Association Of Arthritis Research Articles

Patient Reported Outcomes Following Triple Arthrodesis for Adult Acquired Flat Foot Deformity: Minimum Two Year Follow Up

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: The posterior tibial tendon (PTT) acts as the primary dynamic stabilizer of the medial longitudinal arch and insufficiency of the PTT can result in a broad range of symptoms from asymptomatic to debilitating arthritis in association with flat foot deformity. Staging of AAFD is based on the degree of deformity and broken into four groups. Triple arthrodesis (TA), a simultaneous fusion of the talonavicular, subtalar, and calcaneocuboid joint, is used for patients with intractable pain, instability, and stage 3-4 deformity due to hindfoot pathology. The purpose of this study was to identify patient-specific variables that independently influence PROMIS, Foot Function Index (FFI), and VAS scores as well as complication rates. Methods: A retrospective analysis was conducted of patients that underwent Triple Arthrodesis at our facility from 2014-2021. Patients were selected if they underwent an isolated triple arthrodesis. All cases included either a gastrocnemius recession versus a percutaneous tendo-achilles lengthening depending on the patient’s Silverskiold examination. The electronic medical record was utilized to collect basic patient demographics, previous foot and ankle surgeries, hardware failures, additional procedures, and surgical complications. To evaluate outcomes, we compared Patient Reported Outcomes Measurement Information System (PROMIS) survey scores with the general population and pre-operative vs. post-operative Visual Analog Scale (VAS) scores. Foot Function Index (FFI) scores and scores were utilized as a validation tool for our results. One hundred and thirty two patients met the criteria for our study with a total of 50 participants completing the PROMIS and FFI surveys. Results: The average time point at which the outcomes were collected was 5.50 years postoperatively, ranging from 1.65 to 7.57 years. The average PROMIS physical function was 38.35, pain interference was 61.52, and depression was 49.82 for this population. The mean FFI scores were 58.56 for pain, 60.07 for disability, 48.07 for activity limitation. There was a significant decrease in preoperative and postoperative VAS scores from 5.4 to 2.55 (p < 0.001). Three patients experienced wound complication related to decreased sensation. Conclusion: Our results indicated that only PROMIS depression scores were within one standard deviation of the population mean following a triple arthrodesis procedure. PROMIS physical function and pain interference were both outside of one standard deviation for the population.

Bacterial Compositional Shifts of Gut Microbiomes in Patients with Rheumatoid Arthritis in Association with Disease Activity

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disabling autoimmune disorder. Little is known regarding the association between the gut microbiome and etiopathogenesis of RA. We aimed to dissect the differences in gut microbiomes associated with RA in comparison to healthy individuals and, in addition, to identify the shifts in the bacterial community in association with disease activity; Methods: In order to identify compositional shifts in gut microbiomes of RA patients, V3-V4 hypervariable regions of 16S rRNA were sequenced using Illumina MiSeq. In total, sixty stool samples were collected from 45 patients with RA besides 15 matched healthy subjects; Results: Notably, RA microbiomes were significantly associated with diverse bacterial communities compared with healthy individuals. Likewise, a direct association between bacterial diversity and disease activity was detected in RA patients (Kruskal Wallis; p = 0.00047). In general, genus-level analysis revealed a positive coexistence between RA and Megasphaera, Adlercreutzia, Ruminococcus, Bacteroides, Collinsella, and Acidaminococcus. Furthermore, Spearman correlation analysis significantly stratified the most dominant genera into distinct clusters that were mainly based on disease activity (r ≥ 0.6; p ≤ 0.05). The predictive metabolic profile of bacterial communities associated with RA could support the potential impact of gut microbiomes in either the development or recovery of RA; Conclusions: The overall shifts in bacterial composition at different disease statuses could confirm the cross-linking of certain genera either to causation or progression of RA.

Specific Increase in Joint Neutrophil Extracellular Traps and Its Relation to Interleukin 6 in Autoimmune Arthritis.

Neutrophils and their extracellular traps have been shown to play an important role in the pathogenesis of rheumatoid arthritis (RA), but the detailed mechanisms in joints are still unclear, and their regulation remains to be solved. Here, we explored neutrophil extracellular trap (NET)osis in experimental models of arthritis and further investigated the effects of interleukin-6 (IL-6) inhibition in neutrophils and NETosis. In skins of peptide GPI-induced arthritis (pGIA), citrullinated protein was detected as well as citrullinated histone expression in immunized skin but this was not specific to pGIA. Citrullinated histone expression in pGIA joints was specific to pGIA and was merged with neutrophil elastase, suggesting NETosis. Neutrophils in joints tend to upregulate IL-6 receptors when compared with bone marrow neutrophils. Administration of mouse anti-IL-6 receptor antibodies in pGIA suppressed arthritis in association with a decrease in neutrophil infiltration and NETosis in joints. In the plasma of RA patients, citrullinated protein was significantly reduced after tocilizumab treatment. Our results suggest that IL-6 enhances neutrophil chemotaxis and NETosis in inflammatory joints and could be the source of citrullinated proteins.

Neutrophil Extracellular Traps Tied to Rheumatoid Arthritis: Points to Ponder.

In recent years, neutrophil extracellular traps at the forefront of neutrophil biology have proven to help capture and kill pathogens involved in the inflammatory process. There is growing evidence that persistent neutrophil extracellular traps drive the pathogenesis of autoimmune diseases. In this paper, we summarize the potential of neutrophil extracellular traps to drive the pathogenesis of rheumatoid arthritis and experimental animal models. We also describe the diagnosis and treatment of rheumatoid arthritis in association with neutrophil extracellular traps.

Statistical Analysis of Rheumatoid Arthritis in Association With Demography and Biochemical Investigation

In this paper we discussed the basic statistical analysis of the biological data and associated with thedemographic profile and biochemical profile of the samples of arthritis. Arthritis is a multi-factorial disorderconsisting of more than 100 types of arthritis9, it is really difficult to say that a particular disease is causingthat disorder. For determination of Rheumatoid Arthritis (RA) we have used biochemical tests of the 70individual affected with rheumatoid arthritis. The peripheral blood serum and plasma has been collectedusing vacutainers containing EDTA, the samples have gone through 5 tests for the determining the patternof arthritis. By using this method pre-diagnostic measure for arthritis, results have shown us that most of thepatient have correlative increase and decrease in their serum and plasma level when the patient is affectedwith RA. Various test such as Hb, Uric acid, serum glucose, serum calcium levels are used to determine thepresence of arthritic profile. The results have found completely based on correlation of the demographic datawith the arthritic marker, diabetic marker, lipid marker, kidney function marker, liver marker. The resultshave found that maximum correlation is shown among the liver marker as its maximum correlation with allthe arthritic markers and demographic data.

Reverse shoulder replacement: a day-case procedure

Background and hypothesisReverse shoulder arthroplasty (RSA) is an increasingly popular treatment modality for glenohumeral joint arthritis in association with rotator cuff arthropathy. A prolonged hospital stay following joint arthroplasty risks increased complications for patients plus financial implications for institutions. We hypothesized that RSA could be safely and effectively carried out as an outpatient procedure with reduced risks to patients and institutional costs.MethodsPatients attending our institution for RSA during March 2015 to August 2018 were reviewed preoperatively for consideration for RSA as an outpatient procedure. The inclusion criteria were arthritis of the shoulder having failed conservative management, age older than 50 years, and intact deltoid muscle function. Patients were excluded if they underwent RSA for trauma or for revision following previous total shoulder replacement or hemiarthroplasty. Overall health, social circumstances, and individual wishes were considered.ResultsA total of 21 patients underwent RSA as an outpatient procedure. The mean age was 74 years (range, 59-84 years). There were 8 male and 13 female patients. No overnight stays were required in patients in whom outpatient surgery was planned. The Oxford Shoulder Score increased from a mean of 16 (range, 4-30) preoperatively to a mean of 31 (range, 7-35) at 6 months postoperatively; it was a mean of 36 (range, 7-48) at 12 months postoperatively. Of the patients, 88% were “very satisfied” or “satisfied” with the service and 81% would undergo the surgical procedure again as a day-case procedure.ConclusionRSA as an outpatient procedure can be carried out effectively with high patient satisfaction rates in carefully selected patients.

Artritis reumatoide

ConceptRheumatoid arthritis is a systemic inflammatory disease of immune etiopathogenesis. EpidemiologyPresence of persistent synovitis in the joints. The pattern of joint involvement is usually symmetrical and erosive and can develop at any age. EtiopathogenesisIt is unknown, repeated exposure to certain environmental agents (tobacco and citrullination) has been related as a possible harmful mechanism, associated to a genetic predisposition to an immune response. Clinical manifestationsPatients present swelling of the joints, and polyarticular clinical forms usually appear, with multiple clinical involvement and progress patterns. Other extra-articular manifestations can develop, such as skin diseases, rheumatoid nodules, or pleuropulmonary or hematological manifestations. DiagnosisIt is conducted upon the presence of arthritis in association with radiographic and analytical data such as a positive rheumatoid factor and/or anti-citrullinated peptide antibodies. TreatmentThe course of the disease is poor if left untreated. Early treatment prevents structural progression. Some patients respond to traditional therapies with DMARDs (mostly methotrexate) and avoid further damage, but in many cases biological drugs are required, such as anti-TNF/anti-interleukin, or even anti-CD20, that have played an undisputed role in this disease.

Viral arthritis and vasculitis

Viral arthritis and vasculitis are important differential diagnoses primarily in patients with acute polyarticular arthritis in association with fever and rash, in populations specially at risk and in returning travellers. Parvovirus B19 is the most frequent cause of viral arthritis in Europe, whereas rubella, hepatitisB and C viruses have become less common. Due to worldwide tourism arthritogenic alphaviruses, which are transmitted by mosquito vectors have come into the focus of tropical medicine and rheumatology. Viral arthritis is typically self-limiting but due to severe pain often requires symptomatic therapy with nonsteroidal antirheumatic drugs; however, arthritis and vasculitis may also be amanifestation of an important treatable viral infection, such as hepatitisB, C and human immunodeficiency viruses (HIV).

E coli septic arthritis of the knee: A rare complication in pediatric lupus

Acute septic arthritis in association with systemic lupus Erythematosus (SLE) is uncommon and mostly caused by Gram positive bacteria. Escherichia coli (E coli) septic arthritis complicating lupus is extremely uncommon. The authors describe a case in a 10 year old Indian girl who had SLE with class II lupus nephritis and presented later with acute septic arthritis in her right knee. Although reported earlier in adult subjects, pediatric SLE complicated with E coli septic arthritis at this young age, to the best of authors’ knowledge has never been reported in world literature.

Lipopolysaccharide accelerates collagen‐induced arthritis in association with rapid and continuous production of inflammatory mediators and anti‐type II collagen antibody

Collagen-induced arthritis (CIA) is an animal model for rheumatoid arthritis (RA). Lipopolysaccharide (LPS) is known to accelerate CIA; however, the pathogenetic mechanisms are not yet fully understood. In this study, type II collagen (CII)-immunized mice were found to have marked increases in degree of expression of mRNA of inflammatory mediators such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, and macrophage inflammatory protein-2 (MIP-2) in their arthritic paws and of serum anti-CII antibody concentration before the onset of arthritis induced by LPS injection. The gene expression was rapid and continuous after direct activation of nuclear factor κB. The amounts of mRNA of TNF-α, IL-1β, and MIP-2, as well as of matrix metalloproteinases and the receptor activator of nuclear factor κB ligand, increased with the development of arthritis, correlated positively with clinical severity and corresponded with histopathological changes. Moreover, anti-TNF-α neutralizing antibody inhibited the development of LPS-accelerated CIA and a single injection of recombinant mouse TNF-α induced increases in anti-CII antibody concentrations, suggesting TNF-α may contribute to the development of arthritis by both initiation of inflammation and production of autoantibodies. These data suggest that exacerbation of RA by LPS is associated with rapid and continuous production of inflammatory mediators and autoantibodies.

Interleukin‐22 Reduces the Severity of Collagen‐Induced Arthritis in Association With Increased Levels of Interleukin‐10

The mechanism of action of interleukin- 22 (IL-22) in inflammatory arthritis remains unknown. IL-22-deficient mice exhibit an intact humoral and cellular immune response to collagen and yet have a reduced incidence of collagen-induced arthritis (CIA). Further, administration of anti-IL-22 does not reduce the severity of clinical arthritis but rather improves only certain aspects of joint inflammation as assessed histologically. This study was undertaken to investigate the mechanism of action and role of systemic IL-22 in modulating target organ inflammation. CIA was induced in DBA mice by immunization with collagen and Freund's complete adjuvant. Expression of IL-22 and its receptor (IL-22R) in lymphoid organ and target tissues was determined during various phases of arthritis. The effector functions of IL-22 on induction/regulation of various cytokines in in vitro restimulation cultures were analyzed by enzyme-linked immunosorbent assay (ELISA). Recombinant IL-22 with or without anti-IL-10 antibody was administered to mice following immunization with collagen and prior to the onset of arthritis, and the severity of arthritis was evaluated by clinical scoring and histopathologic assessment. Anticollagen antibodies in mouse sera were analyzed by ELISA. IL-22 and IL-22R were up-regulated in lymphoid organs and joints during the course of arthritis. IL-22 augmented IL-10, IL-17, and IL-6 in lymphoid tissues in vitro. Administration of recombinant IL-22 was associated with an increase in IL-10 levels in vivo and a significant reduction in the progression of arthritis severity. Anti-IL-10 antibody treatment was associated with the abrogation of this protective effect of IL-22. Our data demonstrate, for the first time, that IL-22 has a protective role in inflammatory arthritis.

Linking Crohn's Disease and Ankylosing Spondylitis: It's All about Genes!

Linking Crohn's Disease and Ankylosing Spondylitis: It's All about Genes!

A case of juvenile idiopathic polyarticular arthritis complicated by IgA deficiency in 22q11 deletion syndrome

Chronic arthritis may occur in association with antibody deficiency and chromosomal aberrations. This report presents the case of a 6-year-old girl with chromosome 22q11 deletion syndrome and chronic arthritis. The onset of arthritis occurred at 4years of age. The chronic arthritis course has been the polyarticular type. Neither antinuclear antibody nor rheumatoid factor was detected. Serum IgA was extremely low. She was diagnosed with juvenile idiopathic polyarticular arthritis (JIA) complicated by IgA deficiency in the 22q11 deletion syndrome. There is an increased prevalence of chronic arthritis in association with 22q11 deletion syndrome with IgA deficiency, but the reasons for this association are unknown. This study evaluated the possible correlation between cytokines and the susceptibility to chronic arthritis in the 22q11 deletion syndrome with IgA deficiency. The expression of pro-inflammatory cytokines such as IL-8, IL-6, MIP-1β, and MCP-1 suggests that T and B cells, macrophages and neutrophils modulate joint inflammation by an immune response. And the presence of IL-10 and IL-5 might suggest that the synovitis is associated with JIA and IgA deficiency.

Frühe Spondyloarthritiden

The spondyloarthritides (SpA) are often included in the differential diagnosis of early arthritis with or without low back pain. This is namely true for reactive arthritis which occurs as acute or subacute arthritis in association with urogenital or gastrointestinal bacterial infection. Reactive arthritis can result in chronic or relapsing disease. The SpA group also includes ankylosing spondylitis (axial form or with peripheral arthritis), psoriatic arthritis and SpA in association with inflammatory bowel disease. (Early) undifferentiated SpA has now come into the focus of many researchers since more effective and specific therapy has become available for the SpA. Diagnostic algorithms have been developed and evaluated.

Economic Burden of Psoriatic Arthritis

Psoriatic arthritis (PsA) is a chronic autoimmune disease characterized by inflammatory arthritis in association with skin psoriasis (Ps). PsA may show a heterogeneous and variable clinical course, with involvement of peripheral and axial diarthrodial joints, periarticular structures such as entheses, as well as the skin and nails. Evidence is increasing that affected patients can have significant radiographic joint damage, functional impairment, reduced quality of life (QOL) and long-term work disability. The economic burden of PsA can be considerable. There is an increasing interest in pharmacoeconomic evaluations in PsA, driven mostly by the introduction of highly effective but expensive biologic agents, particularly inhibitors of the proinflammatory cytokine tumour necrosis factor (TNF)-alpha. Treatment with TNFalpha inhibitors results in not only substantial improvements in signs and symptoms of arthritis, but also improvements in all distinct sites of the disease, such as axial arthritis, dactylitis, enthesitis and skin disease. There is a dearth of published pharmacoeconomic evaluations in the field of PsA. The notable clinical efficacy of the TNFalpha inhibitors needs to be factored into a comprehensive assessment of their value. Further analyses are needed to optimize the use of the new biologic agents in PsA.

An unusual presentation of multiple myeloma: a case report

Multiple myeloma can occasionally manifest with joint disease. We report the case of an individual with a progressive bilateral carpal syndrome and a symmetrical severe seronegative polyarthritis and joint swelling. Investigations revealed an erosive seronegative inflammatory arthritis in association with bilateral carpal tunnel syndrome, anaemia, hepatic impairment and nephrotic-range proteinuria. Synovial fluid cytology demonstrated plasmablasts and multinucleated cells with products of chondrolysis. The diagnosis of multiple myeloma (with secondary amyloidosis) was made on serum protein electrophoresis and bone marrow biopsy.The relationship between myeloma and joint disease is discussed, highlighted by the presence in this case of all three pathogenic features associated with arthritis in myeloma patients- an erosive arthritis, carpal tunnel syndrome and an invasive tumoural arthritis.

Knee septic arthritis due to Streptococcus pyogenes associated with acute thrombosis of the tibial and peroneal veins: Case report and review of the literature

We present the case of a 53-y-old patient who complained of fever, pain and oedema of the right knee and the right calf. Colour ultrasonography showed thrombosis of the tibial and peroneal veins, while paracentesis of the knee joint showed characteristics of an inflammatory exudate. Culture of the arthritic fluid revealed Streptococcus pyogenes. Thus, a diagnosis of a septic arthritis of the right knee in association with deep venous thrombosis of the right lower leg was established. From a review of the literature we found no other cases of septic arthritis in association with thrombosis of the adjacent vein. In conclusion, in cases of septic arthritis of a joint one has to consider ruling out thrombosis of the adjacent venous vessels, especially when oedema is not confined to the joint. Missing the diagnosis of such a complication will lead to increased morbidity and mortality.

Rheumatoid arthritis in dermatology

Rheumatoid arthritis (RA) is a chronic progressive disorder characterized by symmetric inflammatory arthritis in association with systemic symptoms. Although considered a “joint disease,” RA is associated with involvement in diverse organ systems, including the skin. Common manifestations include Raynaud phenomenon, rheumatoid nodules, and rheumatoid vasculitis. As with other extra-articular manifestations, dermatologic involvement tends to occur in patients with more severe RA. In addition to manifestations related to the disease, there are also sundry dermatologic reactions related to the medications used to treat RA. Understanding the etiology and therapy for cutaneous manifestations of RA will help optimize patient care.

Functional characterization of a soluble gp130 isoform and its therapeutic capacity in an experimental model of inflammatory arthritis

Soluble gp130 is the naturally occurring antagonist of the interleukin-6 (IL-6)/soluble IL-6 receptor (sIL-6R) complex and selectively inhibits IL-6 trans-signaling. Several isoforms of soluble gp130 have been identified, including an autoantigenic form termed gp130-RAPS (for gp130 of the rheumatoid arthritis antigenic peptide-bearing soluble form) that is present in the serum and synovial fluid of patients with rheumatoid arthritis. The aim of this study was to evaluate the functional properties of gp130-RAPS. To define a role for gp130-RAPS in arthritis, a recombinant version was generated using a baculovirus expression system, and its activities were tested in vitro and in vivo. Gp130-RAPS was shown to bind with high affinity to the stable IL-6/sIL-6R complex, hyper-IL-6, and to effectively modulate leukocyte migration in murine acute peritonitis. A single intraarticular injection of gp130-RAPS suppressed chronic antigen-induced arthritis in association with a reduction in local activation of signal transducer and activator of transcription 3. Although gp130-RAPS contains the previously identified autoantigenic sequence Asn-Ile-Ala-Ser-Phe (NIASF), no increase in the prevalence of anti- gp130-RAPS antibodies was observed in serum or synovial fluid obtained from patients with rheumatoid arthritis. The use of inhibitory antibodies to block IL-6 responses has shown considerable clinical promise. However, the results presented herein suggest that selective targeting of IL-6 trans-signaling may represent a viable alternative to this strategy. In this respect, our present results suggest that the soluble gp130 isoform gp130-RAPS may be useful in the treatment of chronic inflammatory arthritis.

Proliferating multicentric reticulohistiocytosis associated with papillary serous carcinoma of the endometrium

Multicentric reticulohistiocytosis (MRH) is a rare histocytic disease characterized by destructive arthritis in association with classic skin findings. Although MRH is not strictly a paraneoplastic disease, one quarter of cases are malignancy related. We report a case of MRH with an initial remission followed by an acute exacerbation several years later heralding the clinical presentation of endometrial carcinoma. During this flareup a skin biopsy specimen revealed a diffuse dermal infiltrate composed of histiocytes with ground-glass cytoplasm and multiple atypical mitoses. Approximately 40% of the cells stained with the proliferation marker Ki-67. Treatment of endometrial carcinoma resulted in improvement of skin and joint symptoms, and a repeat biopsy specimen no longer demonstrated mitotic figures. These findings support a reactive and proliferative cause of MRH.