Arthritis Patients Research Articles

Biologic and targeted synthetic disease-modifying anti-rheumatic drugs improve body composition in rheumatoid arthritis patients more than conventional synthetic disease-modifying anti-rheumatic drugs: Results from the PRESENT study.

The effects of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) and conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) on body composition and muscle function in rheumatoid arthritis (RA) patients requiring treatment enhancement were compared. This multicenter, prospective, observational study (PRESENT Study) divided RA patients non-randomly into a csDMARD group (n = 100) and a b/tsDMARD group (n = 100). Changes in body composition and muscle function were examined in 80 patients in each group followed for 52 weeks. The percentages of new-onset and improved sarcopenia over 1 year were investigated. Patients in the b/tsDMARD group were divided into three groups by drug type: TNF inhibitors (n = 30), non-TNF inhibitors (n = 23), and JAK inhibitors (n = 27). Baseline median age and disease duration were 70.0 and 4.0 years, respectively. Changes in weight (24 and 52 weeks) and muscle mass (52 weeks) were significantly higher in the b/tsDMARD group (p = .035, p < .001, and p = .002, respectively). On multivariate logistic regression analysis, b/tsDMARD treatment (OR 3.21, p = .002), DAS28-ESR (OR 0.65 p = .011), and muscle mass (OR 0.90, p = .023) were independently associated with increased muscle mass at 52 weeks. The percentages of new-onset and improved sarcopenia were almost equal. There were no significant differences in the time-dependent changes (52 weeks) of clinical status, body composition, muscle function, and status of sarcopenia among TNF inhibitors, non-TNF inhibitors, and JAK inhibitors. Weight and muscle mass increased significantly more with b/tsDMARD than with csDMARD treatment. There were no differences in body composition changes by mode of action with b/tsDMARDs.

Musculoskeletal Ultrasound Findings in First Degree Relatives of Rheumatoid Arthritis Patients

Abstract Background Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that primarily targets synovial joints. Retrospective analysis of individuals who ultimately developed RA have shown RA autoantibodies such as rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA) develop months to years prior to the onset of clinically evident synovitis. So there has been increasing interest in identifying individuals at risk for future development of RA, with the hope of intervening to prevent the onset of disease. Aim of the Work To detect the presence of early synovitis (preclinical stage of RA) among healthy first degree relatives of RA patients by MSUS and its correlation to serological markers. Patients and Methods This was a cross sectional study which was conducted on 60 subjects with high risk of developing arthritis; healthy first degree relatives (FDR) of RA patients classified according to ACR/EULAR 2010 criteria. It was carried out at Ain Shams University Hospital. All patients were recruited from Rheumatology outpatient clinic and the inpatient department of Ain Shams University Hospital. Results The study included subjects aged 16 to 55 years, predominantly female, with a mean BMI of 26.44 kg/m². Rheumatoid arthritis (RA) duration ranged from 1 month to 30 years, averaging 6.96 years. Among familial disease relatives (FDRs), 78.3% were nonsmokers. Arthralgia was common (58.3%), with varied joint involvement. Laboratory findings showed elevated ESR and CRP levels. Wrist and MTP-II joints were most frequently affected on ultrasound. A 7-joint ultrasound score (US7) was developed for efficient rheumatological evaluation. Conclusion This cross-sectional study aimed to assess preclinical synovitis by musculoskeletal ultrasound (MSUS) in first-degree relatives (FDRs) of rheumatoid arthritis (RA) patients and its correlation with laboratory findings. We found a prevalence of 51.6% for MSUS positive findings, primarily synovitis. ESR was significantly higher in FDRs with positive MSUS findings. RF showed the highest positive predictive value (75%) for MSUS positivity. Clinical arthralgia exhibited the highest sensitivity (58%). Our study underscores the potential of combining RF, Anti-CCP, and clinical arthralgia in predicting preclinical synovitis in at-risk populations, facilitating early intervention strategies.

Correlation between Retinal Vasculature by Optical Coherence Tomography Angiography (OCTA) and Retinal Thickness in Rheumatoid Arthritis (RA) Patients with Different Disease Activity Scores

Abstract Background Rheumatoid arthritis (RA) is a systemic autoimmune disease which is characterized by inflammatory arthritis and extraarticular manifestations. It is a chronic inflammatory disease of unknown etiology which affects synovial joints. Its typical presentation starts with inflammation of small peripheral joints which is often symmetric then involves proximal joints if it is not treated. RA may affect the vascular tissue in the body including eye as it affects superficial and deep capillary plexus in foveal avascular zone (FAZ) area, superficial foveal vessel density and choroid. The Disease Activity Score (DAS)ESR is a major scoring system that evaluate activity of RA. The DAS score provides a score between 0 and 10, a larger number indicating more active disease. DAS28 score is calculated according to a formula that is composed of the number of tender joints and swollen joints and ESR. Purpose To investigate the correlation between retinal vasculature by OCTA and retinal thickness in RA patients with different disease activity scores Materials and Methods 60 participants divided into three groups (mild, moderate, and severe) according to disease activity score (DAS), were included in this comparative cross-sectional study. Participants underwent a complete ophthalmologic assessment, measurement of RNFL thickness and retinal thickness using SD-OCT, vessel density using OCTA. Results There were significant difference in perifoveal nasal retinal thickness, parafoveal (inferior and superior quadrants) (superior hemisphere) (average parafoveal retinal thickness), peripapillary vessel density with increased disease activity score. There was no significant difference in RNFL thickness and retinal vessel density with increased disease activity score. There was significant relation between perifoveal retinal thickness in all quadrants and duration of treatment. There was significant relation between parafoveal retinal thickness in superior quadrants and duration of treatment. There was significant relation between DCP whole image and duration of treatment. There was no significant difference in RNFL thickness, OCTA of optic disc with increased duration of treatment. There was significant difference between 3 groups in RNFL thickness (temporal and inferior quadrants). There were significant differences in parafoveal retinal thickness (inferior quadrant. There were no significant differences between 3 groups regarding OCTA results. Conclusion retinal thickness in perifoveal and parafoveal superior quadrant and DCP vessel density showed decremental pattern with increased duration of treatment. RNFL thickness in temporal and inferior quadrants showed thinning with increased DAS28 score. Perifoveal retinal thickness in superior and inferior hemispheres, nasal and inferior quadrants showed thinning with increased DAS28 score. There was no correlation between DAS28 score, duration of treatment and CFT and FAZ.

Digital biomarkers for psoriatic arthritis: a qualitative focus group study on patient-perceived opportunities and barriers

ObjectivesThe widespread adoption of wearables, for example, smartphones and smartwatches in the daily lives of the general population, allows passive monitoring of physiological and behavioural data in the real world....

Gastrointestinal symptoms in patients using methotrexate: A cross-sectional study in a sample with rheumatoid arthritis

BackgroundGastrointestinal intolerance is common in rheumatoid arthritis (RA) patients using methotrexate and may lead to treatment discontinuation. AimTo study the prevalence of gastrointestinal symptoms in a sample of RA methotrexate users as well as its possible association with clinical and epidemiological variables. MethodsCross-sectional study of 192 patients with gastrointestinal symptoms using the MISS (methotrexate intolerance severity score). Clinical and epidemiological variables were collected through chart review and direct questioning. Patients’ adherence to methotrexate was evaluated through Moriski–Green–Levin questionnaire. ResultsThe prevalence of gastrointestinal complaints was high with 55.7% of the sample classified as intolerant. Nausea and pain after drug ingestion were the most common reported complaints. This intolerance was associated with afro-descendant background (p=0.02); presence of associated fibromyalgia (p=0.04), concomitant use of glucocorticoids (p=0.03) and Jak inhibitors (0.03). A tendency towards association with leflunomide use was observed (p=0.06). Logistic regression was used to test drug associations with methotrexate intolerance, and showed that glucocorticoid use was independently associated with methotrexate intolerance OR=1.85; 95% CI=1.01–3.44; p=0.04. Route of administration, presence of previous gastric complaints, age and methotrexate dose did not interfere with MISS. MISS results were associated with moderate adherence to the drug. ConclusionsThere is a high rate of methotrexate intolerance that is more common in afro-descendants, those with associated fibromyalgia, glucocorticoid and Jak inhibitors users.

Effect of Probiotic Supplementation on Disease Activity in Rheumatoid Arthritis Patients

Abstract Background Rheumatoid arthritis (RA), a prevalent inflammatory arthritis with a global incidence of 0.5–1%, is characterized by autoimmune-driven articular pain, cartilage degradation, bone destruction, and functional disability. Emerging evidence suggests a potential link between alterations in gastrointestinal microflora and the development of autoimmune diseases, including RA. Probiotic bacteria have gained attention as a potential adjunctive therapy due to their immunomodulatory properties, offering promise for improving clinical and metabolic outcomes in RA patients. Aim of the Work To study the effects of probiotic supplementation on clinical status of patients with RA. Patients and Methods Sixty Egyptian RA patients aged 18-60 years, diagnosed and screened in the Rheumatology department at Ain Shams University Hospital, were enrolled in this study. The patients were divided into two groups: group A received daily probiotic supplementation for 8 weeks, while group B served as the control. Detailed clinical assessments and laboratory investigations were conducted. Results There were no significant differences in age, sex distribution, disease duration, or disease- modifying antirheumatic drugs (DMARDs) usage between the two groups, consistent with previous research. The probiotic regimen included Lactobacillus acidophilus and Bifidobacterium animalis. Conclusion Probiotic supplementation in RA patients yielded mixed results in this study, with improvements in TJC and ESR but no significant changes in SJC, CRP, or disease activity scores. Further research is needed to elucidate the complex relationship between gut microbiota and RA pathogenesis and to determine the optimal probiotic regimen for improving clinical outcomes in RA patients.

Indirect costs assessment and intangible costs description of rheumatoid arthritis patients with biological therapy in Morocco: ECORAM Study.

The aims of study are to estimate the indirect costs and intangible costs of RA in Morocco and to identify the factors likely to influence these costs among suffering patients. In the current study, data were collected by face-to-face interviews using a questionnaire in addition to the patient's files. Indirect costs including productivity losses and formal care, and intangible costs such as the cessation of physical and leisure activities, family care and divorce or remaining single until menopause's age for women due to the disease were reported for 110 RA patients. The results show that among patients who lost totally or partially their salary, the annual average costs is $2337.73 ± 1649.80 per patient, with a minimum and a maximum of $600 and $9630 respectively. As regards formal care, only 13 patients reported that they paid for care services; the annual average cost was $421.84 ± 261.34 with a minimum of $252 and a maximum of $1200. Statistical analysis revealed significant differences between annual lost salary and gender (p = .04) disease duration (p = .016) and sport/leisure activities cessation (p = .08). Besides the burden in terms of productivity loss and caregivers' costs, the intangible costs are considerable, especially those related to divorce and spinsterhood. These conclusions may contribute to the understanding of the socio-economic impact of the disease and to the development of strategies for better governance of RA in Morocco.

Study of the Association between MTHFR Polymorphism (rs1801133) and the Outcome of Methotrexate Treatment in Rheumatoid Arthritis Patient

Abstract Background Rheumatoid arthritis is a chronic systemic autoimmune disease that causes loss of joint function and significantly reduces the quality of life. Methotrexate is one of the disease- modifying anti-rheumatic drugs that can influence treatment efficacy and toxicity. Methotrexate is used as an anchor drug for the treatment of rheumatoid arthritis and there may be differences in drug action between genotypes. Aim of the Work The present study was aimed to evaluate the impact of methylenetetrahydrofolate reductase (MTHFR) gene C677T (rs1801133) polymorphism on the clinical outcome of methotrexate treatment as regards treatment efficacy or toxicity in Egyptian rheumatoid arthritis patients. Subjects and Methods This study conducted on 45 patients diagnosed with rheumatoid arthritis receiving methotrexate as a first line of treatment. Subjects were classified into two groups; group I (responders, n = 25) and group II (non-Responders, n = 20) according to clinical response to methotrexate by using disease activity score (DAS28). Complete blood count, erythrocyte sedimentation rate, liver function, renal function, C- reactive protein, cyclic citrullinated peptide antibody and rheumatoid factor were done for all patients. Determination of methylenetetrahydrofolate reductase gene C677T (rs1801133) polymorphism was carried out using Real-time polymerase chain reaction. Results The present study did not confirm the presence of a significant association between the genotypic frequencies of the methylenetetrahydrofolate reductase gene C677T (rs1801133) polymorphism among the responders and the non-responders group in patients with rheumatoid arthritis. In addition, the methylenetetrahydrofolate reductase gene C677T (rs1801133) polymorphism did not show significant difference between disease complications among the responders and the non-responders groups. On the other hand, our findings suggested that a statistically significant difference was found between two groups of patients regarding disease activity score (DAS 28). Conclusion The current study revealed that there is no significant association between the genotypic frequencies of the methylenetetrahydrofolate reductase gene C677T (rs1801133) polymorphism among the responders and the non-responders groups of patients with rheumatoid arthritis. Moreover, the methylenetetrahydrofolate reductase gene C677T (rs1801133) polymorphism did not show significant difference between disease complications among the responders and the non-responders groups in patients with rheumatoid arthritis.

Comparative Study between MRI and Ultrasound in Articular Affection of Rheumatoid Arthritis

Abstract Background The earlier investigations showed that ultrasound had a moderate degree of accuracy in identifying and foretelling rheumatoid arthritis complications at various stages of the disease. Objective Evaluation of the accuracy of ultrasound imaging in comparison to MRI as a cheap method using non ionizing radiation in assessment of the rheumatoid arthritis patients. Methods During this study, 20 patients with clinically and laboratory proven rheumatoid arthritis were enrolled after consenting of them and subjected to ultrasound and MRI examination to compare between them in prediction of synovitis, tenosynovitis, joint effusion, bone marrow oedema, bone erosion and power Doppler activity. Results MRI was more accurate than ultrasound in assessment of bone marrow edema. On the other hand and as regard Doppler activity, ultrasound was more accurate than MRI. Finally, no differences were detected between both modalities in detection of synovitis, tenosynovitis, joint effusion and bone erosion. Conclusion Since MRI was more accurate than ultrasound in assessing bone marrow edoema, ultrasound and MRI complement one another in the assessment of articular affection in rheumatoid arthritis. On the other hand, ultrasonography was more accurate than MRI in terms of Doppler activity. Eventually, no variations in the detection of synovitis, tenosynovitis, joint effusion, and bone erosion were found between them.

Serum Calprotectin as an Inflammatory Marker in a Cohort of Egyptian Patients with Psoriatic Arthritis and its Correlation with Disease Activity and Radiological Findings

Abstract Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis and is found in about 20 to 30% of psoriatic patients. The use of inflammatory markers can be disappointing in PsA, since they are elevated in only half of the patients with PsA., in this study we assessed serum calprotectin as a marker of inflammation in psoriatic arthritis and correlated it to disease activity and radiological findings. Objective To measure serum calprotectin level in psoriatic arthritis patients and to assess its association with disease activity score and radiological findings using musculoskeletal ultrasound. Methods This was a Case-Control Study Rheumatology inpatient departments and outpatient clinics at Ain Shams University Hospitals. This study was conducted on 50 patients with psoriatic arthritis according to the classification criteria for psoriatic arthritis (CASPAR) criteria and 30 Normal subjects with no past medical history and with no family history of psoriasis. Results Patients serum calprotectin level had statistically significant higher value in comparison to the control group P-Value &amp;lt; 0.001., and with cutoff point 106.36 ng/ml with sensitivity 98% and specificity of 86.6 %, There was highly statistically significant relation between the level of serum calprotectin and synovial hypertrophy in small hand joints P-Value=0.004 and it can predict synovial hypertrophy in hands by joint ultrasound at the level of 258.9 ng/ml with sensitivity and specificity of 71%, 83% respectively There was also a with statistically significant relation nail bed affection in ultrasound P-Value=0.034. Multiple regression analysis was done in psoriatic arthritis patients and it was found that serum calprotectin was the most predictive for the presence of psoriatic arthritis in comparison to ESR and CRP. Conclusion in psoriatic arthritis patients, serum calprotectin level is significantly higher and is correlated to radiographic and nail changes. Further studies are required to define a specific cutoff serum level for diagnosis.

Clinical correlates of lifetime and current comorbidity patterns in autoimmune and inflammatory diseases

BackgroundAutoimmune and inflammatory diseases (AIDs) are a heterogeneous group of disorders with diverse etiopathogenic mechanisms. This study explores the potential utility of family history, together with present and past comorbidities, in identifying distinct etiopathogenic subgroups. This approach may facilitate more accurate diagnosis, prognosis and personalized therapy. MethodsWe performed a multiple correspondence analysis on patients' comorbidities, followed by hierarchical principal component clustering of clinical data from 48 healthy volunteers and 327 patients with at least one of 19 selected AIDs included in the TRANSIMMUNOM cross-sectional study. ResultsWe identified three distinct clusters characterized by: 1) the absence of comorbidities, 2) polyautoimmunity, and 3) polyinflammation. These clusters were further distinguished by specific comorbidities and biological parameters. Autoantibodies, allergies, and viral infections characterized the polyautoimmunity cluster, while older age, BMI, depression, cancer, hypertension, periodontal disease, and dyslipidemia characterized the polyinflammation cluster. Rheumatoid arthritis patients were distributed across all three clusters. They had higher DAS28 and prevalence of extra-articular manifestations when belonging to the polyinflammation and polyautoimmunity clusters, and also lower ACPA and RF seropositivity and higher pain scores within the polyinflammation cluster. We developed a model allowing to classify AID patients into comorbidity clusters. ConclusionsIn this study, we have uncovered three distinct comorbidity profiles among AID patients. These profiles suggest the presence of distinct etiopathogenic mechanisms underlying these subgroups. Validation, longitudinal stability assessment, and exploration of their impact on therapy efficacy are needed for a comprehensive understanding of their potential role in personalized medicine.

Experiences of Chinese Rheumatoid Arthritis Patients Who Chose Western Medicine, Traditional Chinese Medicine, and a Combination of Treatments: A Study Based on Interviews and Thematic Analysis [Letter

Experiences of Chinese Rheumatoid Arthritis Patients Who Chose Western Medicine, Traditional Chinese Medicine, and a Combination of Treatments: A Study Based on Interviews and Thematic Analysis [Letter

Comparison of the safety profile of tofacitinib and etanercept in rheumatoid arthritis patients aged 60 years and over: The real-life data from the HUR-BIO registry

Objective: To investigate the safety profile of tofacitinib in rheumatoid arthritis (RA) patients aged 60 and over and to compare these findings with etanercept. Materials and methods: HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single-center registry for biological and targeted synthetic DMARDs since 2005. We included RA patients aged ≥ 60 years who were prescribed tofacitinib or etanercept as their first bDMARD or tsDMARD and had at least one control visit. MACE (major adverse cardiovascular event), VTE (venous thromboembolism), malignancy, herpes zoster, and infections requiring hospitalization were recorded for the safety profile. Incidence rate (IR) and incidence rate ratios (IRR) per 1000 patient years were calculated for all safety data. Results: This study consisted of 123 RA patients (tofacitinib n=70, etanercept n=53). In the overall population, the mean age was 67.9 ± 6.2 years and the median follow-up period was 2.1 years. Among the traditional cardiovascular risk factors, smoking history and hyperlipidemia were more common in the tofacitinib group. The IRR per 1000 patients years for MACE, herpes zoster, and infections requiring hospitalization was similar between the groups. All three patients who diagnosed with DVT or PE were in the tofacitinib group, and the significance level of the increase in IR was close to the statistical threshold (p=0.057). There was only one patient who developed non-melanoma skin cancer, and that patient was in the tofacitinib group. Conclusion: The incidence of MACE, herpes zoster, and infections requiring hospitalization was comparable between tofacitinib and etanercept. However, the occurrence of VTE exclusively in the tofacitinib group suggests that this issue needs careful evaluation for these patients.

Erythema nodosum manifestation of Parvovirus B19-associated reactive arthritis.

Parvovirus B19 virus-mediated viral inflammation and immune-complex deposition generate mainly short-term manifestations in the affected individuals. The objective of this study was to determine Parvovirus B19 infection in rheumatoid arthritis (RA) patients. The study employed 50 patients diagnosed with RA and 30 healthy individuals. Blood samples were collected from both groups. The blood samples were screened for Parvovirus B19 infection using polymerase chain reaction to detect B19 DNA and enzyme-linked immunosorbent assay to detect anti-B19 IgM and IgG. 17 (34%) of 50 patients tested positive for parvovirus B19 DNA. In contrast, the mortality rate in the control group was significantly lower (6.7%; p = 0.005). Anti-B19 IgG antibody levels differed significantly with patients and control (p = 0.007), whereas anti-B19 IgM Ab levels did not (p = 0.6). There was a significant correlation between viremia B19 and all measured parameters. Parvovirus-affected patients had significantly higher CRP and ESR, elevated DAS28 scores, and more joint pain compared to parvovirus (-) patients. Anti-CCP and RF values were significantly high in parvovirus (+) patients. Joint erosion was also prevalent in patients who tested positive for parvovirus. The findings of this study suggest that infection with parvovirus in patients with RA, and a possible role of this viral infection in the pathogenesis of RA may contribute to the pathogenesis of RA.

Alterations in Immune Parameters ADP, ANA, IL-1, IL-6, IL-8, STAT-4, and TNF Alpha in Patients with Rheumatoid Arthritis and Osteoarthritis

Background: Rheumatoid arthritis (RA) and osteoarthritis (OA) are chronic joint diseases with distinct pathophysiological mechanisms, but both involve alterations in immune parameters. This research investigates the alterations in several immune parameters, specifically adiponectin (ADP), antinuclear antibodies (ANA), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), signal transducer and activator of transcription 4 (STAT-4), and tumor necrosis factor-alpha (TNF Alpha), in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Also, the current study aims to identify the changes occurring in the physiological and immune parameters of people suffering from rheumatic diseases, as Evaluation of Immunological Inflammatory biomarkers levels ADP, ANA, IL1, IL6, IL8, STAT-4 and TNF-α. Material &amp; Methods: A cross-sectional laboratory-based study with 90 patient’s participant was conducted. Using ELISA kits and laboratory tests, various biomarkers (Immunological Inflammatory biomarkers levels ADP, ANA, IL1, IL6, IL8, STAT-4 and TNF-α were measured among rheumatoid arthritis and Osteoarthritis patients. Results: The findings revealed elevated levels of IL-1, IL-6, IL-8, STAT-4, and TNF Alpha in RA patients, reflecting a heightened inflammatory state. In contrast, OA patients exhibited a more moderate increase in these parameters, suggesting differing immune activation pathways. ADP and ANA levels showed distinct variations between the two patient groups, indicating their potential roles in the pathogenesis and progression of RA and OA. Conclusion: These results contribute to a better understanding of the immune mechanisms underlying RA and OA, highlighting the importance of targeted therapeutic strategies to manage these conditions effectively. Further research is recommended to explore the clinical implications of these findings and develop personalized treatment approaches.

Correlation of Serum IL-1β Level in Rheumatoid Arthritis Patients with Disease Severity Parameters

Rheumatoid arthritis (RA) is a systemic inflammatory, chronic disorder, characterized by prolonged inflammation of the synovial joints, with ultimate destruction of joints, high concentrations of IL-1β in the synovial fluid and serum RA patients correlated with RA incidence. This study was conducted to compare IL-1β concentration in serum from patients with RA and healthy controls with the correlation parameter being related to markers indicating disease severity. A case-control study enrolled 71 patients with RA and 46 healthy controls from an Iraqi Arab population. In the present study, the level of serum IL-1β was detected using a quantitative sandwich enzyme immunoassay method of Enzyme-Linked Immunosorbent Assay (ELISA). This study found a correlation between the serum level of IL-1β and DAS28-CRP severity among RA patients (p=0.065). Furthermore, the serum level of IL-1β was significantly increased in RA patients compared to the level noted in the healthy group (p=0.039). Moreover, the results demonstrated a very weak correlation between the IL-1β level with CRP, ESR, and ACCP (r=0.079, r=0.059, r=0.080), respectively. In conclusion, the current study showed a correlation between the serum level of IL-1β and RA disease severity (DAS28) among the Iraqi Arab population, additionally, the study noted a very weak correlation between the IL-1β level with CRP, ESR, and ACCP.

Efficacy and safety of first-line biological DMARDs in rheumatoid arthritis patients with chronic kidney disease

ObjectiveTo evaluate the efficacy and safety of first-line biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) with chronic kidney disease (CKD), including those undergoing haemodialysis (HD).MethodsThis retrospective...

Exploring Role of SMAD3 in Serum of Rheumatoid Arthritis Patients

Background: Being an autoimmune and inflammatory illness, rheumatoid arthritis results from the body's immune system attacking healthy cells by mistake, creating inflammation in the affected areas. Aim of study: The purpose of this study was to use ELISA to assess the serum concentration level of SMAD3 in RA patients and control groups.. Methodology: The research was conducted between October 15, 2023, and January 15, 2024.The study, conducted at the Medical City Hospital under the Baghdad Government, involved male and female participants ranging in age from 18 to over 75. All participants in the trial provided a total of 90 clinical specimens (5 ml of blood): 45 patients and 45 controls. To use ELISA (Enzyme Linked Immune Sorbent Assay) to examine the immunological parameter Smad3, blood was taken from the patients. Results: There were statistically significant variations in the means of the concentration levels of the parameter Smad3 in RA patients (12.11±4.91) and controls 1.89 (0.98_4). Expression of Smad3 (ng/ml): For RA patients, the male median was 11.21±5.09 (range: 7.33–15.83), whereas the female median was 12.61±4.83 (range: 8.32–16.29). In Stage 1, Smad3 achieved 7.26±2.75, in Stage 2, 10.25±1.46, in Stage 3, 12.3±4.04, and in Stage 4, 18.97±1.72. Conclusion: There were statistically significant variations between the means of the concentration levels of the parameter Smad3 in RA patients and controls. There may be a slight correlation between RA stages and biomarker levels (Smad3), however this relationship is not statistically significant, and the effects are small.

Comparative Analysis of Coagulation Activation in Rheumatoid Arthritis Patients Treated With TNF Inhibitors Versus JAK Inhibitors: A Prospective Study.

This study aims to investigate the activation of the coagulation system of RA patients and assess changes during anti-inflammatory treatment with tumor necrosis factor blockers (anti-TNF) and Janus kinase inhibitors (JAKi). Biomarkers for the coagulation system, including D-dimer, fibrinogen, prothrombin time, activated partial thrombin time, prothrombin fragment 1 + 2, thrombin-antithrombin complex (TAT), activated factor IX, antithrombin complex, and von Willebrand factor (vWF), were longitudinally measured in 83 RA patients treated with anti-TNF and 38 RA patients with JAKi. Data were collected at baseline, after 1, 3, and 6 months. The mean age was 57 (±14) years; 76% was female. The mean DAS28-CRP was 3.6 (±1.3) for anti-TNF users and 4.1 (±1.4) for JAKi users at baseline and declined in both groups. Baseline coagulation markers levels were comparable between groups. In anti-TNF users, D-dimer and fibrinogen levels significantly declined (-0.31 mg/L, p = 0.01 and -0.71 g/L, p < 0.001, respectively), whereas TAT significantly increased after 6 months follow-up (1.46 μg/L, p = 0.03) and no effect on vWF (p = 0.98). In JAKi users, vWF declined significantly during the 6 months follow-up (-37.41%, p < 0.001); additionally, there were reductions of D-dimer, fibrinogen, and TAT that did not reach significance (-0.17 mg/L, p = 0.59; -0.49 g/L, p = 0.12; and 0.68 μg/L, p = 0.27, respectively). The prothrombotic tendency in active RA declined during effective treatment with both anti-TNF and JAKi. Altogether, the biomarkers used in this study suggest that an increased VTE risk in the first 6 months due to either treatment with anti-TNF or JAKi is unlikely.

Coronary Artery Calcification in Rheumatoid Arthritis Patients: A Systematic Review.

Rheumatoid arthritis (RA) is one of the leading autoimmune causes of inflammatory arthropathy worldwide. The musculoskeletal impacts of RA are well described within the literature. More recently, research efforts have highlighted that inflammation associated with the condition is not solely isolated to the joint synovium. Specifically, data has demonstrated that the cardiovascular system is negatively impacted by inflammation tied to RA, with adverse cardiovascular outcomes considered the leading cause of mortality among patients with RA. One approach to determine the risk for cardiovascular disease (CVD) is computed tomography (CT) coronary angiography, a noninvasive imaging approach that analyzes the calcifications within the coronary vessels. This has increasingly been utilized to analyze plaque burden and vessel obstruction, which is measured using the coronary artery calcium (CAC) score. A total of 305 articles were analyzed, and 11 articles were selected for this review based on inclusion and exclusion criteria. The results indicated that nearly 60% of patients with RA experienced an elevated CAC score. As such, patients with RA likely carry a higher risk for adverse cardiovascular outcomes as compared to their healthy counterparts. Additional research is warranted based on these findings to determine whether the addition of CT coronary angiography and analysis of laboratory markers for CVD, including lipid markers in standard protocols for RA comorbid assessment, would help to reduce adverse cardiovascular complications.