Anti-cyclic Citrullinated Peptide Levels Research Articles

Association of Interleukin-17 and ACCP levels with Rheumatoid arthritis patients and Control Groups

Background: Rheumatoid arthritis (RA) represents the prevailing form of chronic inflammatory polyarthritis, characterized by an autoimmune response directed against citrullinated antigens and subsequent synovial joint destruction. The susceptibility to RA appears to be influenced by a complex interplay between a specific immune response to various environmental factors and a favorable genetic predisposition. IL-17 Association with Diseases found to be elevated in various chronic inflammatory conditions including RA especially in cases resistant to anti-TNF therapy. Aim : To investigate the value of IL-17 and ACCP levels with study groups as well as the association of chronic periodontal disease as an environmental risk factor of RA. Methods : This case-control study involved a total of 140 participants were enrolled, with 70 individuals meeting specific criteria and serological testing confirming their RA diagnosis, while the remaining 70 served as healthy controls.The study involved the collection of blood samples from the participants. Various measurements and tests were conducted, including the assessment of disease activity using the Disease Activity Score (DAS28-ESR) and erythrocyte sedimentation rate (ESR), detection of RF through latex agglutination, quantification of anti-cyclic citrullinated peptide (ACCP) and interleukin-17 (IL-17) levels via enzyme-linked immunosorbent assay (ELISA). Results : RA patients exhibited substantially higher values for ESR, RF, ACCP compared to the control group. Also IL-17 substantially higher values for RA patients Notably, the p-values for ESR, ACCP, and IL-17 were 0.0001, 0.02, and 0.0001, respectively, indicating strong statistical significance. patients who had gum problems were 43(61.4 %) while the control group was 9 (12.5%) had a gum problem Statistically, parameter had significant differences (p.value=0.0001).

Serum Vitamin D and Anti-Cyclic Citrullinated Peptide Levels in Rheumatoid Arthritis Patients

Background: Rheumatoid arthritis (RA) is long-term autoimmune disorder that primarily affects the joints. Vitamin D has a role in the activity and pathogenesis of RA. The aim of this study is to determine the correlation of vitamin D and anti-cyclic citrullinated peptide (anti-CCP) with disease activity in RA patients. Methods: A case-control study was conducted between November 2021 and February 2022. A questionnaire was designed to obtain demographic and clinical data from both males and females over 18 years old who did not take vitamin D supplements. A total of 142 blood samples were collected in sterile containers from RA patients. Serum vitamin D and anti-CCP levels from cases and control samples were measured using ELISA. Results: Of the cases, 77.45% were females and 22.55% were males, whereas 67.5% of the controls were females and 32.5% were males. The average age of the cases and controls was 48.1 +/- 1.06 years and 34.0 +/- 1.04 years, respectively. The level of vitamin D was 32.5 +/- 1.8 in the cases and 19.1 +/- 1.6 in the controls. The level of anti-CCP was 42.1 +/- 1.6 in the cases and 0.52 +/- 1.4 in the controls. Vitamin D deficiency level ratio was 21.7% for the cases and 61% for controls, vitamin D insufficiency ratio was 30.4% for the cases and 18% for controls, and vitamin D sufficiency ratio was 47.9% for the cases and 21% for controls. Conclusions: There was an inverse negative correlation between vitamin D level and disease activity in RA patients.

B cell depletion in patients with rheumatoid arthritis is associated with reduced IL-1β in GCF.

We evaluated the effect of B cell depletion on the clinical periodontal findings and IL-1β and MMP-8 levels of the gingival crevicular (GCF) fluid in patients with rheumatoid arthritis (RA). Seventy patients were included in this case-control study. Twenty patients with RA were undergoing B-cell depletion treatment. The second group of RA patients (n = 20) were undergoing non-B-cell depletion treatment with Disease-Modifying Anti-Rheumatic Drugs (DMARD). Control group, with no RA, consisted of 30 individuals. Periodontal parameters including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) were recorded. IL-1β and MMP-8 levels in GCF were determined using enzyme-linked immunosorbent assay. Rheumatological parameters including Disease Activity Score-28 (DAS-28), rheumatoid factor levels (RF), and anti-cyclic citrullinated peptide levels were included in the data analyses. All groups were similar in PD, CAL, BOP, GI, and PI measures. GCF IL-1β levels were 1.85 ± 1.67pg in the B-cell depletion group, 10.50 ± 13.16pg in the DMARD group, and 34.12 ± 29.45pg in the control group (p < 0.001). MMP-8 levels were 21.00 ± 4.23pg in the B-cell depletion group, 8.16 ± 6.94pg in the DMARD group, and 21.45 ± 8.67pg in the control group (p < 0.001). DAS 28, RF, and anti-CCP were similar in RA groups. GCF IL-1β levels were significantly lower in B cell depletion group, and MMP-8 levels were significantly lower in DMARD group, suggesting that rheumatoid arthritis treatments may modify biochemical parameters of GCF. This study suggests that host modulation therapies in RA can reduce local production of IL-1β and MMP-8. Reduction of these inflammatory cytokines and enzymes may have a beneficial effect in controlling periodontal tissue destruction.

Elevated serum Dickkopf-1 is a biomarker for bone erosion in patients with psoriatic arthritis.

Background:Psoriatic arthritis (PsA) is an inflammatory arthropathy characterized by psoriasis and bone erosion on radiology. Dickkopf-1 (Dkk-1) is considered to be the main inhibitor of the Wnt signaling pathway and results in reduced osteoblast proliferation. The aim of this study was to investigate the serum level of Dkk-1 and its association with bone erosion in PsA patients.Methods:Serum Dkk-1 levels were measured by enzyme-linked immunosorbent assay (ELISA) in 69 patients with PsA and 60 controls, including 39 rheumatoid arthritis (RA) patients, and 21 healthy controls (HCs). Rheumatoid factor and anti-cyclic citrullinated peptide levels were also determined by ELISA. The association of Dkk-1 level with clinical and laboratory features of PsA was analyzed. Logistic regression analysis was used to analyze the risk factors for bone erosion in PsA.Results:Dkk-1 was elevated in 68.1% (47/69) of the patients with PsA, 46.2% (18/39) of RA patients, and 9.5% (2/21) of HCs. Serum Dkk-1 concentration was significantly higher in PsA patients compared with that in HCs. The level of serum Dkk-1 was correlated with a swollen joint count, and levels of complement components 3 and 4. Elevated Dkk-1 level (odds ratio = 4.440, 95% confidence interval: 1.246–15.817, P = 0.021) was identified as the risk factor for bone erosion in PsA.Conclusions:The serum level of Dkk-1 is abnormally elevated in PsA patients. The elevation of Dkk-1 might be involved in the mechanism of bone erosion in patients with PsA.

Disease Activity in Disease Modifying Anti-Rheumatic Drug (DMARD) Naïve Rheumatoid Arthritis Patients in A Subset of Karachi Population

Background: Rheumatoid arthritis (RA) is a progressive inflammatory disease affecting the joints with a marked impact upon functional capacity of the patient. The working ability of RA patients can be preserved if the disease modifying antirheumatic drug (DMARD) therapy is initiated early in the course of disease. The objective of our study was to compare the disease activity variables in DMARD-naïve seropositive rheumatoid arthritis (SPRA) and seronegative rheumatoid arthritis (SNRA) patients and to determine correlations between the disease activity variables in RA. Methods: A cross-sectional study recruited n=90 patients from Rheumatology Clinic from May 2020 to October 2020. The rheumatoid factor (RF), anti-cyclic citrullinated peptide levels (ACCP), erythrocyte sedimentation rates (ESR) were clinically measured. Disease activity variables including the tender joint count (TJC), swollen joint count (SJC), health assessment questionnaire-disability index (HAQ-DI) and disease activity score of 28 joints (DAS28) were consistently calculated. Patients were divided into seropositive RA group and seronegative RA group, based on RF and ACCP. Chi squared test and Pearson correlation were applied, p≤0.05 was considered statistically significant. Results: High HAQ-DI and DAS28-ESR scores were found in SPRA than in the SNRA patients and were statistically significant (p=0.000, p=0.054). TJ-28 and SJ-28 counts were higher in SPRA but were not statistically significant. There was a significant correlation of DAS28 with TJ-28 (r=0.816, p-value = 0.000), with SJ-28(r=0.801, p-value = 0.000) and HAQ-DI (r=0.517, p-value = 0.000). Conclusion: Evaluation of inflammatory markers and functional disability was found significant (p=0.000) in determining the disease activity compared to presence of autoantibodies in DMARD naïve RA patients. Keywords: Disease Modifying Antirheumatic Drug; Arthritis; Rheumatoid Factor; Autoimmune Diseases.

Clinical correlation and determination of Dkk-1 and sclerostin levels in patients with rheumatoid arthritis

The aim of this study is to compare serum Sclerostin and Dickkopf-1 (Dkk-1) levels in patients with rheumatoid artrithis (RA) and healty controls to determine their clinical significance in patients with RA. Sixty with RA according to American Collage of Rhematology criteria and at least one year follow up, enrolled in this study and compared thýrty healty controls. To evaluate disease activity score 28 (DAS28) was calculated. Physical function capasity (disability) was asssessed with Health Assesment Quastionnarie (HAQ) and Nottingham Health Profile (NHP). Erythrocyte Sedimentation Rate, C Reactive Protein, Rheumatoid Factor and anticyclic citrullinated peptide levels were determined by routine laboratory methods. Serum sclerostin and Dkk-1 levels of the patients with RA and healty controls were measured by ELISA. Radiographic assesment of hands joints was evaluated according to the modified Larsen score. Between patients with RA and healty controls, there was significant difference with respect to the age (respectively p=0.00) and significant difference with respect to gender (p=0.033). Serum sclerostin and dickkopf-1 levels were significantly higher (p=0.002, p=0.049) in patients with RA compared to healty controls. Serum sclerostin and dickkopf-1 levels were doesnt correlated with clinical and laboratory parameters of disease activity. There was no significant correlation between radiological scoring of joint damage and serum sclerostin and dickkopf-1levels (p 0.05). This study shows that Serum sclerostin and dickkopf-1 levels were increased in RA patients in comparison to control group but there was no significant correlation with the disease activity and joint damage. The sample of our study can be enlarged and further studies are required.

Predicting Imaging Remission in Rheumatoid Arthritis: a Case-control Ultrasound Study.

BackgroundTo elucidate the achievement rates of imaging remission and to examine the characteristics associated with imaging remission status among patients with rheumatoid arthritis (RA) who have attained clinical remission.MethodsNinety-seven patients with RA patients who had attained clinical remission, defined by DAS28-ESR < 2.6 were enrolled. Power Doppler ultrasonography (PDUS) was performed on 16 joints and 2 tendons, including the first to third metacarpophalangeal, second and third proximal interphalangeal, radiocarpal (RC), second and third metatarsophalangeal joints, and extensor carpi ulnaris tendons. They were graded based on a dichotomous assessment. The clinical and laboratory data of patients who had attained imaging remission were compared to those of patients who had attained only clinical remission.ResultsThe imaging remission rate was 51.5% in patients who had attained clinical remission. Forty-seven patients (48.5%) were PDUS positive. Power Doppler was detected most frequently in the right RC joint (n = 40). PDUS positive patients had higher evaluator global assessment (EGA) scores (P < 0.001) than PDUS negative patients. PDUS positive patients also had higher clinical disease activity index and simplified clinical disease activity index scores than PDUS negative patients. Patients who had attained imaging remission had lower pain scores and used nonsteroidal anti-inflammatory drugs less frequently. Patients who had attained imaging remission had higher rheumatoid factor (RF) and anti-cyclic citrullinated peptide levels. A low EGA score was found to be a predictor of imaging remission achievement among patients who had attained clinical remission.ConclusionOnly 51.5% of the patients with RA who had attained clinical remission were also in imaging remission. Patients who had attained imaging remission had lower EGA scores and higher RF levels than patients who had attained only clinical remission.

Autoimmune thyroid disease in Egyptian patients with rheumatoid arthritis

Aim of the workTo determine the frequency of autoimmune thyroid disease (AITD), anti-thyroglobulin (ATG) and anti-thyroid peroxidase (ATPO) antibodies in Egyptian patients with rheumatoid arthritis (RA). Patients and methods60 RA patients and 60 matched controls were enrolled. Clinical and laboratory data were examined in the patients. The disease activity score (DAS28) and modified health assessment questionnaire (MHAQ) were evaluated. Presence of AITD, ATG and ATPO antibodies were assessed. ResultsThe mean age of the patients was 41 ± 10.5 years, 43 (71.7%) were females and had a disease duration of 8.6 ± 4.1 years. Their mean anti-cyclic citrullinated peptide level was 31.8 ± 33.5 IU/ml), DAS28 (4 ± 1.4) and MHAQ was 1.5 ± 0.5. The thyroid hormones (T3, T4 and thyroid stimulating hormone) were comparable to that of the control. The ATG (80.7 ± 39.3 IU/ml) and ATPO (70.3 ± 39.7 IU/ml) antibodies were significantly increased in RA patients compared to the control (21.5 ± 6.6 IU/ml and 20.5 ± 11.2 IU/ml respectively; p < 0.001). Thyroid dysfunction was present in 38.3% compared to 6.7% in controls (p < 0.001). The frequencies of AITD, ATG and ATPO were higher in patients (23.3%, 26.7% and 33.3% respectively) compared to controls (0%, 3.3% and 6.7%). ATG antibodies, ATPO antibodies and AITD positivity in patients were significantly associated with younger age, female gender, erythrocyte sedimentation rate and DAS28. ConclusionAITD is frequent among patients with RA. Therefore, there is a need of screening of thyroid hormone dysfunction as well as of presence of ATPO and ATG antibodies as markers of AITD in RA patients particularly in young patients, females and those with high disease activity.

Serum heat-shock protein-65 antibody levels are elevated but not associated with disease activity in patients with rheumatoid arthritis and ankylosing spondylitis.

ObjectivesHeat-shock proteins (HSPs) have gained increased interest for their role in autoimmune disorders. These proteins are targeted by the immune system in various autoimmune diseases. The aim of this study was to assess the serum heat-shock protein-65 antibody (anti-HSP65) levels and their clinical significance in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS).Patients and methodsA total of 30 patients with RA, 30 patients with AS, and 30 healthy controls were enrolled in this study. All patients were assessed using routine clinical and laboratory evaluations. Serum anti-HSP65 levels were determined by ELISA.ResultsSerum anti-HSP65 levels of both RA and AS patients were significantly higher than those of controls (p=0.014 and p=0.001, respectively). No association was found between serum anti-HSP65 levels and disease activity in either RA or AS patients. There was a significant correlation between anti-HSP65 and anti-cyclic citrullinated peptide levels in patients with RA (p=0.024).ConclusionIn this study, serum anti-HSP65 levels were increased, but not associated with disease activity in both RA and AS patients. These results suggest that HSP antigens may play a role in the pathogenesis. However, further follow-up studies are needed. Identification of target antigens such as HSP65 is vital to developing new immunotherapeutic agents.

Relationship Between Smoking and Structural Damage, Autoimmune Antibodies, and Disability in Rheumatoid Arthritis Patients.

This study aims to investigate the relationship between smoking and structural damage, autoimmune antibodies, and disability in rheumatoid arthritis (RA) patients. This cross-sectional study included 165 RA patients (36 males, 129 females; mean age 52.4±12.8 years; range 21 to 82 years). Disease duration, age at disease onset, smoking habits, rheumatoid factor (RF), and anti-cyclic citrullinated peptide levels were recorded. Morning stiffness, pain with visual analog scale, Health Assessment Questionnaire Scores And Disease Activity Score 28 were calculated. Patients' standard hand radiographs were evaluated. Patients were divided into three groups according to their smoking habits. Ninety-nine patients (60%) were never smokers, 45 patients (27.3%) were long-term smokers and 21 patients (12.7%) were new smokers. Three groups were compared for disease activity. Disease activity score 28 scores were 3.2±1.2, 3.2±1.3, and 3.2±1.4, respectively (p>0.05). The erosion score (2.6±5.8, 7.1±10.9, and 11.1±19.2, respectively) and joint space narrowing score (9.9±7.3, 18.6±14.9, and 17.3±12.3, respectively) according to modified Sharp method were significantly lower in never smokers group than other groups (p<0.05). RF titrations were 55.2±58.9, 60.5±63.1, and 84.9±71.5, respectively, and levels of long-term smokers group were significantly higher than the other groups (p<0.05). Joint space narrowing score was 16.2±11.9 and 6.4±10.4 in RF (+) and RF (-) patients, respectively (p<0.05). There was no significant relationship between anti-cyclic citrullinated peptide levels and others parameters. Although smoking is known as a poor prognostic factor in RA, there was no correlation between disease activity and smoking in our study. However, less radiographic damage was found in never smokers. Smoking does not appear to correlate with RA disease activity but it may be effective in the long-term joint damage.

Measurement of Anti-Cyclic Citrullinated Peptide, Leptin Hormone, and Lipoprotein (a) In Iraqi Female Patients with Rheumatoid Arthritis

Back ground:-Rheumatoid arthritis is one of the most common forms of inflammatory polyarthritis, with a prevalence of approximately 0.8% of adults worldwide, Rheumatoid arthritis patients may become disabled within few years if untreated that may lead to permanent disability. Different biomarkers have been assessed for the improved diagnosis of Rheumatoid arthritis, including a wide range of autoantibodies. However, only rheumatoid factor (RF) and anti-cyclic citrullinated peptide (ACCP) have gained wide acceptance.&#x0D; Aim of the study to investigate the levels of ACCP, Leptin, and Lipoprotein (a) in females with RA to provide information on possible pathophysiologic mechanisms, and to give recommendations for determination of these parameters in diagnosis and follow up of Rheumatoid arthritis patients.&#x0D; Patients and methods:- The study included Forty women with RA and Thirty apparently healthy women with matching age and weight as controls.The patients were selected at the outpatient clinic of Rheumatology &amp; Rehabilitation in Medical City/ Baghdad Teaching Hospital during the period from (May2013 ) to (December2013 ). &#x0D; Results:-The results showed that levels of ACCP antibodies in serum of patients with RA were significantly higher than in serum of healthy control. Also there were significant differences between mean of serum leptin level and Lp (a) in patients compared to the control group.&#x0D; Conclusion:- Serum biomarkers like ACCP, Leptin, &amp; Lipoprotein (a) assays are becoming increasingly available and may help in early diagnosis and assessment of complications in Rheumatoid arthritis patients.

AB0373 Integrating Treatment Goals of Physicians, Patients, and Payers during Treatment with Golimumab in Patients with Rheumatoid Arthritis

BackgroundPhysicians, patients, and payers may have different ideas about what constitutes successful treatment and how treatment goals should be defined for rheumatoid arthritis (RA).ObjectivesTo evaluate the overlap between attained treatment...

Defining the role of Porphyromonas gingivalis peptidylarginine deiminase (PPAD) in rheumatoid arthritis through the study of PPAD biology

BackgroundAntibodies to citrullinated proteins are a hallmark of rheumatoid arthritis (RA). Porphyromonas gingivalis peptidylarginine deiminase (PPAD) has been implicated in the initiation of RA by generating citrullinated neoantigens and due...

Assessment of Interleukin‐6 Receptor Inhibition Therapy on Periodontal Condition in Patients With Rheumatoid Arthritis and Chronic Periodontitis

Overproduction of interleukin (IL)-6 may play a pathologic role in rheumatoid arthritis (RA) and chronic periodontitis (CP). The present study assesses IL-6 receptor (IL-6R) inhibition therapy on the periodontal condition of patients with RA and CP. The study participants were 28 patients with RA and CP during treatment with IL-6R inhibitor, and 27 patients with RA and CP during treatment without IL-6R inhibitor. Periodontal and rheumatologic parameters and serum levels of cytokine and inflammatory markers and immunoglobulin G against periodontopathic bacteria were examined after medication with IL-6R inhibitor for 20.3 months on average (T1) and again 8 weeks later (T2). No differences were observed between the groups in any parameter values at T1, except for serum IL-6 levels. The anti-IL-6R group showed a significantly greater decrease in gingival index, bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and serum levels of IL-6 and matrix metalloproteinase (MMP)-3 from T1 to T2 than the control group (P <0.05). A significant correlation was found between changes in serum anticyclic citrullinated peptide levels and those in PD and CAL in the anti-IL-6R group (P <0.05), whereas both groups exhibited a significant association between changes in serum MMP-3 levels and those in BOP (P <0.05). Changes in periodontal and serum parameter values were different between the patients with RA and CP during treatment with and without IL-6R inhibitor.

Is serum anti-cyclic citrullinated peptide level useful in the diagnosis of rheumatoid arthritis?

BackgroundTo find out whether serum level of anti-cyclic citrullinated peptides (anti-CCP) could be useful in the diagnosis of rheumatoid arthritis (RA). MethodsThe study was performed against 1972 patients who visited Hanyang University Medical Center and were tested positive for anti-CCP. ResultsWhen test results were classified into 6 groups according to the anti-CCP level, diagnostic rates of RA in each group were distributed from 73.6% to 77.2%. The increase of serum level did not have any correlation with the diagnostic rate of RA. ConclusionsThe level of serum anti-CCP was not useful in the diagnosis of RA.

Specific expression of PAD4 and citrullinated proteins in lung cancer is not associated with anti-CCP antibody production

Anti-citrullinated protein antibodies (ACPAs), produced against citrullinated proteins, are diagnostic and prognostic markers of rheumatoid arthritis (RA). The underlying mechanism that explains the connection of smoking, citrullination [catalyzed by peptidyl arginine deiminases (PADs)] and ACPAs is still unclarified in RA. Thus, we searched for a non-arthritic model in which an increased cell death allows the formation of autoantibodies. Data supporting that lung cancer might be a good candidate are as follows: (i) smoking plays a role in its pathogenesis, (ii) the disease is frequently accompanied by paraneoplastic syndrome, (iii) smoking increases citrullination in the lung, (iv) various types of malignancies are associated with increased citrullination and (v) lung cancer tissue shows similarities with RA synovium. Serum PAD4, rheumatoid factor (RF) and ACPA levels were measured in 42 lung cancer patients; expression of cytokeratin 7 (CK7), PAD4 and citrullinated proteins was visualized in 113 lung cancer tissues. All parameters were analyzed in correlation with smoking history. None of the patients had polyarthritis or autoimmune disease. Significantly increased RF levels were associated with higher PAD4 levels in smoker lung cancer patients compared with non-smokers. Both PAD4 and citrullination immunostaining strongly correlated with that of CK7 in lung cancer, however, did not differ according to smoking history. Two of 30 smoker lung cancer patients had high anti-cyclic citrullinated peptide levels. In conclusion, PAD4 and citrullination may be helpful in distinguishing lung cancer from healthy tissue. Smoking, abnormal serum PAD4 and RF levels may not be sufficient for the production of ACPAs and development of autoimmunity.

Sonographic and Electrodiagnostic Evaluations in Patients With Aromatase Inhibitor–Related Arthralgia

To investigate the prevalence of arthralgia in breast cancer patients taking aromatase inhibitors (AIs) and perform a detailed rheumatologic assessment including autoimmune serology, musculoskeletal sonography, and electromyography (EMG) in these patients. Postmenopausal patients with stage I to III breast cancer who were taking adjuvant AIs were enrolled (n = 92). Patients who were not receiving hormone treatment were included as a control group (n = 28). Musculoskeletal sonography and EMG were applied to the patients and the controls along with markers of autoimmunity. Thirty patients (32.6%) reported to have AI-related new-onset or worsening arthralgia. The most commonly affected joints were knee (70%), wrist (70%), and small joints of the hand (63%). Patients taking AIs had increased tendon thicknesses compared with those who never received AIs (P < .001). Patients with AI-related arthralgia had higher rates of effusion in hand joints/tendons than those without arthralgia (P = .033). More patients with AI-related arthralgia had EMG findings consistent with carpal tunnel syndrome (CTS) than those without arthralgia (P = .024). No significant difference was observed in erythrocyte sedimentation rates, C-reactive protein, antinuclear antibody, antidouble stranded DNA antibody, rheumatoid factor, or anticyclic citrullinated peptide levels between patients and controls or between those with and without arthralgia. Patients with AI-related arthralgia often show tenosynovial changes suggesting tenosynovitis, exerting local problems but lacking a systemic inflammatory component. Our finding of increased CTS frequency also supports this hypothesis.

Relationship of immunogenetic and immunologic markers and their influence on disease activity and radiological progression in patients with early rheumatoid arthritis

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Measuring metacarpal cortical bone by digital x-ray radiogrammetry: a step forward?

Changes in metacarpal cortical bone mineral density (BMD) using digital x-ray radiogrammetry were studied in patients with early rheumatoid arthritis. After 1, 2, and 5 years, large BMD losses were found: -1.7%, -2.8%, and -5.6%, respectively. Elevated erythrocyte sedimentation rate and anti-cyclic citrullinated peptide levels were independent predictors of bone loss, indicating that the largest amount of bone loss was found in patients with severe inflammation and high production of auto-antibodies, who are known to be at the highest risk of developing radiological bone damage. Studies are needed about the spatial and time relationship between erosions and juxta-articular and metacarpal bone loss.

Rheumatoid Arthritis Masked by Docetaxel Chemotherapy in a Patient With Ovarian Carcinoma

The taxanes (paclitaxel and docetaxel) are antimicrotubule agents used in the treatment of breast and ovarian cancers. Taxanes promote regression of collagen-induced arthritis in both animal models and humans by inhibiting proliferating synoviocytes. We report a case of rheumatoid arthritis suppressed by the administration of docetaxel-based chemotherapy. In October 2006, a 66-year-old woman presented to the hospital with symptoms in multiple joints that began 4 weeks after she had completed chemotherapy for ovarian cancer. She complained of pain, swelling, and stiffness in her hands and wrists bilaterally, as well as in her right elbow, left shoulder, and bilateral knees and ankles. She noted morning stiffness lasting approximately 2 hours and diminished grip strength. In June 2006, the patient had been diagnosed with ovarian carcinoma and had been treated with surgery, followed by adjuvant chemotherapy with docetaxel (60 mg/m2) and carboplatin dosed every 3 weeks for 4 cycles. Chemotherapy had ended in September 2006. The patient reported that her articular symptoms first began 6 months before her diagnosis of cancer, and had progressively worsened. Strangely, both her pain and stiffness had improved dramatically for the duration of her chemotherapy treatments, only to reappear again 4 weeks after the final cycle of chemotherapy. At presentation, she had swelling and tenderness in the metacarpophalangeal, proximal interphalangeal, and carpometacarpal joints bilaterally, as well as in multiple other joints. Laboratory studies showed a normocytic anemia, an erythrocyte sedimentation rate of 84 mm/h, and a C-reactive protein of 31 mg/L. Plain radiographs of the hands demonstrated symmetrical synovial thickening and joint space swelling involving the wrists and small joints of the hands. Rheumatoid factor was 673 IU/mL (normal <10 IU/mL), and an anticyclic citrullinated peptide level of 369 U/mL (normal <20 U/mL). A diagnosis of new-onset rheumatoid arthritis masked by concomitant docetaxel chemotherapy was made, and the patient was started on nonsteroidal anti-inflammatory drugs, corticosteroids, and sulfasalazine. Over the next 3 months, she showed a modest symptomatic and functional improvement. Docetaxel and paclitaxel are diterpenes extracted from the bark of yew trees of the genus Taxus. These agents, collectively known as taxanes, are used in the treatment of breast and ovarian cancer because of their ability to block the organization of the microtubule cytoskeleton during mitosis, inhibiting cell division. Because of their antimicrotubule properties, taxanes can also suppress cell migration, chemo-taxis, and adhesion. Outside of their role in cancer therapy, taxanes are potentially useful agents in rheumatoid arthritis because of their inhibitory effects on synovial cells. Because synoviocyte proliferation and pannus formation are the pathologic hallmarks of rheumatoid arthritis, taxanes represent a plausible therapy for this condition. To this end, paclitaxel has been shown to arrest mitosis and cell proliferation in cultured synoviocytes from both animals1 and humans.2 In addition, paclitaxel prevents the formation of collagen-induced arthritis in rats and induces clinical regression of existing arthritis.3 To date, there has only been one account of human rheumatoid arthritis improving with taxane therapy. In that report, a 38-year-old woman with longstanding rheumatoid arthritis showed an unexpected and marked amelioration in her arthritic symptoms while receiving paclitaxel chemotherapy for breast cancer.4 Although taxanes have been previously proposed for the therapy for human rheumatoid arthritis, clinical trials in this area are lacking, perhaps, because of the toxicity profile of these agents. Optimal concentration, dosing intervals, administration route, duration of therapy, cost, safety, and evaluation of side effects have never been investigated in rheumatoid arthritis patients. A phase II clinical trial evaluating paclitaxel in rheumatoid arthritis is currently underway.5