or low disease activity. CONCLUSION: The number of RA-related surgeries decreased over a 20-year period, but foot/ankle joint surgeries increased in the site-specific evaluation.
35596818 Real-world evidence of the effectiveness and safety of generic tofacitinib in rheumatoid a 2022 May 21 Generic tofacitinib has been available in India for more than a year and is widely used in rheumatoid arthritis (RA) therapy. There is scarce real-world data on its effectiveness and safety from India, especially given infection endemicity. We retrospectively analysed records (demographic and clinical information, haematology and biochemistry, adverse events) of patients prescribed generic tofacitinib from a single centre in Mumbai, India. Disease activity was calculated using the disease activity score-28 and erythrocyte sedimentation rate (DAS28-ESR) and other tools, and we used paired T-tests for significant response. We defined clinical tofacitinib failure as a composite outcome, including clinician's decision to change to an alternative disease-modifying anti-rheumatic drug (DMARD) or flare after self-withdrawal. We performed logistic regression and survival analysis for determinants of clinical failure. We reviewed records of 102 patients (92 female; median age: 53 years) with mean RA duration of 146 months. Thirteen had prior treatment with innovator tofacitinib. There was significant improvement in disease activity parameters at a mean duration of 186 days. No serious adverse events were reported; 4 patients had tuberculosis and 19 patients had mild COVID-19 while on treatment. Clinical failure was seen in 25 patients, and mean time to failure on survival analysis was 357 days. No baseline characteristic predicted clinical failure. Generic tofacitinib showed good effectiveness and a tolerable adverse effect profile, despite tuberculosis endemicity and COVID-19. Setting up registries would be valuable in gaining more data on generic tofacitinib. Key Points • There is scarce data from India regarding the use of tofacitinib in rheumatoid arthritis, despite widespread use. • In this retrospective analysis of 102 patients at a single centre, we found tofacitinib monotherapy was efficacious and tolerable. • Tuberculosis was detected in four and nineteen patients had mild covid.
35295888 Diagnostic value of semi-quantitative grading of musculoskeletal ultrasound in wrist and h 2022 We used semi-quantitative grading of musculoskeletal ultrasound to evaluate wrist and hand lesions of subclinical synovitis, in order to make earlier diagnosis of rheumatoid arthritis. A total of 164 patients were included in this study. Physical examination and ultrasound examination were used to evaluate 30 joints of the wrist and hand. According to the clinical symptoms, the patients were divided into subclinical synovitis (SS) group and clinical synovitis (CS) group. The wrist and hand joints of patients with rheumatoid arthritis between the two groups were evaluated by semi-quantitative grading of musculoskeletal ultrasound, including synovitis, Power Doppler signal, joint effusion and bone erosion. We found that the total score of semi-quantitative ultrasound, synovitis score and Power Doppler signal score in the SS group were lower than those in the CS group (P<0.05). There was no significant difference in joint effusion score and bone erosion score (P>0.05). In the analysis of laboratory examination, the value of anti-RA33 antibody and ESR of SS group were decreased than that of CS group, with statistically significant difference (P=0.004), while that of RF, AKA and CCP had no significant difference between the two groups (P>0.05). In this study, the author also compared the tenosynovitis between the two groups. There was statistically significant difference (P=0.033). In conclusions, semi-quantitative grading of musculoskeletal ultrasound has certain diagnostic value for the diagnosis of subclinical synovitis in wrist and hand lesion.
35283656 Rheumatoid Cerebral Vasculitis in a Patient in Remission. 2022 Cerebral vasculitis is a very rare extra-articular complication of rheumatoid arthritis (RA) that is often challenging to diagnose. Elevated titers of rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), and antinuclear antibodies (ANA) have been linked with severe complications. The absence of highly elevated titers of RF, anti-CCP, and ANA can complicate the diagnosis of RA-associated cerebral vasculitis. We report the case of a 59-year-old woman with long-standing arthritis maintained on rituximab and leflunomide who developed sudden headaches and altered level of consciousness. Laboratory work-up revealed normal lymphocyte count and mildly elevated total serum protein and anti-CCP with negative RF and ANA and no evidence for viral or bacterial infections. Cerebrospinal fluid analysis (CSF) showed slightly elevated anti-CCP with normal levels of CXCL-13 and interleukin 6 (IL-6). Brain magnetic resonance imaging (MRI) showed ill-defined lesion of high T2 signal. Using MR angiogram, MR perfusion, and MR spectroscopy, the diagnosis of rheumatoid cerebral vasculitis was confirmed. The patient was treated with intravenous methyl-prednisolone with fast complete improvement. We conclude that adequate immunosuppression in RA might not be able to prevent rare extra-articular manifestations such as rheumatoid cerebral vasculitis.
35036891 Impact of autoimmune serology test results on RA classification and diagnosis. 2022 Rheumatoid arthritis (RA) is the most common systemic autoimmune disease and also the most severe arthritic disorder. The measurement of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) in serum supports the diagnosis of RA, which gained increasing significance over the last 65 years. However, a high variability between RF and ACPA methods has been described, impacting the diagnostic performance of the current ACR/EULAR RA classification criteria. The great number of commercially available assays, often lacking traceability to an international standard, is a major factor attributing to this in-between assay variability. The adoption of an international standard for ACPA, as is since long available for rheumatoid factor, is therefore highly desirable. Further harmonization in clinical interpretation of RF/ACPA assays could be obtained by harmonization of the cut-offs, for both the low and high antibody levels, based on predefined specificity in disease controls. Reporting test result specific likelihood ratios (LR) adds value in the interpretation of autoantibody tests. However, a good understanding of the control population used to define antibody test result interval-associated LRs is crucial in defining the diagnostic performance characteristics of antibody serology. Finally, specificity in RA classification can be improved by refining serological weight scoring taking into account the nature of the antibody, the antibody level and double RF + ACPA positivity.
35301105 The association between rheumatoid arthritis and cardiovascular disease among adults in th 2022 Mar 14 PURPOSE: To explore the rheumatoid arthritis (RA)-cardiovascular diseases (CVD) association in relative and absolute risk scales among US adults aged ≥20 years over time and the effect modification of the association by age. METHODS: We analyzed aggregated data from all ten continuous National Health and Nutrition Examination Survey cycles. A sample of 35,062 complete-case subjects was considered. The design-based regressions were used to investigate the associations in relative and absolute scales. RESULTS: In relative scale, the CVD odds ratio was 2.32, 2.19, and 1.97 among adults with RA than no arthritis in 1999-2006, 2007-2012, and 2013-2018 cycles, respectively. This time trend was not statistically significant. The absolute risk estimates were 11, 10, and 9 per 100 CVD events. We also observed a significant effect modification by age; the higher relative risk among younger adults (<50 years) with RA and higher absolute risk in older adults (≥80 years) with RA were consistent across survey cycles. CONCLUSIONS: There is a significant association between RA and CVD among US adults in both relative and absolute risks. Moreover, age is a significant effect modifier for this association; but with opposing age-related trends in relative and absolute scales.
35626351 Synovial Fluid Interleukin Levels Cannot Distinguish between Prosthetic Joint Infection an 2022 May 11 Inflammatory arthritis affects the level of synovial inflammatory factors, which makes it more difficult to diagnose prosthetic joint infection (PJI) patients with inflammatory arthritis. The aim of this study was to analyze synovial interleukin levels to distinguish between PJI and active rheumatoid arthritis (RA) after a hip or knee arthroplasty. From September 2019 to September 2021, we prospectively enrolled patients with joint pain after arthroplasty due to aseptic prosthesis loosening (n = 39), acute RA (n = 26), and PJI (n = 37). Synovial fluid from the affected joint is obtained and tested with a standard enzyme-linked immunosorbent assay. Receiver operating characteristic curve (ROC) was analyzed for each biomarker. Interleukin (IL)-1β, IL-6, and IL-8 showed promising value in differentiating of aseptic loosening from PJI, with areas under the curves (AUCs) of 0.9590, 0.9506, and 0.9616, respectively. Synovial IL-1β, IL-6, and IL-8 showed limited value in distinguishing between PJI and acute episodes of RA after arthroplasty, with AUCs of 0.7507, 0.7069, and 0.7034, respectively. Interleukins showed satisfactory efficacy in differentiating aseptic loosening from PJI. However, when pain after arthroplasty results from an acute episode of RA, current synovial interleukin levels do not accurately rule out the presence of PJI.
31613490 Psoriatic Arthritis. 2022 Jan Psoriatic arthritis (PsA) is chronic inflammatory arthritis associated with psoriasis (PsO) and found in about 20 to 30% of such patients.  It shares many clinical features with other spondyloarthropathies and also rheumatoid arthritis (RA). It is usually seronegative, but a small percentage of patients may be positive for rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies). The clinical manifestations are varied and can change over time, evolving from one articular pattern to another.  There is a considerable financial and psychological burden associated with this disease. There has been significant progress recently in understanding the disease pathogenesis, which has translated into new therapies.
35444896 Correlation of Depression and Anxiety With Rheumatoid Arthritis. 2022 Mar Background Psychiatric comorbidity with a chronic disease is linked with poor patient outcomes. Therefore, the current research assessed the correlation of rheumatoid arthritis (RA) with depression and anxiety disorders.  Methodology A prospective observational study was undertaken at a public sector hospital between December 2020 to June 2021. All individuals who presented with rheumatoid arthritis were included in the study. A healthy cohort acted as the control group. Depression and anxiety were assessed using the Hamilton depression rating scale (HDRS) and the Hamilton anxiety rating scale (HAM-A), respectively. The patients were inquired about their gender, age, and duration of RA. Further stratification was done using the Chi-squared test. A p-value of <0.05 was decided as the cut-off for significance. All data from the patients were collected in a predefined pro forma.  Results A total of 169 patients with RA and 85 healthy controls were enrolled in the study. The mean depression score among patients with RA was 19.65 ± 1.44 versus 14.4 ± 1.31 in the control group (p<0.001). Moreover, the mean anxiety score in patients with RA was 19.44 ± 2.4. About 71% of patients with RA were diagnosed with psychiatric issues, while only 7.1% of individuals in the control group had either depression or anxiety (p<0.0001). Furthermore, it was found that the majority of the patients with RA had depression with a frequency of 70 (58.3%), while only six participants in the control group had depression. None of the participants had moderate or severe depression. However, 16 (69.6%) patients with RA had major anxiety issues. In 27 patients, mixed anxiety-depression disease was diagnosed. Out of these, 23 (85.2%) had the depression-dominant mixed disorder.  Conclusion The present study highlighted the alarming incidence of depression and anxiety among patients with RA. Furthermore, it also indicated the relationship between severity of psychiatric comorbidity with chronic rheumatoid arthritis in our population. Further large-scale studies are needed to ascertain the demographic confounders that may help predict psychiatric disorders among patients with RA.
34994311 The role of flavonoids in inhibiting IL-6 and inflammatory arthritis. 2022 Jan 7 Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the synovial joints. RA has well-known clinical manifestations and can cause progressive disability and premature death along with socioeconomic burdens. Interleukin-6 (IL-6) has been implicated in the pathology of RA where it can stimulate pannus formation, osteoclastogenesis, and oxidative stress. Flavonoids are plant metabolites with beneficial pharmacological effects, including anti-inflammatory, antioxidant, antidiabetic, anticancer, and others. Flavonoids are polyphenolic compounds found in a variety of plants, vegetables, and fruits. Many flavonoids have demonstrated anti-arthritic activity mediated mainly through the suppression of pro-inflammatory cytokines. This review thoroughly discusses the accumulate data on the role of flavonoids on IL-6 in RA.
35022703 Hand and foot MRI in contemporary undifferentiated arthritis: in which patients is MRI val 2022 Jan 12 OBJECTIVES: Identifying patients that will develop rheumatoid arthritis(RA) among those presenting with undifferentiated-arthritis(UA) remains a clinical dilemma. Although magnetic-resonance-imaging(MRI) is helpful according to EULAR-recommendations, this has only been determined in UA-patients not fulfilling 1987-RA-criteria, whilst some of these patients are currently considered as RA because they fulfill the 2010-criteria. Therefore, we studied the predictive value of MRI for progression to RA in the current UA-population: i.e. not fulfilling RA-classification-criteria (neither 1987- or 2010-criteria) and not having an alternate diagnosis. Additionally, the value of MRI was studied in patients with a clinical diagnosis of UA, regardless of the classification-criteria. METHODS: Two UA-populations were studied: criteria-based-UA as described above(n = 405) and expert-opinion-based-UA(n = 564), i.e. UA indicated by treating rheumatologists. These patients were retrieved from a large cohort of consecutively included early arthritis patients that underwent contrast-enhanced MRI-scans of hand-and-foot at baseline. MRIs were scored for osteitis, synovitis and tenosynovitis. Patients were followed for RA-development during 1-year. Test-characteristics of MRI were determined separately for subgroups based on joint-involvement and autoantibody-status. RESULTS: Among criteria-based-UA-patients(n = 405), 21% developed RA. MRI-detected synovitis and MRI-detected tenosynovitis were predictive. MRI-detected tenosynovitis was independently associated with RA-progression(OR 2.79; 95%CI 1.40-5.58), especially within ACPA-negative UA-patients(OR 2.91; 1.42-5.96). Prior risks of RA-development for UA-patients with mono-/oligo-/polyarthritis were 3%, 19%, 46%, respectively. MRI-results changed this risk most within the oligoarthritis-subgroup: PPV was 27% and NPV 93%. Similar results were found in expert-opinion-based-UA(n = 564). CONCLUSION: This large cohort-study showed that MRI is most valuable in ACPA-negative UA-patients with oligoarthritis; a negative MRI could aid in preventing overtreatment.
35033948 Therapeutic effects of Chinese medicine Di-Long (Pheretima vulgaris) on rheumatoid arthrit 2022 Mar Chinese medicine Di-Long, the dried body of Pheretima vulgaris (Chen) has been used for the treatment of joint inflammation, arthralgia and numbness of limbs for many years. This study was to investigate the anti-rheumatoid arthritis (RA) effects of Di-Long and to explore its possible mechanisms. The identification and quantification of representative components in Di-Long extracts (DL) were carried out by HPLC analysis. The anti-RA effects and mechanisms of DL were studied in CIA mice, RAW 264.7 macrophages and spleen T lymphocytes. The Th1/Th2 cell ratio in CIA mice spleens were determined by Flow cytometry. The cytokine levels were determined by ELISA method. The expressions of p-NF-κB p65 in ankle joints of CIA mice were detected by Immunohistochemistry analysis. The phosphorylation of NF-κB signaling pathway in RAW 264.7 macrophages and expressions of T-bet and GATA-3 in CIA mice spleens were determined by Western blots. The treatment with DL significantly decreased the paw thickness, arthritis scores and inflammatory cells infiltration in CIA mice. The TNF-α, IL-6 concentrations in both mice serum and macrophages secretion were markedly reduced with the treatment of DL, as well as the phosphorylation of NF-κB pathway. DL inhibited the expressions of T-bet and GATA-3 and decreased Th1/Th2 cells ratio in CIA mice spleens. DL reduced IFN-γ, IL-2 levels in mice serum and spleen T lymphocytes, and increased IL-4 levels in CIA mice serum. Chinese medicine Di-Long have significant anti-RA effects. The mechanisms might be inhibiting the activation of NF-κB signaling pathway and regulating the balance of Th1/Th2 cells.
32119492 Juvenile Idiopathic Arthritis. 2022 Jan Juvenile idiopathic arthritis (JIA) is a heterogeneous group of idiopathic inflammatory arthritis affecting children younger than 16 years of age and lasting six weeks or longer. The terminology of chronic arthritis in children has evolved from juvenile chronic arthritis (JCA) and juvenile rheumatoid arthritis (JRA) to JIA since 1995. According to the consensus conference of the International League of Associations for Rheumatology (ILAR) in 2001, there are seven JIA categories: a) oligoarthritis; b) rheumatoid factor (RF) positive polyarthritis; c) RF negative polyarthritis; d) systemic arthritis; e) psoriatic arthritis; f) enthesitis-related arthritis; g) undifferentiated arthritis. These subtypes have distinct phenotypes, genetic predispositions, pathophysiology, laboratory findings, disease course, and prognosis. Although chronic arthritis is mandatory for all subtypes, the extraarticular and the systemic manifestations characterized every specific subtype. Recently, a new preliminary data-driven classification for JIA is proposed and being formally validated by the Pediatric Rheumatology International Trial Organization (PRINTO).