Coexistence Of Rheumatoid Arthritis Research Articles

Coexistence of Hashimoto’s thyroiditis, rheumatoid arthritis, Sjogren’s syndrome, and ulcerative colitis

Introduction and importance: The coexistence of Hashimoto’s thyroiditis and ulcerative colitis has been previously mentioned, as these diseases are autoimmune diseases. Limited data about the coexistence of rheumatoid arthritis in patients with Hashimoto’s thyroiditis have been published till now. Meanwhile, the coexistence of Sjogren’s syndrome during the course of rheumatoid arthritis is well known. The coexistence of Hashimoto’s thyroiditis, Sjogren’s syndrome, and ulcerative colitis has also been reported in rare cases. Case presentation: A 32-year-old female, with a 10-year history of Hashimoto’s thyroiditis, 4 years of rheumatoid arthritis, and 2 years of secondary Sjogren’s syndrome, presented to our Rheumatology Department, complaining of fatigue, weight loss, intermittent abdominal pain, and bloody diarrhea for the last 6 weeks. Her colonoscopy findings were compatible with a diagnosis of ulcerative colitis. Clinical discussion: Multiple autoimmune syndromes are defined as the presence of three or more autoimmune diseases in the same patient. They have an increased frequency in patients with a previous history of another autoimmune disease, and a higher correlation with females. The prevalence is rare and was documented only by two systematic reviews, with the rest being separate case reports. Autoimmune thyroid disease and Sjögren’s syndrome were the most frequent diseases encountered, followed by rheumatoid arthritis, and systemic lupus erythematosus. The presence of these autoimmune diseases together suggests that they share a common pathological and physiological genesis. Conclusion: This is the first case report, to our knowledge, that describes the coexistence of Hashimoto’s thyroiditis, rheumatoid arthritis, Sjogren’s syndrome, and ulcerative colitis within 10 years, without a positive family history or psychological stress. Therefore, further studies and long-term surveys are needed to identify other factors that can contribute to the coexistence of these rare diseases.

Adipokines in Rheumatoid Arthritis: Emerging Biomarkers and Therapeutic Targets.

Rheumatoid arthritis (RA) is a chronic inflammatory disease manifested by joint involvement, extra-articular manifestations, and general symptoms. Adipose tissue, previously perceived as an inert energy storage organ, has been recognised as a significant contributor to RA pathophysiology. Adipokines modulate immune responses, inflammation, and metabolic pathways in RA. Although most adipokines have a pro-inflammatory and aggravating effect on RA, some could counteract this pathological process. The coexistence of RA and sarcopenic obesity (SO) has gained attention due to its impact on disease severity and outcomes. Sarcopenic obesity further contributes to the inflammatory milieu and metabolic disturbances. Recent research has highlighted the intricate crosstalk between adipose tissue and skeletal muscle, suggesting potential interactions between these tissues in RA. This review summarizes the roles of adipokines in RA, particularly in inflammation, immune modulation, and joint destruction. In addition, it explores the emerging role of adipomyokines, specifically irisin and myostatin, in the pathogenesis of RA and their potential as therapeutic targets. We discuss the therapeutic implications of targeting adipokines and adipomyokines in RA management and highlight the challenges and future directions for research in this field.

Probable endometrial tuberculosis in a patient with rhupus

Endometrial tuberculosis (TB) is an uncommon manifestation of disseminated TB. Rhupus is the coexistence of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We describe a case of endometrial TB in rhupus patient an immunosuppressed.Contribution: We describe an uncommon presentation of disseminated TB, endometrial TB, in a rare rheumatic disease, rhupus. A high index of suspicion for TB is imperative in immunocompromised patients presenting with chronic urogenital symptoms especially in an endemic area.

P17 A bend in the road: a patient with rheumatoid arthritis developing multicentric reticulohistiocytosis

P17 A bend in the road: a patient with rheumatoid arthritis developing multicentric reticulohistiocytosis

Complex Overlap Syndrome of Rheumatoid Arthritis and Systemic Lupus Erythematosus - A Therapeutic Breakthrough with Azathioprine

This case study explores the complex nature of coexisting autoimmune diseases, which is most effectively demonstrated by the coexistence of rheumatoid Arthritis (RA) and systemic lupus erythematosus (SLE), also referred to as “rhupus syndrome.” A comprehensive evaluation of a 28-year-old woman with joint discomfort, morning stiffness, and increased C-reactive protein (CRP) values was conducted. Anti-cyclic citrullinated peptide (CCP), antinuclear antibodies (ANA), and other pertinent serological indicators were examined in the laboratory. The patient’s medical background, prior therapies, and family history were considered to create an individual therapy strategy. The patient’s symptoms remained despite a long history of disease-modifying anti-rheumatic medication (DMARD) use. Positive outcomes for anti-CCP, anti-ANA, and anti-double-stranded DNA (anti-dsDNA) antibodies provide light on the overlap of multiple autoimmune diseases. The diagnostic difficulty was increased when autoimmune neutropenia was diagnosed with a bone marrow biopsy. Once azathioprine therapy was started, symptoms significantly and quickly improved within a month. Azathioprine was found to be successful in the remission of the disease. Azathioprine therapy’s critical role in treating overlapping autoimmune illnesses emphasizes the necessity for individualized and advanced testing and treatment. Targeted immunosuppressive medicines have the potential to make significant advances and enhance patient care and results.

Assessment of the clinical features of rheumatoid arthritis-related interstitial lung diseases: a retrospective evaluation.

Rheumatoid Arthritis (RA) stands as the most prevalent form of inflammatory arthritis, affecting approximately 1% of the population. Among individuals diagnosed with RA, a notable proportion, ranging from 10% to 40%, also experience Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD). This coexistence of RA and ILD has been identified as a detrimental factor contributing to increased mortality rates. Furthermore, RA-ILD often exhibits an insidious nature, posing challenges in its timely detection and management. Hence, our objective was to conduct a retrospective analysis of the clinical characteristics observed in patients who underwent evaluation for RA-ILD. A total of 87 patients who were evaluated for RA-ILD within one year were included in the study. This study was conducted retrospectively using a cross-sectional and descriptive approach to analyze the demographic and clinical data of the included patients. Among the 87 patients, eight were diagnosed with RA-ILD, with four being male and four being female. Of the eight patients, two had non-specific interstitial pneumonia, five had usual interstitial pneumonia, and one had nodules consistent with RA. Subpleural fibrosis increased the likelihood of RA-ILD by 6.9 times. In the group with ILD, the residual volume and total capacity were found to be lower compared to the other group. Among the eight patients diagnosed with RA-ILD, five had used methotrexate before the diagnosis. In order to mitigate the risk of delayed diagnosis of RA-ILD, which can lead to increased mortality and has a subtle onset, it is recommended that patients with RA who possess certain risk factors undergo regular monitoring. It is advisable for RA patients to undergo annual assessments involving carbon monoxide diffusion capacity and spirometry function tests. In cases, where deemed necessary, more advanced investigations such as high-resolution computed tomography should be conducted.

Romatoid Artrit ve Orak Hücreli Anemi Birlikteliği; Olgu Sunumu

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease that primarily affects the synovial joints. Sickle cell anemia is a chronic inherited disease with vaso-occlusive attacks associated with hemoglobin structure defect. The coexistence of rheumatoid arthritis and sickle cell anemia is rarely reported in the literature. In this case report, the diagnosis and treatment plan of a 26-year-old female patient who was diagnosed with sickle cell anemia and applied to our outpatient clinic with bilateral hand arthritis findings will be presented in the light of the literature.

Combination of rheumatoid arthritis and sarcoidosis, which had occurred during rituximab therapy, complicated secondary immunodeficiency and intolerance to the main basic drugs: Case repost and literature review

Sarcoidosis is a rare multisystem disease which may accompany various autoimmune diseases in 17,6% cases. Despite of the fact that T-cell immunity impairments play a key role in these two conditions, their combination is extremely rare. It is difficult to choose therapy for patients with coexisted diseases, and it is even harder in case of comorbid pathology. In this article we considered a complicated case of treatment patient with a coexistence of rheumatoid arthritis and sarcoidosis, which had occurred during rituximab therapy. In addition to the combination of two autoimmune diseases, the selection of therapy for this patient was complicated by secondary immunodeficiency and intolerance to the main basic drugs.

A case report on Rheumatoid Arthritis with sickle cell trait

A female patient aged 6 years, a suspected case of sickle cell trait (SCT) having symptoms of Rheumatoid arthritis (RA), while evaluating joint complaints in adult sickle cell disease (SCD) patients, a number of sickle cell-based entities come to mind such as avascular necrosis, osteomyelitis, bone infarcts, and septic arthritis. RA is a chronic systemic inflammatory disease, many reports highlighted the occurrence of RA in SCD presenting as diagnostic challenges for cases with chronic inflammatory arthritis, SCT also have appeared to persist in some populations at a perplexingly high rate given the degree of early mortality of homozygosity of SCD, our case report showed that not only SCD but if a patient has SCT they can develop RA as complication. Our case report concludes that during the evaluation of a SCT patient who presents with chronic synovitis, one should strongly consider the possibility of coexistence of RA and SCT.

Coexistence of Rheumatoid Arthritis and Familial Mediterrean Fever: A Case Report and Review of the Literature

Familial Mediterranean Fever (FMF) is the most prevalent monogenic autoinflammatory disease characterized by clinical featuresof recurrent episodes of fever, leukocitosis, serositis, myalgia, erysipelas-like skin lesions, lasting 12-72 hours. Rheumatoidarthritis (RA) is a chronic, systemic inflammatory disease. The most prominent feature is symmetrical pain and swelling of thehands, wrists, feet, and knees. The exact mechanisms underlying the coexistence of FMF and RA has not been reported previously.So far, only 8 cases of the coexistence of FMF and RA have been reported. In this report, we aimed to explain the associationbetween FMF and RA and report one more case of this coexistence.

Rheumatoid arthritis in a sickle cell patient: a dangerous association?

Introduction - The diagnosis of rheumatoid arthritis remains a challenge because sickle cell disease can result in various rheumatological manifestations, including joint and bone pain. The concomitant presence of rheumatoid arthritis and sickle cell disease makes the therapeutic management of both conditions problematic.
 Observation - A 24-year-old man, a nurse by profession, has been followed for 10 years for homozygous sickle cell disease at the Sickle Cell Disease Research Center (CRLD) of Bamako, Mali. He has presented for 8 months symmetrical polyarthritis with morning stiffness of 3 hours, distinct from the usual vaso-occlusive crisis. The Analog Visual Scale was estimated at 80/100. He reported unquantified weight loss and asthenia. The physical examination showed a deformity in bilateral ulnar deviation, flexion of the right elbow, twelve painful joints, and five swollen joints. Normochromic normocytic anemia (hemoglobin 8.3g/dl), inflammatory syndrome with C - Reactive Protein (CRP) 130.91 mg, and Sedimentation Rate (ESR) 72mm at the first hour were noted. Rheumatoid Factor was weakly positive at 21.3 IU and Anti Citrullinated Peptide Antibodies at 385.2 IU. The radiography discovered bilateral erosive carpets without associated tarsitis and osteonecrosis of both femoral heads. The diagnosis of a very active immunopositive erosive rheumatoid arthritis meeting the criteria of ACR / EULAR 2010 was retained. A treatment based on prednisone 10 mg per day was initiated, associated with methotrexate at a dosage of 15 mg weekly in single-dose, folic acid, calcium, and vitamin D.
 Conclusion - The coexistence of rheumatoid arthritis in sickle cell patients makes the diagnosis of polyarthritis difficult.

THE STUDY OF THYROID FUNCTION IN RHEUMATOID ARTHRITIS IN NORTH BIHAR

RA patients coming from North Bihar reason i.e. Darbhanga, Madhubani, Samastipur etc. at DMCH, OPD. The study was of prospective nature, and analytical cross sectional study.The relationship between thyroid function and rheumatoid arthritis (RA) is a debatable subject and many studies have successfully demonstrated the autoimmune nature of thyroid dysfunction in RA. In a systematic review analyzing the results of 54 studies that investigated the coexistence of ADs within individuals and 9 studies that examined within-family associations, these data supported an increased prevalence of ATDs among patients with RA. In a separate study investigating the frequency of rheumatic diseases in patients suffering from ATDs, various rheumatic diseases were detected in 62% of patients with ATDs, one of which wasRA. The combination of RA and autoimmune thyroiditis was already recognized half a century ago. More recently, the coexistence of RA and hypothyroidism was reassessed, but data on this relationship remains sparse. As hypothyroidism and RA are both relatively common autoimmune diseases associated with increased CVD morbidity and mortality.Further research into the interaction between these two diseases is worthwhile, both from a cardiovascular and from an immunological point of view.

Metabolic syndrome,hematological markers of inflammation and disease activity in rheumatoid arthritis

Background: The coexistence of Rheumatoid Arthritis (RA) and Metabolic Syndrome (MetS) is common. Aim: The present study assessed the effect of MetS on disease activity and hematological markers of inflammation to Platelets/Lymphocyte Ratio (PLR) and Neutrophil/Lymphocyte Ratio (NLR) in RA patients. Study design: A cross-sectional case control study using STARD reporting guideline. Methods: The present study included 5 groups: treatment-naive RA patients with MetS (GI, n=50), treated RA patients with MetS (GII, n=50), treatment-naive RA patients without MetS (GIII, n=50), treated RA patients without MetS (GIV, n=50) and healthy age and sex-matched controls (GV, n=50). RA was diagnosed based on the 2010 ACR/EULAR criteria. Disease activity of RA patients was calculated using the DAS-28 score. For the diagnosis of MetS, we adopted the Harmonized Joint Scientific Statement (HJSS) on metabolic syndrome recommendations. Results: Patients in GI had significantly higher DAS28 when compared with other groups. GII and GIII patients had significantly higher DAS28 when compared with GIV. It was also shown that GI patients had significantly higher PLR and NLR when compared with GIII. Similarly, GII patients had significantly higher PLR and NLR when compared with GIV. Logistic regression analysis identified presence only MetS [OR (95%CI): 8.66 (1.34-56.1), p=0.024] and increased PLR (OR (95%CI): 0.98 (0.96-0.99), p=0.002) as independent predictors of high disease activity in treatment-naive patients while increased PLR was the only independent predictor of disease activity in treatmentexperienced patients. Conclusion: Metabolic syndrome is associated with elevated hematological markers of inflammation and disease activity in treatment-naive RA patients. Both PLR and NLR are risk factors for RA activity in treatment-naive patients with PLR being more strongly correlated with disease activity.

Association of Gout with Rheumatoid Arthritis and Pulmonary Toxicity of Methotrexate: A Case Report about Algerian Women

Coexistence of rheumatoid arthritis and gout is considered as rare however some patients may gather both diseases. Long-term treatment with Methotrexate may cause pulmonary pathology. We report a case of a 48-year-old Algerian woman with medical history (swelling of knee and joint pain in the shoulders and hands) diagnosed with Rheumatoid Arthritis (RA), after 3 years of self-medication with Methotrexate; she returned with hyperurecimia that confirmed the co-presence of the gout and RA as well as a pneumonia confirmed with clinical sign and chest X-Ray. Methotrexate dose compliance can reduce adverse effects.
 Keywords: Rheumatoid arthritis; Gout; Pneumonia; Methotrexate; Toxicity.

The Co-Existence of Rheumatoid Arthritis and Systemic Lupus Erythematosus Biomarkers: Is It Rhupus?

Background: Rhupus is a rare clinical condition where rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) overlap and is characterized by the presence of erosive arthritis with symptoms and signs of SLE. This study aims to investigate the prevalence of anti-CCP antibodies in SLE patients from CHU BLIDA (Immunology unit) and its association with anti-DNA and Anti Sm, in order to make a diagnosis of rhupus among our patients. Methods: Our retrospective study included 96 patients fulfilling the American College of Rheumatology (ACR) classification criteria for lupus. anti-CCP antibodies, anti-Sm were analyzed by ELISA, anti-DNA antibodies were determined by both IFI on Crithidia luciliae substrate and ELISA. The FR by Laser Nephelemetry. Inclusion criteria are the presence of at least one immunological marker of LES with anti-CCP. The sex ratio F / H is equal to 13/1, where the average age is 37 years. Results: Anti-CCP was found in 14 patients (14.6% ), 56.25% and 39.59% had positive anti-DNA and antiSm respectively; rheumatoid factors (RF) were positive in 27.08% of cases; anti-CCP / FR combination was found in 7.3% of cases. Besides, the combination of anti-CCP and anti-DNA was found in 12.5%. These two autoantibodies were simultaneously absent in 49.92% of cases. Arthritis was found in 80 patients. Our results concerning the prevalence of immunological and clinical markers of RA such as anti-CCP, RF and arthritis in our lupus patients corroborate with those of the literature. Conclusion: Based on the presence of shared clinical features of RA and SLE along with the presence of anti-DNA and anti-CCP antibodies in our patients, our findings strongly support the contention that rhupus is a true overlap between RA and SLE. Despite being a rare entity, it is important to know the clinical and humoral elements that allow its early diagnosis, making it easier to start treatment in a timely manner and reduce its possible complications.

An overlap of Alport syndrome and rheumatoid arthritis in a patient and literature review

BackgroundAlport syndrome is a rare genetic kidney disease, and rheumatoid arthritis as a common autoimmune disease also causes renal lesions in addition to arthritis. The overlap of them has rarely been reported.Case presentationA 44-year-old man had a history of multi-joint swelling and pain for more than half a year. His laboratory data with double positive for rheumatoid factor and anticitrullinated protein antibodies further supported the diagnosis of early rheumatoid arthritis. His previous medical history including progressive hearing loss for several years and microhematuria for one year attracted our attention. Renal biopsy showed thin basement membrane nephropathy and lymphocytes infiltration of interstitium. To make a precise diagnosis, targeted Next Generation Sequencing (NGS) of an inherited renal disease panel including Alport syndrome genes was performed, which revealed the missense mutation in COL4A5 (c.1351 T > C, p.Cys451Arg). Further in silico analyses predicted that the p. Cys451Arg mutation is functionally “damaging”, so the diagnosis of Alport syndrome was finally proved. The patient has been receiving the treatment of total glucosides of paeony and leflunomide for rheumatoid arthritis, and Cozaar 50 mg for the protection of kidney so far. During the 10-months follow-up, swelling and tenderness of the joints in this patient had been generally relieved, with no obvious improvement in microhematuria and a slight increase in proteinuria.Conclusionwe reported an adult man with the coexistence of rheumatoid arthritis and Alport syndrome with the missense mutation in COL4A5 (c.1351 T > C, p.Cys451Arg). Whether the overlap of them is occasional or has a common pathophysiological mechanism is still unclear.

The effect of concomitant hand osteoarthritis on pain and disease activity in patients with rheumatoid arthritis

IntroductionPain is a core complaint among rheumatoid arthritis (RA) patients, and persistent pain requires treatment adjustments according to current strategies. We aimed to quantify the impact of hand osteoarthritis (OA) on health status and residual pain in patients with RA.MethodsThis cross-sectional survey compared RA patients with and without osteoarthritis of the hand. The main outcome was pain intensity. Other measurements included disease activity scores (the Disease Activity Score 28-joints; the Simplified Disease Activity Index, SDAI; the Clinical Disease Activity Index, CDAI), functional disability and self-reported quality of life, and the proportion of patients with residual pain (Patient Acceptable Symptom State, PASS).ResultsEighty-one patients were analyzed, including 39 with RA and OA and 42 with RA only. The patients were mainly women (94%), with a median disease duration of 13 years. This group also reported a higher intensity of pain (visual analogue scale, VAS 70 mm vs. 30 mm; p = 0.003), higher disease activity (3.89 vs. 2.88; p = 0.001), and greater functional disability irrespective of treatment and comorbidities. A strong correlation (r2 = 0.69; p < 0.001) between pain and disease activity was observed, although no differences in pain were observed between groups according to disease activity categories. Patients with RA and OA had a higher proportion of residual pain (59% vs. 29%; p = 0.006) even in the absence of clinical inflammation.ConclusionThe coexistence of RA and hand OA is associated with distorted disease activity measurements in RA. Osteoarthritis contributes to persistent pain and greater disability in patients with RA.

Pelvic fractures after definitive and postoperative radiotherapy for cervical cancer: A retrospective analysis of risk factors.

This study clarified the incidence of and identified the risk factors for post-radiation pelvic insufficiency fractures (PIFs) in women who received postoperative definitive or adjuvant radiotherapy (RT) for cervical cancer. The medical records and data of imaging studies, including computed tomography scan and magnetic resonance imaging, of women with cervical cancer who received external-beam RT for the entire pelvic area between January 2003 and December 2012 at our institution were reviewed. A total of 533 patients with histologically diagnosed cervical cancer who received RT (298: definitive RT, 235: adjuvant RT) were included in this study. Eighty-four patients (15.8%) developed PIF in the irradiated field. Median age at onset of PIF was 72.5years (range: 54-95years), and 82 of them (98%) were postmenopausal women. Sixty-nine patients (80%) developed PIF within 3years from the completion of RT. The median time for the development of PIF was 14months (range: 1-81months). The most commonly involved fracture site was the sacral bone. Postmenopausal state, coexistence of rheumatoid arthritis, and high-dose-rate intracavitary brachytherapy (HDR-ICBT) use were significant predisposing factors for the development of PIF, according to multivariate analysis. The incidence rate of PIF among patients who received RT for locally advanced cervical cancer was 15.8%. The principal predisposing factors for post-radiation PIF were postmenopausal state, rheumatoid arthritis, and HDR-ICBT use. Active interventions, including bone density screening followed by medication, should be considered during the early stage of RT for women with high-risk factors of PIF.

Comorbidity of gout and rheumatoid arthritis in a large population database

Coexistence of rheumatoid arthritis and gout is considered to be unusual. The current study was designed as a population-based cross-sectional study, utilizing the medical database of Clalit Health Services, the largest healthcare provider organization in Israel. Data of adult patients who were previously diagnosed with rheumatoid arthritis was retrieved. For each patient, five age- and sex-matched control patients were randomly selected. Different parameters including BMI, socioeconomic status, and existence of gout as well as smoking and hypertension were examined for both groups. The study included 11,540 patients with rheumatoid arthritis and 56,763 controls. The proportion of gout in the study group was high compared to controls (1.61 vs. 0.92%, P<0.001). In a multivariate analysis, rheumatoid arthritis was associated with gout (OR=1.72, 95% CI 1.45-2.05, P=0.00). The proportion of gout in rheumatoid arthritis patients is not lower than in the general population.

Co-occurrence of rheumatoid arthritis with ulcerative colitis: A rare case

Ulcerative colitis (UC), an autoimmune disorder with unknown etiology, is a systemic disease with various extraintestinal manifestations such as arthritis, kidney and liver disease, and eye disorders. The present case study focuses on the co-occurrence of UC and rheumatoid arthritis (RA) in a 60-year old female patient. Although the co-existence of RA with autoimmune disease is common, its association with inflammatory bowel disease is rare. The present study highlights the significance of further research to identify the factors and interactions that influence and contribute to the co-existence, which may assist in early diagnosis. Moreover, it focuses on the need to consider the chance of co-occurrence during the differential diagnosis, though the association is rare.