Arthritis Disease Activity Research Articles

Serum and synovial matrix metalloproteinase-3 as markers of disease activity in early rheumatoid arthritis

Matrix metalloprotein ase-3 (MMP-3) is one of the MMPs produced in rheumatoid arthritis (RA) joints. The aim of this study was to evaluate serum and synovial fluid (SF) MMP-3 as markers of disease activity in early RA. Thirty early RA patients together with age-matched and sex-matched 12 primary knee osteoarthritis patients and 12 apparently healthy individuals as control groups were enrolled in this study. MMP-3 was measured in serum and SF samples using enzyme-linked immunosorbent assay. Assessment of disease activity in RA patients was carried out using disease activity score-28 (DAS-28), and radiographs of the hands, wrists, and forefeet were obtained and evaluated according to Larsen score. As regards mean serum levels of MMP-3, there was a statistically significant elevation in RA patients compared with the control groups (P<0.001). Moreover, the mean SF levels of MMP-3 in RA patients were statistically significantly higher than that in osteoarthritis patients (P<0.001). In RA patients, there was a statistically significant difference (P<0.001) between mean serum and SF levels, being higher in the SF. There was a statistically significant positive correlation (P<0.05) between serum MMP-3 with disease duration, DAS-28, and Larsen score. As regards mean SF MMP-3 levels, there was a high statistically significant positive correlation (P<0.001) with DAS-28 and a statistically significant positive correlation (P<0.05) with Larsen score. Elevated serum and synovial MMP-3 levels reflect disease activity in RA patients; thus, it could be used as a useful marker for disease activity. The cross-sectional design of our study did not allow us to produce conclusions with respect to disease course and prognosis. Thus, we recommend further studies on large numbers of patients and serial measurements of MMP-3 to determine the rate of disease progression.

Baseline adiponectin and leptin levels in predicting an increased risk of disease activity in rheumatoid arthritis: A meta-analysis and systematic review

To determine the pathogenic role of adipokines, such as adiponectin and leptin, in rheumatoid arthritis (RA) by investigating whether serum levels of these adipokines correlated with disease activity in RA patients. Medline, Cochrane, EMBASE and Google Scholar were searched for studies published until 5 November 2015 reporting serum levels of leptin and adiponectin and measures of disease activity including DAS scores and radiographic progression scores (such as total change in SHS scores and number of erosions). Secondary outcomes included pain scores, functional status and health questionnaires. Only randomized controlled trials, cohort studies, or two-armed prospective or retrospective studies were included. A χ2-based test of homogeneity was performed using Cochran’s Q statistic and I2. A total of 917 predominantly female participants (average age range, 39–56 years) from six prospective cohort studies were included for assessment. A fixed-effects analysis was applied for leptin levels due to lack of heterogeneity among the studies (Q = 4.4364; I2 = 32.38). A random-effects analysis was applied to serum levels of adiponectin because of significant heterogeneity between studies (Q = 4.444, I2 = 77.50%). Serum leptin levels were higher in RA patients with high disease activity (pooled SMD: 0.53, 95% CI: 0.24–0.82); however, serum adiponectin levels did not correlate with RA disease activity (pooled OR: 1.38, 95% CI: 0.77–2.47). The meta-analysis provides an additional factor to determine high disease activity index in RA, that is, serum leptin levels, which can be of benefit when choosing treatment strategies.

Focus group interviews reveal reasons for differences in the perception of disease activity in rheumatoid arthritis

ObjectiveDoctors frequently see patients who have difficulties coping with their disease and rate their disease activity high, despite the fact that according to the doctors, the disease activity is low. This study explored the patients’ perspectives on this discordance that may help to understand why for some patients, usual care seems to be insufficient.MethodsIn our qualitative study we conducted focus group interviews where questions were used as a guideline. Transcripts were analyzed using inductive thematic analysis.FindingsTwenty-nine patients participated in four focus groups. Participants could not put their finger exactly on why doctors estimated that their disease activity was low, while they experienced high levels of disease activity. During the in-depth focus interviews, seven themes emerged that appeared related to high experienced disease activity: (1) perceived stress, (2) balancing activities and rest, (3) medication intake, (4) social stress, (5) relationship with professionals, (6) comorbidity, and (7) physical fitness.ConclusionWhen patients were asked why their view of their disease activity was different from that of their physician, seven themes emerged. The way participants coped with these themes seemed to be the predominant concept. Specific interventions that focus on one or more of the reported themes and on coping may improve not only the quality of life of these patients but also the satisfaction with the patient–doctor relationship for both parties.

Appearance of hindfoot valgus deformity and recurrence of hallux valgus in the very early period after hallux valgus surgery in a poorly controlled rheumatoid arthritis case: A case report

Control of rheumatoid arthritis (RA) disease activity is an important factor related to the development of hallux valgus (HV) deformity. Furthermore, if valgus hindfoot remains and/or appears after HV surgery, the affected foot is at risk of recurrence of HV deformity. We experienced a case suggesting the possibility that hindfoot valgus deformity appeared after HV surgery because of poor control of RA disease activity, and the HV deformity recurred in the very early period after surgery.

055 Disbaility, Disease Activity and Psychological Distress in Active Psoriatic Arthritis: Secondary Analysis of a Clinical Trial

055 Disbaility, Disease Activity and Psychological Distress in Active Psoriatic Arthritis: Secondary Analysis of a Clinical Trial

Fractures lead to worsening of disease activity in rheumatoid arthritis

Objectives: The cause of rheumatoid arthritis (RA) flares is multifactorial and not well understood. No reports of fractures influencing disease activity in patients with RA have been published. The purpose of this study was to determine whether fractures influence disease activity in patients with RA.Methods: Hospital records of 470 patients with RA between 2011 and 2014 were analyzed. We first examined the incidence of flare using multiple regression analysis. Secondly, we examined the incidence of flare using DAS28-ESR, DAS28-CRP, and drug changes before bone fracture until bone union in the fracture cases.Results: Multiple linear regression analysis showed that female sex (p < 0.001), bottom DAS28-ESR (p < 0.001), and fracture (p = 0.041) were independent factor for DAS28-ESR at the last observation period, and sex (p = 0.040), bottom DAS28-CRP (p < 0.001), and fracture (p = 0.019) were independent factor for DAS28-CRP at the last observation period. The average DAS28-ESR value was significantly increased from 3.19 (prefracture) to 3.58 (bone union). The average DAS28-CRP value was also significantly increased from 2.45 (prefracture) to 2.79 (bone union).Conclusions: We have demonstrated that fractures influence disease activity in patients with RA. Larger numbers of fracture cases are required to confirm the present observations; however, the prevention of fracture is clearly required in patients with RA.

Calprotectin (S100A8/A9) and S100A12 are associated with measures of disease activity in a longitudinal study of patients with rheumatoid arthritis treated with infliximab

Objectives: The pro-inflammatory proteins calprotectin (a heterocomplex of S100A8/A9) and S100A12 have been associated with disease activity in rheumatoid arthritis (RA). The aim of this study was to compare their potential as biomarkers in a prospective study of RA patients starting with infliximab as their first biological disease-modifying anti-rheumatic drug (DMARD).Method: Thirty-nine RA patients were examined and serum samples collected when starting with infliximab and after 3, 6, and 12 months. Calprotectin and S100A12 were analysed by enzyme-linked immunosorbent assays (ELISAs) and, together with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), measured at all time points. A disease activity score of 28 joints (DAS28) was calculated. Radiographs of the hands, wrists, and feet were taken at baseline and after 3 years, and assessed according to the modified Sharp/van der Heijde (SvH) score. Responsiveness was evaluated according to the European League of Associations for Rheumatology (EULAR) response criteria based on 28 joints.Results: Both S100 proteins were significantly higher in seropositive than in seronegative patients (p = 0.01). Calprotectin correlated significantly with CRP (ρ = 0.51–0.75), ESR (ρ = 0.32–0.52), and DAS28 (ρ = 0.32–0.62). S100A12 correlated with calprotectin (ρ = 0.62–0.77) and CRP (ρ = 0.32–0.63). The S100 proteins, and especially calprotectin (ρ = 0.23–0.39), showed weak associations with radiographic progression, unlike CRP/ESR. None of the S100 proteins could predict responsiveness.Conclusions: Calprotectin showed the strongest correlation with measures of disease activity and may be better than S100A12 when evaluating disease activity in RA patients. More extensive studies are needed to further compare the predictive value of the S100 proteins relative to radiographic progression.

Efficacy of MRP8/14 as a Marker of Disease Activity in Rheumatoid Arthritis

Objective: Early and accurate evaluation of the presence and activity of synovitis is extremely important in the diagnosis and treatment of rheumatoid arthritis. Myeloid related protein 8/14 (MRP8/14), also known as calprotectin or S100A8/A9 is considered as a sensitive marker for local inflammatory activity in rheumatoid arthritis. The aim of this study is to demonstrate the efficacy of MRP8/14 as a marker of disease activity in RA. Methods: Thirty-one patients with diagnosis of RA who received treatment without biological drugs at our institution were included in this study. Serum MRP8/14, CRP and MMP-3 were tested in all patients. Disease activity was evaluated using DAS28-CRP and SDAI. Ultrasonography was performed on the wrists and MCP joints of both hands using semi-quantitative scale of power Doppler signal. The sum of scales in joints was calculated as the PD score. The correlation of MRP8/14 with serum biomarkers, disease activity and ultrasonography examination was investigated. Result: Serum MRP8/14 was strongly correlated with CRP (r = 0.63) and MMP-3 (r = 0.69). A correlation was observed between serum MRP8/14 and DAS28-CRP (r = 0.53) and SDAI (r = 0.66). No significant correlation was found between PD scores and MRP8/14. Conclusion: This study demonstrated that MRP8/14 is correlated with evaluated disease activity and markers of serum inflammatory response in patients not using biological drugs. MRP8/14 is considered an effective new method for objective evaluation of synovitis in RA.

Morning Stiffness in Rheumatoid Arthritis: Investigating its Relationship with Disease Activity as Assessed by Power Doppler Ultrasonography and Composite Scores

Objective: This study investigated potential associations of morning stiffness (MS) with rheumatoid arthritis (RA) disease activity and ultrasonography (US).Methods: We conducted a cross-sectional ...

Semaphorin 3A, a potential immune regulator in Familial Mediterranean Fever

Semaphorin 3A (sema3A) plays a regulatory role in immune responses, mainly affecting the activation of regulatory T cells. It has been found to correlate with disease activity in rheumatoid arthritis and systemic lupus erythematosus. Familial Mediterrenean Fevere (FMF) is an autoinflammatory disease; yet a possible role for regulatory T cells has been described.

Up-regulation of CD64-expressing monocytes with impaired FcγR function reflects disease activity in polyarticular psoriatic arthritis

Objectives: The aim of this study was to assess monocyte Fc receptor (FcR) status and function in patients with active psoriatic arthritis (PsA) in relation to healthy controls (HC) and to disease activity.Method:The study population comprised 23 patients with active polyarticular PsA and 33 age- and gender-matched HC. Immunoglobulin (Ig) levels, inflammatory laboratory parameters, patient-reported outcomes of joint disease activity, skin scoring (Psoriasis Area and Severity Index, PASI), and joint status were determined in the patients. Monocytes were analysed for the expression of FcRs for IgG (FcγR) class I (CD64), IIa (CD32a), IIb (CD32b), and III (CD16), the FcR for IgA (FcαR) (CD89), and surface-bound IgG. The monocytic FcγR function was assessed by evaluating IgG immune complex (IC) binding and tumour necrosis factor (TNF)-α production following IgG-IC stimulation. The monocytes were further subdivided and analysed according to their CD14 and CD16 expression.Results:The PsA patients presented elevated serum levels of IgG1, 2, and 3 and increased numbers of CD64+ monocytes. Furthermore, the PsA monocytes exhibited increased cell-bound IgG, and the FcγR function was affected in terms of reduced IgG-IC-mediated TNF-α release. These findings correlated significantly with different markers of joint disease activity. PsA was also accompanied by an increase in the CD16 low-expressing monocyte subset.Conclusions:An intensified humoral immune response affects monocytes and their FcR status in active polyarticular PsA. The up-regulated CD64+ monocytes seem to be have an important role in psoriatic joint inflammation. These cells may prove to be a useful target in future PsA therapeutic interventions.

027. Self-Reported Comorbidity Burden Correlates with Functional Disability and Disease Activity in Early Rheumatoid Arthritis

027. Self-Reported Comorbidity Burden Correlates with Functional Disability and Disease Activity in Early Rheumatoid Arthritis

Vitamin D Status in Egyptian Patients with Rheumatoid Arthritis

Background: Vitamin D is a potent regulator of calcium homeostasis and may have immunomodulatory effects. The influence of vitamin D on human autoimmune disease has not been well defined. The aim of this cross sectional study was to estimate the prevalence and determinants of vitamin D deficiency in patients with rheumatoid arthritis as compared to healthy controls and to analyze the association between 25-hydroxyvitamin D with disease activity. Methods: The study includes 55 consecutive rheumatoid arthritis patients and 25 healthy controls, not on vitamin D supplements. Together with parameters of disease activity, all patients had serum 25-hydroxyvitamin D [25(OH)D] measured by ELISA kit in a centralized laboratory. Disease activity in rheumatoid arthritis was assessed by Disease Activity Score 28 (DAS28) and Health Assessment Questionnaire (HAQ). According to activity indexes, patients were divided into subgroups with high activity of the disease (DAS28>5.1), moderate activity of the disease (3.2 Results: 25-hydroxyvitamin D deficiency, insufficiency and sufficiency were found in 16.00, 4.00 and 80.00% of controls, respectively, while, 25(OH)D insufficiency and sufficiency were found in 21.80 and 78.20% of rheumatoid arthritis patients, respectively with no significant difference between groups (P 5.1). Disease duration was significantly longer in patients with moderate disease activity vs. those with low and high disease activity (P Conclusions: In rheumatoid arthritis patients, vitamin D deficiency is quite common, but similar to that found in control subjects; disease activity (expressed as ESR) is inversely related to 25(OH)D levels.

Assessment of serum 25-hydroxy vitamin D level as a predictor of disease activity in rheumatoid arthritis

Assessment of serum 25-hydroxy vitamin D level as a predictor of disease activity in rheumatoid arthritis

Conventional versus novel acute phase reactants in disease activity of rheumatoid arthritis: Does a correlation truly exist?

Conventional versus novel acute phase reactants in disease activity of rheumatoid arthritis: Does a correlation truly exist?

Treating to target of minimal disease activity and normal function in polyarticular juvenile idiopathic arthritis with adalimumab: analysis from a phase 3 clinical trial

The Juvenile Arthritis Disease Activity Score (JADAS) 1 is becoming widely accepted in juvenile idiopathic arthritis (JIA) for defining a treat to target strategy.

Modified-release prednisone: a guide to its use in rheumatoid arthritis

A low-dose, modified-release (MR) formulation of prednisone (Rayos®, Lodotra®), administered in the evening, has been developed to counter the circadian rise in pro-inflammatory cytokine levels that contributes to disease activity in rheumatoid arthritis. In well-designed 12-week trials, the proportion of patients with a ≥20 % improvement in the signs and symptoms of rheumatoid arthritis according to American College of Rheumatology criteria (primary endpoint) was significantly greater with MR prednisone than with placebo in one trial, and a significantly greater mean relative reduction in the duration of morning stiffness (primary endpoint) was seen with MR prednisone than with immediate-release prednisone in the other trial. Treatment with evening MR prednisone for up to 12 months was generally well tolerated.

AB0953 A Comparison of Region-Based and Pixel-Based CEUS Kinetics Parameters in the Differentiation of Rheumatoid Arthritis and Simil-Rheumatoid Psoriatic Arthritis

BackgroundContrast Enhanced Ultrasound (CEUS) examination of the small joints has emerged as a sensitive tool for assessing disease activity in arthritis (1). This evaluation bases on subjective semi-quantitative scales, that...

AB0042 Human Host Defense Peptide Cathelicidin (LL37) Serum Levels Are Increased in Anti-Cyclical Citrullinated Peptide Positive Patients with Recent Onset Inflammatory Arthritis

BackgroundDisruption of normal innate immune responses to pathogens and toxins may contribute to Rheumatoid Arthritis (RA) pathogenesis. The host defense peptide cathelicidin (LL37) is produced as part of the innate...

Clinical measurement of disease activity in rheumatoid arthritis: why, how and utility of patient self-assessment

Regular monitoring of disease activity and adjustment of treatment to achieve tight control of disease activity is important in rheumatoid arthritis (RA), as abrogation of inflammation and synovitis will achieve disease remission and best clinical outcomes. Self-assessment of disease activity by patients is an interesting concept currently under evaluation, potentially used in clinical practice to assist in achieving treat-to-target outcomes. In addition, it has the potential to improve patient engagement in their own control of their disease and at the same time improve adherence and awareness of their RA. In this review, the importance of disease monitoring in RA is discussed and several potentially useful self-assessment methods by patients (e.g., self-assessed joint counts and self-reported questionnaires) are presented with a discussion of its potential use in clinical practice.