28-joint Disease Activity Research Articles

Evaluation of anti-citrullinated type II collagen and anti-citrullinated vimentin antibodies in patients with juvenile idiopathic arthritis

BackgroundTo determine the prevalence and significance of anti-citrullinated vimentin and anti-citrullinated type II collagen antibodies and elucidate their role in the disease process of juvenile idiopathic arthritis (JIA).MethodsSera were obtained from 95 patients with various subtypes of JIA, 19 systemic lupus erythematosus (SLE) patients, and 10 healthy children. Antibodies were measured in the sera against citrullinated and native type II collagen and vimentin (vim1-16 and vim 59-74) by enzyme-linked immunosorbent assay. Samples were compared to anti-cyclic citrullinated peptide (anti-CCP) antibody and rheumatoid factor (RF) isotypes, and our previously measured anti-citrullinated fibrinogen and α-enolase antibodies on the same patient population, in addition to erythrocyte sedimentation rate and C-reactive protein. The relationship between the anti-citrullinated antibody profile and disease activity and joint damage were also investigated.ResultsTwenty-three JIA patients (24%) demonstrated reactivity to anti-citrullinated type II collagen. Ten JIA patients (10.5%) demonstrated reactivity to anti-citrullinated vimentin 1–16 antibodies and 7 (7.4%) to anti-citrullinated vimentin 59–74 antibodies. One IgM RF-positive polyarticular patient was positive for all 5 of the citrullinated autoantibodies tested. Thirty-seven different subsets of patients were identified based on their anti-citrullinated autoantibody and RF isotype profile. No significant associations were noted with anti-citrullinated type II collagen and anti-citrullinated vimentin antibodies with joint damage or disease activity. Anti-citrullinated vimentin 59–74 antibodies demonstrated the highest overall specificity at 89.7%, with anti-citrullinated vimentin 1–16 and anti-citrullinated type II collagen antibodies at 86.2%.ConclusionThis study demonstrates that antibodies to multiple citrullinated epitopes are present in the sera of patients with various subtypes of JIA. It also demonstrates the frequent occurrence of anti-citrullinated type II collagen and anti-citrullinated fibrinogen antibodies. The presence of autoantibodies to citrullinated antigens in JIA patients is highly diverse.

A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study

To conduct a proof-of-concept randomized trial of an Internal Family Systems (IFS) psychotherapeutic intervention on rheumatoid arthritis (RA) disease activity and psychological status. Patients with RA were randomized to either an IFS group for 9 months (n = 39) or an education (control) group (n = 40) that received mailed materials on RA symptoms and management. The groups were evaluated every 3 months until intervention end and 1 year later. Self-assessed joint pain (RA Disease Activity Index joint score), Short Form-12 physical function score, visual analog scale for overall pain and mental health status (Beck Depression Inventory, and State Trait Anxiety Inventory) were assessed. The 28-joint Disease Activity Score-C-reactive Protein 4 was determined by rheumatologists blinded to group assignment. Treatment effects were estimated by between-group differences, and mixed model repeated measures compared trends between study arms at 9 months and 1 year after intervention end. Of 79 participants randomized, 68 completed the study assessments and 82% of the IFS group completed the protocol. Posttreatment improvements favoring the IFS group occurred in overall pain [mean treatment effects -14.9 (29.1 SD); p = 0.04], and physical function [14.6 (25.3); p = 0.04]. Posttreatment improvements were sustained 1 year later in self-assessed joint pain [-0.6 (1.1); p = 0.04], self-compassion [1.8 (2.8); p = 0.01], and depressive symptoms [-3.2 (5.0); p =0.01]. There were no sustained improvements in anxiety, self-efficacy, or disease activity. An IFS-based intervention is feasible and acceptable to patients with RA and may complement medical management of the disease. Future efficacy trials are warranted. ClinicalTrials.gov identifier: NCT00869349.

Do Radiographic Joint Damage and Disease Activity Influence Functional Disability Through Different Mechanisms? Direct and Indirect Effects of Disease Activity in Established Rheumatoid Arthritis

To explore the relationship between rheumatoid arthritis (RA) disease activity and functional disability over time, considering indirect (predictive) and direct (concurrent) associations as well as the influence of radiographic joint damage and treatment strategy. Functional disability [Health Assessment Questionnaire (HAQ)], disease activity [28-joint Disease Activity Score (DAS28)], and radiographic joint damage [Sharp/van der Heijde score (SHS)] were measured in 4 consecutive randomized controlled trials with increasingly intensive (tight control) treatment strategies. Average followup time for the 3 cohorts was 97, 53, and 50 months, respectively. Next to current DAS28, the previous DAS28 was used to study the predictive effect of a change in DAS28 on progression of functional disability (HAQ). Finally, it was investigated whether SHS mediated the predictive effect of DAS28. In patients treated with intensive treatment strategies, the progression of HAQ over time was statistically significantly less (p < 0.0001). The predictive influence of DAS28 on HAQ progression increased over the duration of the disease. SHS was not found to influence HAQ progression and did not mediate the predictive effect of DAS28. In the less intensively treated patients, the direct effect of disease activity decreased with disease duration, and contrarily, SHS did influence HAQ progression, but was not found to (fully) mediate the predictive effect of DAS28. In patients with RA treated with modern treatment strategies, there is less functional decline over time. Further, disease activity does predict functional decline but joint damage does not. This might indicate that factors associated with cumulative disease activity but not visible on radiographs can influence functional decline in patients with RA. This further underlines the importance of disease activity as a treatment target in early RA and in established RA.

Metabolic syndrome in psoriatic arthritis patients: A cross-sectional study

The major objective of our study was to assess the prevalence of metabolic syndrome in Indian patients with psoriatic arthritis. This was a one-time survey involving no follow-up. The study was performed among outpatients attending the speciality clinics of an institutional tertiary referral centre. A consecutive sample of 100 patients diagnosed as having psoriatic arthritis in our clinics was included in the study. Height, weight, body mass index, blood pressure and waist circumference of patients were measured at the enrolment visit. Venous samples were taken after 8 h of overnight fasting for the estimation of serum cholesterol, triglycerides and plasma glucose levels. The primary study outcome was the prevalence of metabolic syndrome in the study population. Fifty-eight and 59 patients had metabolic syndrome according to the Adult Treatment Panel III criteria and the consensus definition of metabolic syndrome for adult Asian patients, respectively. Patients with metabolic syndrome were older (P < 0.001), with longer duration of psoriasis (P = 0.017), and higher Bath Ankylosing Spondylitis Activity Index (P = 0.016) than those without metabolic syndrome. Metabolic syndrome is common in Asian Indian patients with psoriatic arthritis, especially in those with long-standing psoriasis and active joint disease.

AB0289 Can cd11c expression successfully predict response to etanercept in rheumatoid arthritis patients?

BackgroundThe treatment of rheumatoid arthritis (RA) with biologic drugs such as anti-tumor necrosis factor alpha (TNF) has significantly improved the clinical outcome in patients; however, 30-40% of patients fail to...

AB0926 The relationship between disease activity indices in patients with psoriatic arthritis

BackgroundPsoriatic arthritis (PA) is a chronic inflamatory joint diseasewhich combines skin disease (psoriasis) with various joint manifestations (spondylitis, peripheral arthritis, dactilytis and enthesitis) (1). Some authors said that 11% of...

AB0589 Subclinical atherosclerosis found both in psoriatic arthritis and rheumatoid arthritis

BackgroundCardiovascular disease (CVD) is found in almost all chronic musculoskeletal diseases that include Psoriatic arthritis (PsA) and rheumatoid arthritis (RA).ObjectivesTo assess subclinical atherosclerosis in patients with PsA and RA.MethodsPatients with...

AB1275 Ultrasound evaluation of the hands and wrists joints: a proposal of a new 10-joint ultrasound score for diagnosis and assessment of early rheumatoid arthritis patients

BackgroundPrevious reports have described the use of ultrasound (US) scores to evaluate rheumatoid arthritis (RA). However, no previous studies have used the ultrasound assessment of the hand and wrist joints...

THU0121 The interferon type I signature towards prediction of non-response to rituximab in rheumatoid arthritis patients

BackgroundB cell depletion therapy is efficacious in rheumatoid arthritis (RA) patients failing on tumor necrosis factor (TNF) blocking agents. However, approximately 40-50% of rituximab (RTX) treated RA patients have a...

AB0612 The investigation of factors associated with efficacy of methotrexate in rheumatoid arthritis and seronegative spondyloarthropathies

BackgroundRheumatoid arthritis and seronegative spondyloarthropathies have high prevalence and present as the major cause of early invalidity worldwide. DMARDs present as an essential part of the treatment of these diseases....

SAT0014 Correlation of CRP haplotypes with response to anti-TNF therapy in UK patients – results from the BRAGGSS cohort

BackgroundAnti-TNF medication is the most effective treatment method in patients with RA and reduces inflammation by blocking the TNF pathway. However, this treatment is expensive, costing ∼£10,000 per patient, per...

AB0451 The efficacy of anti-tumor necrosis factor therapy and the factors which contribute to fatigue in rheumatoid arthritis

BackgroundFatigue is an important domain in the assessment of disease impact but has rarely been evaluated consistently after initiation of treatment in Rheumatoid Arthritis (RA) patients. Due tothe known efficacy...

THU0174 Impact of IL-6R and IL-6ST Polymorphisms on Response to Anti-TNF Therapy in UK Patients – Results from the Braggss Cohort

BackgroundAnti-tumour necrosis factor (anti-TNF) biologic therapy is a highly effective yet expensive treatment for patients with Rheumatoid Arthritis (RA). Patient eligibility for therapy and response to treatment is assessed using...

SAT0014 Synovial Sublining Macrophages: A Sensitive Biomarker for Response to Treatment in Early RA Patients.

BackgroundThe synovial membrane is the primary site of inflammation in rheumatoid arthritis and as such the study of pathobiological synovial specimens has led to a greater understanding of disease pathogenesis....

THU0087 Synovial Ectopic Lymphoid-like Structures are Associated with Diagnosis of Rheumatoid Arthritis, Disease Activity and Antibody Status in Early Arthritis Patients

BackgroundThe presence of ectopic lymphoid-like structures (ELS) within the synovial tissue of a cohort of patients with inflammatory arthritis is well recognised. There is also data supporting the concept that...

Frequencies of circulating IL-17-producing CD4+CD161+ T cells and CD4+CD161+ T cells correlate with disease activity in rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) is a common autoimmune disease that is primarily driven by effector T cells, particularly Th17 cells, which are mainly contained within CD4+CD161+ T cells. Thus, we aimed to explore whether the frequencies of circulating IL-17-producing CD4+CD161+ T cells and CD4+CD161+ T cells were correlated with RA disease activity. METHODS: The surface phenotype and cytokine production of blood were analyzed by flow cytometry in 52 RA patients and 17 healthy controls. The disease activity was evaluated by the 28-joint disease activity score. RESULTS: The frequencies of circulating IL-17-producing CD4+CD161+ T cells and CD4+CD161+ T cells were increased in RA patients, and they were elevated in patients with active disease status compared to patients with low disease status. Furthermore, their frequencies were positively correlated with disease activity parameters. Receiver operating characteristic curve analysis revealed that IL-17-producing CD4+CD161+ T cell levels were able to distinguish disease activity with 60.7% sensitivity and 87.5% specificity, while CD4+CD161+ T cell levels showed 92.9% sensitivity and 66.7% specificity. CONCLUSION: These results support the hypothesis that Th17 cells are involved in the pathogenesis of RA and suggest that circulating CD4+CD161+ T cells are a potential biomarker of RA disease activity.

Variación del nivel de citoquinas en líquido sinovial de equinos con enfermedad articular tratados con bisfosfonatos

Osteoarthritis is one of the most common joint diseases in sport horses and is also cause of great economic losses associated. Early diagnosis of this disease, which sometimes is not feasible with radiographic studies, brings the possibility of early treatment in order to avoid greater commitment of underlying subchondral bone. While related cytokines play a physiological role in normal arthicular bone remodeling their increase may be considered pathological. This study postulates the determination of osteoarthicular cytokine levels (TNF-α, IL-1 β, IL-6, IL-4), as early diagnosis of osteoarthritis as well as for the evaluation of pamidronate, an aminobisphosphonates of second generation, post treatment OA evolution. We divided the animals in three groups that were classified according to the presence or not of joint disease and also considering degree of activity of OA and treatment response with bisphosphonates. As can be observed, the cytokines levels were elevated during active joint disease, and decreased after bisphosphonates treatment.

Bone Effects of Biologic Drugs in Rheumatoid Arthritis

Biologic agents used in the treatment of rheumatoid arthritis (RA) are able to reduce both disease activity and radiographic progression of joint disease. These drugs are directed against several proinflammatory cytokines (TNFα, IL-6, and IL-1) which are involved both in the pathogenesis of chronic inflammation and progression of joint structural damage and in systemic and local bone loss typically observed in RA. However, the role of biologic drugs in preventing bone loss in clinical practice has not yet clearly assessed. Many clinical studies showed a trend to a positive effect of biologic agents in preventing systemic bone loss observed in RA. Although the suppression of inflammation is the main goal in the treatment of RA and the anti-inflammatory effects of biologic drugs exert a positive effect on bone metabolism, the exact relationship between the prevention of bone loss and control of inflammation has not been clearly established, and if the available biologic drugs against TNFα, IL-1, and IL-6 can exert their effect on systemic and local bone loss also through a direct mechanism on bone cell metabolism is still to be clearly defined.

Baseline comorbidities in patients with rheumatoid arthritis who have been prescribed biological therapy: A case control study

AimTo determine whether rheumatoid arthritis (RA) patients who have been prescribed biological agents exhibit a different comorbidity burden than RA patients who take disease-modifying antirheumatic drugs (DMARDs) alone, and to understand the association between comorbidity and other variables, as well as the association between comorbidity and multimorbidity. MethodsThis observational case–control study included 114 RA patients treated with biological agents and a control group comprising 163 sex- and age-matched RA patients treated with DMARDs only. Current and previous data regarding the patients’ disease activity, comorbidities, and treatments were collected. The data were analysed using bivariate and multivariate regression models. ResultsThe patients who were prescribed biological agents exhibited poorer disease control, received more DMARDs and steroids, and underwent more total joint arthroplasties compared with the patients in the control group. However, the risk factors for cardiovascular disease and the comorbidity frequency were similar between cases and controls. The most prevalent comorbidities were hypertension, obesity, and respiratory, thyroid, and upper gastrointestinal disorders. The incidence of cardiovascular disease was low, and only 29% of the patients exhibited multimorbidities. A bivariate association of age, late diagnosis, joint replacements and a high score on the health assessment questionnaire score (HAQ) with comorbidity was observed. There were also correlations between the Charlson index and age, joint reconstructive surgery, disease activity (DAS28), and HAQ score. However, when binary logarithmic regression models were applied, only patient age remained significantly associated with comorbidity and multimorbidity [hazard ratio, 1.08; 95% confidence interval, 1.05–1.12; p<0.0005]. ConclusionRA patients taking biological drugs have a comorbidity burden equivalent to those treated with DMARDs alone. Age is the main predictive factor of comorbidity in these patients.

Physician scores vs patient self-report of joint and skin manifestations in psoriatic arthritis

We aimed to determine the degree of agreement between patient self-report and physician assessment of joint disease activity and damage and degree of skin disease. Patients were followed up in the PsA clinic for homunculus for tender joints, swollen joints, deformed joints and problematic joints, as well as the severity of their psoriasis. A rheumatologist documented tender joints, swollen joints and damaged joints as well as psoriasis area and severity index score. The scores were compared using the concordance correlation coefficient and Bland-Altman plots were constructed. One hundred and forty outpatients participated in the study (60 females and 80 males) with a mean age of 52.8 years. Their mean age at onset of psoriasis was 27.4 years and at PsA onset was 36.9 years. The average duration of psoriasis at the time of the study was 25.3 years and of PsA was 16.2 years. The correlation between patient and physician scores was poor for tender and swollen joints, although it was better for deformed joints and psoriasis area and severity index score but still did not reach a level of good agreement. PsA patient's self-report has a poor correlation with physician assessment. Thus patient self-reported data are insufficient to accurately monitor PsA disease activity when compared with a physician's joint examination and skin score. Expert physical examination should remain the gold standard for the assessment of actively inflamed joint and skin disease in patients with PsA in both clinical trials and observational cohort studies.