DAS28 Levels Research Articles

Helicobacter pylori upregulates PAD4 expression via stabilising HIF-1α to exacerbate rheumatoid arthritis

ObjectiveHelicobacter pylori infection has been reported to aggravate rheumatoid arthritis (RA), but the relevant mechanism remains unclear. This study aimed to investigate the underlying pathogenic mechanism of H. pylori infection...

Clinico Pathological Study of Rheumatoid Arthritis Association with C -Reactive Protein (CRP); a Potential Biomarker of Cartilage Damage

Objective: To explore the association between rheumatoid arthritis (RA) and C-reactive protein (CRP) levels as a potential biomarker of cartilage damage. Methodology: This case control study was done at Department of pathology Ziauddin University Clifton Campus, Karachi from June 2018 to May 2019. Patients diagnosed with rheumatoid arthritis (RA) according to established criteria, aged 18 years or older and both male and female participants were included. Clinical data was collected through medical record review and direct patient interviews. Blood samples were collected from participants for CRP measurement using standard laboratory assays. Serum CRP levels were quantified using high-sensitivity CRP assays in a certified clinical laboratory. CRP levels was defined based on established cutoff values, typically exceeding 3 mg/L. Statistical Analysis: Statistical analysis will be performed using SPSS version 26. Results: Mean age of patients was 43.38+.56 years, while control group subjects had a slightly lower mean age of 42.33+6.93 years (p = 0.412). Gender distribution showed a predominant female representation, with 76 female patients (88.4%) and 75 female controls (87.2%) (p = 0.816). There was a strong positive correlation was observed between DAS28 and CRP levels, with a Pearson correlation coefficient of r= 0.745 and (p < 0.01), indicating a significant association between disease activity and CRP concentration. Conversely, the correlation between DAS28 and ESR was weaker and not statistically significant (r = 0.123, p = 0.258). Conclusion: Study revealed that the significant elevation of serum CRP levels in RA patients compared to healthy individuals. The positive correlation between serum CRP levels and the extent of joint damage observed radiographically, suggesting CRP's potential as a biomarker for estimating disease severity and cartilage deterioration in RA.

Estimation levels of CTHRC1and some cytokines in Iraqi patients with Rheumatoid Arthritis

Collagen triple helix repeat containing-1 (CTHRC1) is an essential marker for Rheumatoid Arthritis (RA), but its relationship with pro-inflammatory, anti-inflammatory, and inflammatory markers has been scantily covered in extant literature. To evaluate the level of CTHRC1 protein in the sera of 100 RA patients and 25 control and compare levels of tumour necrosis factor alpha (TNF-α), interleukin 10 (IL-10), RA disease activity (DAS28), and inflammatory factors. Higher significant serum levels of CTHRC1 (29.367 ng/ml), TNF-α (63.488 pg/ml), and IL-10 (67.1 pg/ml) were found in patient sera as compared to that in control sera (CTHRC1 = 15.732 ng/ml, TNF-α = 33.788 pg/ml, and IL-10 = 25.122 pg/ml). There was no significant correlation between the level of serum CTHRC1 and DAS28 (r = 0.046, P = 0.650), while there were positive significant correlations between the levels of serum CTHRC1 and CRP (r = 0.372, P = 0.0001), ACPA (r = 0.254, P = 0.01), TNF-α (r = 0.202, P = 0.044), and IL-10 (r = 0.260, P = 0.0001). The level of CTHRC1 (> 25.385 ng/ml) in combination with the levels of CRP and ACPA provided a good indication of RA prediction with sensitivity = 71.0%, specificity = 100.0%, accuracy = 0.71%, positive predictive value (PPV) = 100.0%, and negative predictive value (NPV) = 46.3%. The study showed a significant correlation between the levels of CTHRC1 and TNF-α, and IL-10. These molecules may play a prominent role in the diagnostic and etiology of RA

Plasma extracellular DNA and neutrophilic leukocyte activity in patients with rheumatoid arthritis

Neutrophilic leukocytes play a key role for the joint damage in development of rheumatoid arthritis (RA). The specific death mode of these cells (netosis) may be an important reason of increase of cell-free DNA (cfDNA) in peripheral blood of the RA patients. Of great interest would be studies of alleged relationships between the of blood cfDNA contents being able of playing the role of an auto-antigen participating in the initiation of autoimmune reactions, and indices of neutrophil activation in this immunopathological disorder. The aim of the present study was to determine the levels of cfDNA in blood plasma of patients with RA depending on the clinical course of the disease, and to evaluate possible relationships between this index and activation of neutrophilic leukocytes. The study was conducted on 28 conditionally healthy donors and 63 patients with RA from the Rheumatology Department at the Clinic of Immunopathology (Novosibirsk). The level of cfDNA was determined using PicoGreen fluorescent dye. Neutrophils from the peripheral blood of donors and patients with rheumatoid arthritis were isolated in a Ficoll-Urografin density gradient. Neutrophilic leukocytes accounted for more than 98% of the fraction of isolated cells, and their viability was 99%. A portion of freshly isolated neutrophils was stimulated by phorbol myristate acetate. Concentration of myeloperoxidase in blood plasma of donors and patients with RA was determined using the Human MPO ELISA kit. It has been shown that the increased concentration of extracellular DNA in blood plasma of RA patients correlates with an higher degree of disease activity, and this parameter may serve as a relatively independent indicator of the disease intensity. A correlation was found between the level of cfDNA and common biochemical markers used to assess the activity of disease, i.e., DAS-28 and C-reactive protein levels in serum (p 0.05). Decrease of cfDNA concentrations is detected during treatment of the RA patients. This is due to the expected prognosis, i.e., a decreased manifestation of the disease, which also means correct administration of therapy. A relationship was found between the level of cfDNA and blood myeloperoxidase concentration in RA patients. The data obtained during the study suggest a possible connection between increased concentration of extracellular DNA, and activation of neutrophilic leukocytes in rheumatoid arthritis, with increased netosis in the affected joints.

Assessment of Vitamin D Level in Psoriasis and Psoriatic Arthritis Patients

Objective: Investigating the relationship between vitamin D status and psoriasis and psoriatic arthritis is the goal of this investigation. Methods: 120 individuals with psoriasis & 38 patients with psoriatic arthritis (PsA) participated in a case-control research; 89 (56.3%) of the patients were men. Every patient with psoriasis had their erythrocyte sedimentation rate (ESR) and disease activity score utilizing 28 joints (DAS28) computed, and every person with PsA had their disease area and severity index (PASI) assessed. 164 volunteers, matched for age and sex (91 men and 73 women), made up the control group. Serum vitamin D levels were measured in both patients and controls. Results: Both patients' and controls' vitamin D levels were 17.4and 28.3 respectively. When compared to patients with disease durations of 10 years or less, the level of vitamin D was lower in patients with disease durations equal to or greater than that. The two patient groupings' vitamin D levels do not significantly differ from one another. Psoriasis and PsA have been associated with elevated PASI and DAS28 levels due to low vitamin D levels. Conclusion: Low blood Vitamin D levels are connected with patients who have psoriasis and PsA. In both PsA and psoriasis, vitamin D insufficiency has been linked to the persistence of the illness. Keywords: vitamin, psoriasis, diseases severity index, psoriatic arthritis

Correlation between percentage of fat mass and level of disease activity in rheumatoid arthritis.

Introduction:Controversies exist regarding the relationship between body fat and disease activity in patients with rheumatoid arthritis. The evaluation of the disease is critical for establishing treatment and prognosis. Fat mass could be a predictive factor for poor prognosis in rheumatoid arthritis because of its association with low- and high-grade inflammation.Objective:To evaluate the correlation between fat mass values and disease activity in patients with rheumatoid arthritis.Materials and methods:This was a cross-sectional study. Eighty female patients diagnosed with rheumatoid arthritis (American College of Rheumatology of 1987) were evaluated. For each one, the evaluation determined fat mass using bioelectrical impedance analysis and disease activity using the Disease Activity Score on 28 joints (DAS28).Results:The mean age was 59.11 ± 9.92 years, with an average disease duration of 14.13 ± 10.13 years; 85% of patients showed a high body fat percentage. Pearson’s correlation between DAS28 values and fat mass was r = 0.035 (p = 0.76).Conclusion:The levels of DAS28 showed no correlation with fat mass percentage. Further studies are required to clarify the factors that can modify these levels.

Stachys schtschegleevii tea, matrix metalloproteinase, and disease severity in female rheumatoid arthritis patients: a randomized controlled clinical trial.

Stachys schtschegleevii (SSC) is a herbal medicine used to treat infections. To date, this is the first study aimed to investigate the effects of SSC tea on disease activity score (DAS), serum inflammatory biomarkers and matrix metalloproteinases (MMP-1 and MMP-3) among women with rheumatoid arthritis (RA). This pilot, triple-blind, randomized controlled clinical trial was conducted among forty-four women (age: 30-65 years) diagnosed with moderately active RA. Subjects were randomly assigned (1:1 ratio) into either SSC group (2.4 g/day SSC + 2.4 g/day black tea, n=22) or placebo (2.4 g/day black tea, n=22) for 8 weeks. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin-1 beta (IL-1β), and MMPs were measured using ELISA. According to the American College of Rheumatology guideline considering hs-CRP, DAS28 was assessed. Both study groups had respondent rates above 94.9%. The SSC intervention caused significant reductions in the number and the percent changes of the tender joints (SSC: -74.39%vs.placebo: -57.15%, mean differences= -0.77; P<0.05) and DAS28 [SSC: -32.44% vs.placebo: -22.32%, mean differences= -0.41, P<0.05). Unlike the intervention within SSC group that showed significant reductions in the mean serum levels of hs-CRP, IL-1β, and MMP-3, SSC caused significant MMP-3 reductions (SSC: -20.59%vs.placebo: 1.29%, P<0.05). The SSC intervention showed an appropriate clinical efficacy for female RA patients, accompanying remarkable reductions in the number of tender and swollen joints, DAS28, and serum levels of MMP-3. This can provide additional insights to the interventional studies controlling RA-related pathological and inflammatory outcomes. Trial registration Prospectively registered at the Iranian Registry of Clinical Trials (IRCT), linked to the WHO Registry Network ( https://en.irct.ir/trial/11602 , IRCT registration number: IRCT2015032011335N5, Registration date:2015-05-12). Key Points • Stachys schtschegleevii improved clinical outcomes and attenuated disease severity in RA patients. • Stachys schtschegleevii ameliorated serum level of MMP-3 in RA patients.

Immunological and Biological Manifestation of Rheumatoid Arthritis Patient in Iraq

Rheumatoid arthritis is one of the highly incidence autoimmune disease. In present study the immunologicaland clinical biochemical test was checked in patients with RA in Iraq. Here 70 serum specimens wereobtained from patients suffer from RA and 30 serum specimens from healthy control cohorts. Antinuclearantibodies (ANA) level, C-reactive protein level, erythrocyte sedimentation rate (ESR), activity of alanineaminotransferase (ALT), activity of aspartate aminotransferase (AST), concentration of blood urea andserum creatininand diseases activity score (DAS)-28 were evaluated in sera of patients and healthy controlcohorts. The results showed that significant elevation in level of ANA, ESR, CRP and DAS-28 in patientsgroup as compared to healthy control group (P&lt;0.05). No significant difference between patients group andhealthy control group in terms of activity of ALT, AST, concentration of blood urea and serum creatinine.The person test (r) was done to evaluate the correlation between ESR, ANA, CRP, ALT, AST, blood urea andserum creatinine. The results showed significant relation between levels of ESR, CRP and ANA and activityof disease in terms of DAS-28. The results showed no significant relation between level of CRP, ALT, AST,blood urea and serum creatinine in patient’s sera and DAS-28. It can be concluded from present study thatthe some laboratory parameters related with activity of RA such as ESR, ANA, CRP and other parametersdo not related with activity of RA such asALT, AST, blood urea and serum creatinine.

Impact of disease activity and treatments on ovarian reserve in patients with rheumatoid arthritis in the ESPOIR cohort.

Patients with RA have a higher prevalence of infertility than the general population. This study sought to examine the impact of RA disease activity and treatments on ovarian reserve measured by serum anti-Müllerian hormone (AMH) levels in the ESPOIR cohort. We sought to better define the indications for fertility preservation. Patients and serum analysis data were derived from the French national cohort ESPOIR. Enrolled patients (n = 102; 18-37-year-olds) fulfilled ACR/EULAR 2010 criteria for RA. Serum AMH levels were measured at T0, T6, T12, T24 and T36 months post-diagnosis. The impacts of RA activity (DAS28 and CRP level) and treatments (MTX only or with other medications) were evaluated at each study visit. A gradual decrease in patients' serum AMH levels was observed over time, in line with the descending curve described for healthy women. Serum AMH levels of RA patients in comparison with the values considered normal for age did not reveal any significant differences (P > 0.05). We did not observe any impact of RA treatments. We demonstrated an inverse correlation between AMH variation and disease activity (DAS28: r = -0.27, P = 0.003; CRP: r = -0.16, P = 0.06). This is the first study to determine serum AMH levels of a large cohort of RA patients over 36 months. Rapid disease activity control appears to be required to limit changes in the ovarian reserve. Fertility preservation is not likely to be necessary if inflammation is promptly controlled. NCT03666091.

Evaluation of the relationship of immuno-inflammatory process with dyslipidemia and myocardial morphofunctional parameters in patients with chronic heart failure on the background of rheumatoid arthritis

Objective. To evaluate the relationship between the manifestations of the immune-inflammatory process with dyslipidemia and morphofunctional parameters of the myocardial state in patients with chronic heart failure (CHF) with a preserved left ventricular ejection fraction (CHF-SFV) against the background of seropositive rheumatoid arthritis (RA).Subjects and methods. The study involved 57 women with CHF-SFV, formed as a result of coronary heart disease and/or hypertension. All patients had functional class I and II according to NYHA. All patients were divided into comparable groups: the first group included 31 patients with a combination of CHF and seropositive RA of radiological stage I-III, the second group included 26 patients without RA. Patients with RA had a low and moderate degree of activity according to DAS28. The Diagnosis of CHF was verified by ESC (European Society of Cardiology) criteria, the diagnosis of RA – by EULAR/ACR criteria (2010). The therapy was in line with current clinical recommendations. Methotrexate was used as a basic anti-inflammatory drug in patients with RA. The average dosage was 12,9±2,5 mg/week. In the study groups, a comparative analysis of the main laboratory and instrumental indicators used in the diagnosis and monitoring of CHF, as well as the relationship of manifestations of the immunoinflammatory process with dyslipidemia and indicators of diastolic myocardial dysfunction was performed. Results. The level of total cholesterol in the CHF group without RA averaged 4,4±0,9 mmol/l and 5,2±2,2 mmol/l in the CHF and RA group (p=0,09); triglycerides – 1,9±0,7 and 1,5±0,9 mmol/l (p=0,3); low-density lipoproteins (LDL – C)-2,6±0,8 and 3,1±1,1 mmol/l (p=0,04); high – density lipoproteins (HDL-C) – HDL) – 1,3±0,2 and 1,3±0,1 mmol/l, respectively (p=0,7). In the group of CHF on the background of RA, a direct relationship between the intake of methotrexate (the average dose was 12,9±2,5 mg/week) and the level of HDL-C: R=0,3; R2=0,1; F=0,9; (p=0,01). In the group of CHF and RA, there was a statistically significant relationship between the ratio of transmittal flow parameters with the level of DAS28 and RF: R=0,5; R2=0,3; F=2,6 (p=0,04).Conclusion. Against the background of the immuno-inflammatory process caused by RA, a significant increase in the level of LDL was detected, which can negatively affect the course of dyslipidemia in patients with CHF-SFV. There was an increase in the concentration of HDL on the background of treatment with methotrexate in the group of CHF-SFV and RA. A direct correlation of the ratio of parameters of the transmittal flow with the RF and DAS28 levels was found. This relationship may affect the progression of left ventricular diastolic dysfunction in the group of CHF and RA, but prospective studies are needed to clarify its role.

Does autoimmune thyroid disease affect rheumatoid arthritis disease activity or response to methotrexate?

ObjectiveTo investigate if autoimmune thyroid disease (AITD) impacts rheumatoid arthritis (RA) disease activity or response to methotrexate.MethodsA nationwide register-based cohort study of 9 004 patients with new-onset RA from the...

THU0190 METHOTREXATE THERAPY IS NOT ASSOCIATED WITH AN INCREASED RISK OF LIVER FIBROSIS ASSESSED BY THE FIBROSIS-4 INDEX

Background: Methotrexate (MTX) holds a unique place in the management of rheumatoid arthritis (RA) given its favorable balance between efficacy and safety. However, conflicting data still suggest a potential risk of MTX-induced long-term liver fibrosis. The fibrosis-4 (FIB-4) index was originally proposed as a simple and non-invasive marker of liver fibrosis in HIV/HCV co-infection. In patients with RA, FIB-4 values have been correlated to the amount of histologic liver lesions, suggesting that this index may be a valuable marker to diagnose liver disease in RA patients (1). Objectives: To estimate the amount of scarring in the liver with the FIB-4 index in RA patients on maintenance therapy with MTX. Methods: We performed a cross-sectional study including successive RA patients hospitalized in the Rheumatology department of Cochin Hospital for a 12-month period. Data on liver function, disease activity, hepatotoxic and cardiovascular risk factors were systematically collected. The FIB-4 index was calculated according the following formula: (age(years) × AST(U/L)/platelet (PLT) (109/L) × √ALT(U/L)). Using a lower cutoff value of 1.45, a FIB-4 score 3.25 had a 97% specificity and a positive predictive value of 65% for advanced fibrosis (2). Results: We included 170 patients with established RA: 141 (83%) were women, the mean age was 59+/-12 years and the mean disease duration was 15+/-11 years. Positive rheumatoid factors and anti-CCP antibodies were detected in 134 patients (79%). 102 patients (60%) were treated with methotrexate, with a mean dose of 10.0+/-8.4 mg/week, a mean treatment duration of 9.5+/-10.3 years and a cumulative dose of 5.3+/-5.1g. 23 patients (13.5%) received conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) other than MTX, 112 (66%) corticosteroids (99 with a dose 3.25. The FIB-4 was low and not significantly different between patients receiving MTX, patients previously treated with MTX and patients never treated with MTX (median 1.1, 1.25 and 1.18, respectively, p=0.709). This result was not modified after adjustment on treatments with other csDMARDs, corticosteroids, and bDMARDs. No correlation was observed between FIB-4 values and the cumulative dose of MTX (r=0.09, p=0.271). The FIB-4 index was low and similar between patients receiving cumulative MTX doses 1.45 (median cumulative MTX dose 5.5g vs. 3.5g, p=0.302). No association was detected between the FIB-4 index and parameters of disease activity (DAS28, ESR and CRP levels), the body mass index, traditional cardiovascular risk factors and metabolic syndrome. Conclusion: RA patients with long-term maintenance MTX therapy have low FIB-4 values suggesting that MTX is not associated with an increased risk of advanced liver fibrosis.

The influence of tocilizumab immunogenicity markers on the effectiveness of treating rheumatoid arthritis

Purpose. The study assesses the impact of tocilizumab immunogenicity markers on clinical response to conducted treatment in patients with rheumatoid arthritis.&#x0D; Materials and methods. A total of 17 patients with the confirmed diagnosis of RA receiving tocilizumab therapy for more than 1 year were enrolled into the study. Blood serum samples were collected once every six months before every drug injection during 2.5 years of treatment. The concentration of antibodies to tocilizumab and level of tocilizumab was determined using the ELISA. Additionally, DAS28 values were measured at the first and the last patient visit during the course of study, whereas levels of C-reactive protein (CRP), white blood cells, platelets, rheumatoid factor, and circulating immune complexes were only measured at the last examination.&#x0D; Results. Positive correlations between the antibodies to tocilizumab and the last point DAS28 values were found, as well as a negative correlation of tocilizumab level and the level of DAS28.&#x0D; Conclusions. The data obtained indicate a significant effect of serum levels of tocilizumab, as well as of the concentration of antibodies to tocilizumab on the effectiveness of RA treatment. A routine study of these biomarkers might be useful for individualizing treatment approaches for RA patients and determining the causes of tocilizumab resistance.

High density lipoprotein in rheumatoid arthritis: emerging role in predicting inflammation level and osteoporosis occurrence

Dyslipidaemia is common in patients with rheumatoid arthritis (RA) appearing both early and advanced stages of the disease. A retrospective study was designed to explore the clinical significance of high density lipoprotein (HDL) in Chinese patients with RA. Serum levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were compared between RA patients complicated with osteoporosis (OP) and without OP, using logistic regression and ROC curve to analyse the association of HDL with OP. C reactive protein (CRP), erythrocyte sedimentation rate(ESR), rheumatoid factor(RF), anti-cyclic citrulline polypeptide antibody (anti-CCP), 28 joints disease activity(DAS28) as well as organ involvement rates were then analysed between RA patients with different HDL levels. Serum levels of HDL were 1.2 ± 0.3 mmol/L in RA patients complicated with OP, significantly higher than those without OP; HDL was a risk factor for RA patients with OP, OR (95% CI) being 10.2 (4.5–23.0) after adjusting for gender, age and body mass index(BMI). RA patients with HDL ≤ 1.04 mmol/L had significantly higher levels of CRP, ESR, DAS28 and cardiovascular disease (CVD) incidence rate, yet OP incidence rate was lower. HDL was a predictor of RA-related OP, indicating potential value as predictor of disease complications in RA patients.

The effectiveness of nurse-led case management for patients with rheumatoid arthritis in Taiwan.

Case management is a patient-centred approach which has shown efficacy in managing patients with chronic and life-threatening disease. Presently, the effect of case management delivered by nurses for rheumatoid arthritis (RA) patients remains unclear, especially for those subjects who reside in Asia. This study aimed to examine the effectiveness of nurse-led case management (NLCM) among RA patients in Taiwan. A quasi-experimental research design was utilised to recruit RA patients from a hospital in Taiwan. All patients who were diagnosed as having RA from January 2017 to June 2018 were free to opt to participate in the intervention. The experiment group (n=50) received six sessions of NLCM over six months, while the control group (n=46) received only standard care during the same time period. Effectiveness data were collected through the review of medical records and a structured questionnaire that included the Taiwanese Depression Questionnaire (TDQ), the arthritis self-efficacy scale and a disease activity score by 28 joints (DAS28) at three time points (T1: before NLCM; T2: three days after NLCM completion; and T3: six months after NLCM completion). The effects of NLCM were determined using a generalised estimating equations model. After adjusting for several potential confounders, we found that the NLCM implementation decreased the levels of DAS28 (T1=-0.78; T2=-0.85; all at P=.01) and TDQ (T1=-3.86; T2=-10.57; all at P<.05) and enhanced ASES level for RA patients (T1=132.03; T2=484.69; all at P<.05). This study adopted a non-randomised, unblinded and uncontrolled intervention, and the findings supported the positive effects of NLCM following the use of a robust statistical method. The findings may serve as a reference for instituting more appropriate interventions for RA patients.

Platelet/Lymphocyte, Lymphocyte/Monocyte, and Neutrophil/Lymphocyte Ratios as Biomarkers in Patients with Rheumatoid Arthritis and Rheumatoid Arthritis-Associated Interstitial Lung Disease.

BackgroundThe objective of this study was to assess the diagnostic value of platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and neutrophil/lymphocyte ratio (NLR) as biomarkers in patients with rheumatoid arthritis (RA) and rheumatoid arthritis-associated interstitial lung disease (RA-ILD).Material/MethodsDemographic and laboratory data were acquired for 198 RA and 103 RA-ILD patients and 290 healthy controls. The subjects were categorized into female and male groups and further subcategorized based on age into <60 years and ≥60 years subgroups. One-way analysis of variance (ANOVA), receiver operating characteristics (ROC), Pearson analysis, multiple linear regression analysis, and logistic regression analysis were performed to analyze the association of PLR, NLR, and LMR with RA and RA-ILD.ResultsMean PLR and NLR were lowest in the control group, followed by the RA and RA-ILD groups (p<0.05). Mean LMR was lowest in the RA-ILD group, followed by the RA and control groups (p<0.05). The area under the ROC (AUROC) values of the PLR to distinguish between RA and controls, RA-ILD and controls, and RA-ILD and RA were 0.676, 0.776, and 0.650, respectively (p<0.001). Multiple linear regression analysis suggested a significantly positive association between the level of PLR and the level of DAS28 (p<0.001). The odds ratio of PLR was 1.101 for RA (p=0.023) and 1.217 for RA-ILD (p<0.001) when compared to the controls.ConclusionsPLR may be applied as a new biomarker for predicting and diagnosing RA and RA-ILD and for distinguishing RA-ILD patients from RA patients and healthy subjects.

High burden of adverse events is associated with reduced remission rates in early rheumatoid arthritis.

Adverse events (AEs) are common during disease-modifying antirheumatic drug (DMARD) treatment, but their influence on treatment results is unclear. We studied AEs in relation to disease activity in early rheumatoid arthritis (RA). Ninety-nine patients started intensive treatment with three conventional synthetic DMARDs (csDMARDs) and oral prednisolone, and were randomized to a 6-month induction treatment with infliximab or placebo. All AEs during the first 12months of treatment were recorded. We scored each AE based on severity (scale 1-4) and defined the burden of AEs as the sum of these scores. Patients were divided into tertiles according to the burden of AEs. As outcomes, we assessed 28-joint disease activity score (DAS28) levels and remission rates at 12 and 24months. Three hundred thirty-one AEs in 99 patients were reported, and 27 (8%) were categorized as severe or serious. Mean burden of AEs per patient was 5.4 ± 4.3. Seventy-nine AEs (24%) led to temporary (n = 52) or permanent (n = 27) csDMARD discontinuation. Of discontinuations, 1, 21, and 57 were detected in the first, second, and third tertiles, respectively. DAS28 remission rates decreased across tertiles at 12months (94, 94, and 76%; p for linearity 0.029) and at 24months (90, 86, and 70%; p for linearity 0.021). Mean DAS28 levels increased across tertiles at 12months (1.5 ± 1.0, 1.7 ± 0.9, and 1.9 ± 1.2; p for linearity 0.021) and at 24months (1.4 ± 0.8, 1.6 ± 1.0, and 1.9 ± 1.1; p for linearity 0.007). High burden of AEs is associated with higher disease activity and lower likelihood of remission in early RA.

The Relationship Between Cardiac Conduction Times, Cardiovascular Risk Factors, and Inflammation in Patients with Early Arthritis.

To investigate the prevalence of conduction disorders in patients with early arthritis and the relationship with inflammation and traditional cardiovascular (CV) risk factors. Patients with rheumatoid arthritis (RA) have a 2-fold higher risk of sudden cardiac death, possibly owing to conduction disorders. This increased risk might already be present at the clinical onset of arthritis. Therefore, we assessed electrocardiography, blood pressure, 28-joint Disease Activity Score (DAS28), lipid profile, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level in 480 patients with early arthritis at baseline and after 1 year. The prevalence of conduction disorders was 12.5%. Conduction times at baseline were not associated with DAS28, ESR, or CRP levels and did not change during antirheumatic treatment. Baseline and the improvement in DAS28 (European League Against Rheumatism response), ESR, and CRP were significantly associated with heart rate, lipid profile, and blood pressure. Elevated total cholesterol and blood pressure were associated with an increased QRS time. The change in heart rate differed 7.3 bpm between patients with the least versus largest DAS improvement. The prevalence of conduction disorders in patients with early arthritis was 12.5%, which is similar to the general population and was not associated with changes in inflammation markers. However, a high cholesterol was associated with a prolonged QRS time. Therefore, the emphasis of CV risk management in arthritis should not be only on treatment of disease activity but also on traditional CV risk factors. The relationship between the improvement in disease activity and heart rate is remarkable because this could imply a 10-year CV mortality risk difference of 24%.

INFLAMMATION-LOWERING EFFECTS OF ORAL ANTIDIABETIC DRUGS IN RHEUMATOID ARTHRITIS

Objective. The primary aim of this study is to underline the inflammation-lowering effect of oral antidiabetic drugs, namely the CRP, ESR and DAS28 levels. The secondary aim was to show that these effects are dependent on the dose of the antidiabetic drug. Methods. The study has an observational, case-control design. The information was gathered from the case reports of the patients that were admitted in Sf. Maria Clinical Hospital in Bucharest, beginning with 2010 and until May 2016. It included a case group of 20 subjects and a control group of 20 subjects who were followed approximately 3 years from the diagnosis of RA. Results. There were no significant group differences at baseline. During the follow-up, the medians of DAS28, CRP and ESR were significantly lower in the group treated with oral glucose lowering agents (p&lt;0.005). Secondly, the presence of metformin both as monotherapy and in combination with other antidiabetic drugs was associated with a statistically significant decrease in the medians of the three mentioned variables (p&lt;0.05). The metformin dose can predict the value of CRP (p=0.005), accounting for 18.9% of the variation of CRP. Moreover, there is a negative correlation between CRP level and metformin, r=-0.434, p=0.003. This negative correlation was also seen between metformin and CRP value (p=0.027), when metformin was used in monotherapy. Conclusion. The main insights achieved in this study relate to the ability of metformin to significantly lower both DAS28 and CRP level in patients with RA and T2DM, when compared to those that are affected only by RA. An element that needs further study is if these benefits can also extend to RA patients without T2DM, but with impaired glucose tolerance or important cardiovascular risk factors.

Circulating adiponectin and visfatin levels in rheumatoid arthritis and their correlation with disease activity: A meta-analysis.

This study aimed to evaluate the relationship between circulating adiponectin and visfatin levels and rheumatoid arthritis (RA) and to establish a correlation between serum adipokine levels and RA activity. We conducted meta-analyses on serum/plasma adiponectin or visfatin levels in patients with RA and controls and correlation coefficients between circulating adiponectin and visfatin levels and Disease Activity Score of 28 joints (DAS28) in RA patients. Eleven studies comprising 813 RA patients and 684 controls were included in this meta-analysis. The meta-analysis revealed that adiponectin levels were significantly higher in the RA group than in the control group (standardized mean difference [SMD] = 1.529, 95% confidence interval [CI] = 0.354-2.704, P = 0.011). Circulating adiponectin level was not associated with RA activity based on DAS28 and C-reactive protein (CRP) levels. Visfatin levels were significantly higher in the RA group than in the control group (SMD = 2.575, 95% CI: = 0.963-4.189, P = 0.002). A trend of positive correlation among circulating visfatin levels and DAS28 and CRP levels was found (correlation coefficient = 0.416, 95% CI: = -0.917 to 0.795, P = 0.177; correlation coefficient = 0.366, 95% CI: = -0.074 to 0.687, P = 0.101, respectively). Our meta-analysis demonstrated that circulating adiponectin levels were significantly higher in patients with RA than in controls. Circulating visfatin levels were significantly higher in patients with RA than in controls and a positive correlation between circulating visfatin level and RA activity is suggested.