Disease Activity In RA Patients Research Articles

Neutrophil- and Platelet-to-Lymphocyte Ratios (NLR & PLR) and Their Relation with Disease Activity in Rheumatoid Arthritis Patients

Abstract Background RA is the most common chronic inflammatory arthritis and is associated with progressive destruction of synovial joints and physical disability. It is a polygenic disease characterized by autoimmunity and systemic inflammation with progressive impairment of the joints, resulting in lifelong disability and increased mortality. Aim of the Work The aim of the study is to study the correlation between both of Neutrophil- and platelet-to-lymphocyte ratios (NLR&PLR) and disease activity in RA patients. Patients and Methods Our cross-sectional case-control study enrolled 50 patients with RA, in addition to 30 healthy volunteers as a control group.All included patients were subjected to full history taking with special emphasis on history of RA, thorough clinical examination was done with special emphasis on musculoskeletal examination. Results When we compared RA patients with the controls, we found a highly statistically significant difference between them regarding NLR and PLR being higher in the RA group. In our study we found that both NLR and PLR has fair diagnostic value to discriminate between RA patients and controls using the ROC curve at a cut-off value of 2.58 and 151.05 respectively. In RA patients, highly statistically significant correlation was found between both NLR and PLR. In addition, statistically significant correlation was found between NLR with both VAS score and DAS28_ESR and also between PLR with ESR, VAS score and RF.PLR also correlated significantly with US7 score, PDUS synovitis and gray GSUS tenosynovitis. Conclusion NLR and PLR that can be obtained via CBC (which is convenient, inexpensive and fast), can serve as an additional useful marker for the diagnosis of RA. NLR and PLR has important value in the assessment of RA related disease activity. In contrast to traditional markers, they are less expensive and effective measure of inflammation that is not impacted by the cytokines influencing the ESR and CRP. US7 score is a simple and effective measure to detect subclinical synovitis in RA patients and to assess and follow up disease activity.

The Relationship Between FoxP3 and SOCs3 Gene Expressions and Disease Activity in Rheumatoid Arthritis.

Immune dysregulation plays an important role in the pathogenesis of rheumatoid arthritis (RA). The CD4+CD25 high FoxP3+ subset of regulatory T cells plays an essential role in preventing autoimmunity and maintaining immune homeostasis. Negative regulation of JAK/STAT signaling is controlled by Suppressor of Cytokine Signaling (SOCs3) proteins. SOCs is produced at lower levels in RA. Our aim was to evaluate the expressional dysregulation of SOCs3 and FoxP3 genes in RA patients in relation to disease activity. We have recruited 90 patients with RA and 60 healthy controls in case control study. Whole blood samples were collected from RA patients and healthy subjects. The measurement of FoxP3 and SOCs3 gene expression was performed by real-time PCR (qPCR). Patients with RA had significantly decreased expression levels of FoxP3 and SOCs3 genes in comparison with controls (P<0.001), in addition to the insignificance correlation of both genes with disease activity in RA patients. FoxP3 and SOCs3 genes showed significant defects in rheumatoid arthritis patients with no significant difference in disease activity.

Anti-Carbamylated Protein Antibodies, Tumour Necrosis Factor Alpha and Insulin Resistance in Egyptian Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus

BackgroundRheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are autoimmune diseases. Premature atherosclerosis and cardiovascular diseases are two of the most important complications of these diseases. Anti-carbamylated protein antibody (Anti-carP Ab) is one of the antibodies which was studied in RA and SLE. In our study, we studied the relation between anti-carP Ab, disease activity and insulin resistance in RA and SLE patients. Methods90Patients with SLE and RA were enrolled and subjected to history taking, clinical examination and assessment of disease activity using SLE disease activity index 2000 (SLEDAI-2K) scoring for SLE patients and disease activity score 28 (DAS28-ESR) for RA patients. Samples were examined for complete blood count (CBC), creatinine, inflammatory markers, Tumour necrosis factor alpha (TNF alpha), fasting insulin, fasting blood sugar (FBS), lipid profile and anti-carPAb. HOMA-IR (homeostasis model assessment for insulin resistance) was calculated. ResultsPatients with RA and SLE showed higher levels of anti-carPAb in comparison with healthy subjects (8.25ng/ml for RA, 7ng/ml for SLE and 0.6ng/ml for healthy subjects with p value <0.001). There was a positive correlation between anti-carPAb and disease activity of RA (p value <0.001) and a positive correlation between anti-carPAb and TNF alpha in RA. In SLE, there was no correlation of anti-carP Ab with disease activity while, HOMA-IR showed a positive correlation with nephritis (p value 0.04). ConclusionAnti-carP antibody is a marker of disease activity in RA patients and has high specificity for both RA and SLE detection.

Red cell distribution width and mean platelet volume in rheumatoid arthritis patients: Its association with disease activity

IntroductionHemogram parameters have been recently proposed as markers of inflammation in various studies from different parts of the world. Two of these hemogram parameters are red cell distribution width (RDW) and mean platelet volume (MPV). AimTo evaluate the relation between RDW and MPV with disease activity of rheumatoid arthritis. To assess whether RDW and MPV can be used to follow disease activity in RA patients. MethodsThis is an observational cross-sectional study that was carried out on 60 rheumatoid arthritis patients who fulfilled the ACR/EULAR2010 classification criteria of RA attending to Rheumatology and Rehabilitation inpatient and outpatient clinics at Zagazig University Hospitals. All cases were subjected to full history taking, clinical examination, and laboratory investigations; differential complete blood picture (CBC), acute phase reactants (CRP and ESR), rheumatoid factor (RF) and anti-cyclic-citrullinated peptide (anti-CCP) antibodies. Disease activity was measured by disease activity score 28 (DAS28). ResultsThe cut-off levels of RDW and MPV were 14.85 and 11.25. Patients with RDW>14.85 had higher Disease Activity Score 28 (DAS28; p=0.0003), ESR (p=0.0001) and CRP (p=0.0001). RDW was positively correlated with disease activity markers (ESR, CRP and DAS28) in rheumatoid arthritis patients. But, DAS28 was not different between patients with MPV>11.25 and <11.25. ConclusionRDW was strongly correlated with disease activity. Also, RDW was better than ESR and CRP in detecting RA disease activity. According to these findings we suggest that RDW can be used in clinics to follow disease activity. In addition, RDW is widely available; as it's usually included in routine complete blood picture and there will be no need for further cost.

Hematological markers and ultrasound 7-joint inflammation score as add-on tools in the assessment of inflammation in rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is an autoimmune disease characterized by synovial inflammation and joint destruction that eventually induces severe disability. Inflammation is the key determinant and primary underlying mechanism leading to disability and increased mortality in patients with RA. This study aimed to correlate the hematological markers and ultrasound 7-joint inflammation score to disease activity in rheumatoid arthritis patients.ResultsThe current study involved 54 RA patients diagnosed according to the 2010 ACR/EULAR classification criteria for RA and thirty healthy control subjects. There were 48 females (88.9%) and 6 males (11.1%). The age of patients ranged from 32 to 60 years, with a mean of 46.04 ± 5.65 years. Using disease activity score 28-ESR, total white blood cell count and absolute lymphocytic count were significantly lower in RA patients with high disease activity. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume, ESR, and CRP were significantly higher in patients with high disease activity using disease activity score 28 CRP. Also, a statistically significant positive correlation was detected between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and both clinical disease activity scores. Red cell distribution width but not platelet distribution width was significantly higher in RA patients but both parameters had no association or correlation with clinical disease activity scores. Neutrophil-to-lymphocyte ratio was found to have a statistically significant positive correlation with the tenosynovitis score by powered Doppler ultrasound. There were statistically significant positive correlations between disease activity score 28 ESR and CRP and synovitis and tenosynovitis scores by greyscale and powered Doppler ultrasound using the ultrasound 7 score.ConclusionNeutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume could be potential inflammatory markers for follow-up of disease activity in RA patients. The ultrasound 7 score is a simple and practical scoring system for use in the detection of inflammation, even subclinically in RA patients, which may help the physician in his clinical decisions. The combined use of both hematological markers and the ultrasound 7 score may be of great value.

THE ROLE OF ACUTE-PHASE REACTANTS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Radiographic evaluation is still the most important tool for assessing structural damage to joints and the skeleton. The progression of the radiographic damage to the joints in the hands and feet is an important and objective variable for assessing the disease's activity as well as predicting the outcomes of treatment. In this study, radiographic assessment of the hand joints, acute phase reactants (ESR and CRP), and ACPA autoantibodies were used to assess the disease activity in RA patients treated with methotrexate therapy. Their roles as prognostic indicators of disease outcome were also examined. The serum of 70 participants (35 in the untreated RA group and 35 in the control group) was tested using the ELISA method DIA-STATTM Anti-CCP (Axis-Shield Diagnostics). In the same participants, RF was determined using the agglutination test (Latex RF test). Patients were treated with methotrexate at an average dose of 10 mg once weekly. For clinical evaluation of disease activity in every patient's radiographic index (RI), sedimentation, CRP, and RF were analyzed at certain time intervals (baseline, after 6, 9, and 12 months). The dynamic changes in the mean values of the RI score, sedimentation, CRP, and RF were used to assess RA. RI showed an increased radiographic progression of hand joint damage at time intervals between baseline and 9 months (p = 0.0167) and between baseline and 12 months (p = 0.0089). Statistical analysis showed statistically significant differences among the mean values of ESR in the four time intervals (p = 0.00002). Also, statistically significant differences were shown in the mean values of CRP in the four time intervals (p = 0.0488) (standard deviations showed great variations). At baseline, progression was seen in 3 (10%) patients, after 6 months in 13, and after 9 and 12 months RI progression was seen in 15. It was also observed that most patients had increased values of RF and CRP. Despite the methotrexate therapy, progression of the radiographic damage followed, especially in patients with increased values of sedimentation, CRP, and RF with persistence of previous hand joint erosions, as predictors of the aggressive course of disease. Keywords: Rheumatoid arthritis, Rheumatoid factor, Reactants of the acute phase. &nbsp

Efficacy of Atorvastatin Plus Conventional Disease-Modifying Antirheumatic Drugs on Disease Activity in Rheumatoid Arthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

We queried the PubMed, Embase, Web of Science, and the CENTRAL (Cochrane Central Register of Controlled Trials) databases for this study. The pooled efficacy was evaluated using standardized mean differences. The inverse of the variance model was used for data pooling. Based on the search, we identified 9 randomized controlled trials. The trials included 258 patients in the atorvastatin plus DMARD groups and 246 patients in the DMARD alone groups. The primary outcome was the change from baseline in the 2018 (209:228 Disease Activity Score in 28 Joints). Based on the Disease Activity Score in 28 Joints, disease activity in RA patients decreased significantly in patients given atorvastatin plus DMARD compared with patients given DMARD alone (standardized mean difference, -2.46; 95% confidence interval, -3.98 to -0.95; p = 0.0015; I2 = 97%; p < 0.01). Subgroup analysis did not identify any confounding factors, and no publication bias was detected in the meta-analysis. The result supports that atorvastatin could be added to DMARDs to treat patients with RA.

Galectin-9 expression correlates with therapeutic effect in rheumatoid arthritis

Galectin-9 (Gal-9) is a multifunctional immunomodulatory factor highly expressed in RA. This study aimed to investigate the expression of Gal-9 and its correlation with disease activity and therapeutic response in RA patients. Active RA patients were enrolled and treated with tacrolimus (TAC) alone or in combination therapy for 12 weeks in a prospective cohort study. Clinical and immunological parameters were recorded at baseline and week 12. We measured Gal-9 expression in different T cell subsets and in plasma. The disease activity of RA patients decreased after treatment. At baseline, the Gal-9 expression percentage was higher in the group with severe disease than in mild or moderate groups. After treatment, the Gal-9 expression in CD3+, CD4+, CD8+ and CD4-CD8− cell subsets decreased, as well as Gal-9 mean fluorescence intensity in CD3+, CD4+ and CD8+ T cells. Similarly, plasma Gal-9 levels were lower at week 12 than at baseline. Good responders showed significantly lower Gal-9 expression on CD3+ and CD4+ T cell subsets and lower plasma Gal-9 levels than poor responders. Gal-9 expression positively correlates with disease activity in RA patients. Gal-9 can be regarded as a new biomarker for evaluating RA activity and therapeutic effect, including TAC.

Validation of the adjusted multi-biomarker disease activity score as a prognostic test for radiographic progression in rheumatoid arthritis: a combined analysis of multiple studies

BackgroundThe multi-biomarker disease activity (MBDA) test measures 12 serum protein biomarkers to quantify disease activity in RA patients. A newer version of the MBDA score, adjusted for age, sex, and adiposity, has been validated in two cohorts (OPERA and BRASS) for predicting risk for radiographic progression. We now extend these findings with additional cohorts to further validate the adjusted MBDA score as a predictor of radiographic progression risk and compare its performance with that of other risk factors.MethodsFour cohorts were analyzed: the BRASS and Leiden registries and the OPERA and SWEFOT studies (total N = 953). Treatments included conventional DMARDs and anti-TNFs. Associations of radiographic progression (ΔTSS) per year with the adjusted MBDA score, seropositivity, and clinical measures were evaluated using linear and logistic regression. The adjusted MBDA score was (1) validated in Leiden and SWEFOT, (2) compared with other measures in all four cohorts, and (3) used to generate curves for predicting risk of radiographic progression.ResultsUnivariable and bivariable analyses validated the adjusted MBDA score and found it to be the strongest, independent predicator of radiographic progression (ΔTSS > 5) compared with seropositivity (rheumatoid factor and/or anti-CCP), baseline TSS, DAS28-CRP, CRP SJC, or CDAI. Neither DAS28-CRP, CDAI, SJC, nor CRP added significant information to the adjusted MBDA score as a predictor, and the frequency of radiographic progression agreed with the adjusted MBDA score when it was discordant with these measures. The rate of progression (ΔTSS > 5) increased from < 2% in the low (1–29) adjusted MBDA category to 16% in the high (45–100) category. A modeled risk curve indicated that risk increased continuously, exceeding 40% for the highest adjusted MBDA scores.ConclusionThe adjusted MBDA score was validated as an RA disease activity measure that is prognostic for radiographic progression. The adjusted MBDA score was a stronger predictor of radiographic progression than conventional risk factors, including seropositivity, and its prognostic ability was not significantly improved by the addition of DAS28-CRP, CRP, SJC, or CDAI.

Neuropathic pain in a sample of Egyptian patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is an autoimmune disease characterized by polyarthritis that may cause irreversible joint disability. Pain is the most important symptom in RA patients that requires more attention and careful evaluation. Despite the improvement in medications used to control inflammation in RA patients, a relevant number of them still experience neuropathic pain even with disease remission. This study was conducted to estimate the frequency of neuropathic pain (NP) in RA patients and to assess its relationship with disease activity, functional status, and overweight.ResultsNP was detected in 12.5% (14 patients) of RA patients. Highly significant differences were found between RA patients with NP and those without NP as regards disease duration, visual analog scale (VAS) of pain, disease activity score 28 (DAS28-ESR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), body mass index (BMI), health assessment questionnaire (HAQ) score, and Douleur Neuropathique in 4 (DN4) questionnaire for NP assessment (p < 0.001). The correlation between the DN4 questionnaire and the parameters of disease activity in RA patients with NP was not significant. By univariate analysis, the possible risk factors for NP in RA patients were disease duration, VAS, DAS28-ESR, HAQ, and BMI; however, by multivariate analysis, no possible risk factors for NP in RA patients were detected.ConclusionAlthough pain in patients with RA was classified as nociceptive in nature, a relevant proportion of patients might also have NP. NP in RA patients was related to functional disability, high disease activity, and overweight.

O08 Development and validation of a new tool to assess inflammatory foot disease activity in RA: the Rheumatoid Arthritis Foot Disease Activity Index

Abstract Background Rheumatoid arthritis (RA) commonly affects the feet, resulting in pain, walking difficulties, and disability. Omission of foot joints from the disease activity score-28 (DAS-28) may lead to underestimation of foot disease and suboptimal medical and non-medical management. Therefore, the overall objective of this study is to evaluate the measurement properties of the Rheumatoid Arthritis Foot Disease Activity Index-5 (RADAI-F5), a newly developed 5-item (0-10 numerical rating scale) patient-reported outcome measure (PROM) with a summary score (0-10) for measuring foot disease activity in people with RA. Methods Participants with RA recruited from NHS rheumatology outpatient clinics completed the RADAI-F5, a self-modified Rheumatoid Arthritis Disease Activity Index (mRADAI-5) which is a self-reported measure of global disease activity, the Foot function index (FFI), Foot Impact Scale impairment/footwear (FIS-IF) and activity/participation (FIS-AP) subscales. DAS-28 was also recorded for each participant whenever possible. Participants completed RADAI-F5 again at 1 week to allow evaluation of 1-week reproducibility. Construct validity was evaluated using Spearman’s rho to test a priori hypotheses for expected strength of associations between the RADAI-F5 and the alternative disease activity and foot-related disability scales at baseline. Internal consistency was evaluated using Cronbach’s alpha. One-week reproducibility was evaluated using the intraclass correlation coefficient (ICC), 90% smallest detectable change (SDC90), and 95% limits of agreement (LOA). Content validity was evaluated using 5-point Likert scales for readability and relevance. Results Of 142 respondents, 103 were female and 36 were males with a mean (SD) age of 55 years (12.5) and mean (SD) RA disease duration of 39 months (70.4). Mean (SD, range) RADAI-F5 scores for the sample were 5.02 (2.47, 9.2). Associations were largely consistent with a priori hypotheses for construct validity. Strong associations were observed between the RADAI-F5 and MRADAI-5 (0.789, CI 0.73-0.85), the FFI (0.713, CI 0.62-0.79) and FIS-IS (0.695, CI 0.66-0.82) (p &amp;lt; 0.001). Moderate associations were observed with the FFI-AP (0.478, p &amp;lt; 0.001, CI 0.37-0.63). A weak association was observed between the RADAI-F5 and the DAS-28 (0.379, p &amp;lt; 0.001, CI 0.26-0.57). The RADAI-F5 demonstrated high internal consistency (Cronbach’s Alpha=0.82), and floor and ceiling effects were both absent. The RADAI-F5 demonstrated good reproducibility (ICC=0.868, p &amp;lt; 0.001, CI 0.80-0.91) and the value for SDC90 was 2.26. The upper and lower bounds for 95% LOA were -2.57 to 2.80, with 97% of scores observed within these bounds. Content validity was confirmed with 82% and 84% of participants rating the instrument as relevant and easy to understand respectively. The median time for completion was 5 minutes. Conclusion The RADAI-F5 is a highly valid and reliable PROM for measuring foot disease activity in RA patients. Furthermore, the RADAI-F5 appears to be feasible for use in clinical practice and can be used as an adjunct to the DAS28 to measure foot disease activity. Disclosures A. Hoque: Grants/research support; Stipend from Versus Arthritis to complete the Versus Arthritis MSK internship 2019 at Glasgow Caledonian University.

Sonographic evaluation of enthesopathy in rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is one of the most common autoimmune diseases. It affects mainly the synovial membranes of the small joints. However, it may also have extra-articular manifestations. Enthesopathy may occur as one of the extra-articular manifestations of RA and is not clinically detected. Ultrasound (US) is a relatively new tool for the detection of enthesopathy.AimThe aim of this study was to assess the presence and distribution of enthesopathy in RA patients using US.Patients and methodsTwenty-nine consecutive patients with RA and 14 age-matched healthy controls were included in this study. All RA patients met the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA. Six entheses sites were evaluated using gray scale and Doppler US with a linear transducer and were scored using the Madrid Sonography Enthesitis Index (MASEI).ResultsUS detected the presence of enthesopathy in patients with RA. There was a statistically significant difference in the enthesopathy score of plantar aponeurosis insertion and Achilles tendon insertion. The total enthesopathy score was statistically significant in patients with RA versus controls.ConclusionUS entheseal abnormalities are present in a high percentage of RA patients. US enthesopathy is not associated with disease activity in RA patients.

Relationship between neutrophil-lymphocyte, platelet-lymphocyte ratio and disease activity in rheumatoid arthritis treated with rituximab.

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) may be used as indicators of inflammatory markers and disease activity due to inflammatory changes in neutrophils, platelets and lymphocytes. Our aim is to investigate the relationship between NLR, PLR ratio and disease activity in RA patients treated with rituximab. Thirty-eight patients (8 male, 30 female, mean age 56.8±11.8years) diagnosed with RA and 30 healthy controls were included in the study. Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR), lymphocyte, neutrophil, platelet counts, ESR, C-reactive protein (CRP), PLR, and NLR were evaluated before and after rituximab in RA patients. The relationship between all parameters was assessed by Pearson's correlation, Wilcoxon signed-rank, Mann-Whitney U and paired t tests. The levels of CRP, ESR, and DAS28-ESR decreased significantly at 6months of rituximab treatment compared to pre-treatment. NLR and PLR ratios were higher in patients with RA than the control group. The median levels were 33.5mm/hour, 5.7mg/dL, and 3.7 respectively after 6months of rituximab treatment. And, the levels were lower than baseline treatment. There was a significant correlation between the levels of DAS28-ESR and NLR, DAS28-ESR and PLR before and after treatment. The NLR and PLR were higher than healthy controls and correlated with DAS28-ESR in patients with RA. These parameters which are indicative of disease activity decrease with rituximab and correlate with disease activity at 6months. The NLR and PLR may be useful indices to evaluate RA disease activity treated with rituximab.

Évaluation de l’activité de la polyarthrite rhumatoïde

The management of RA has changed radically over the last 15years, with the introduction of new drugs and treatment strategies and with the emergence of new concepts: tight control and treat to target. In particular, the necessity to evaluate disease activity using an objective and accurate instrument has been demonstrated. The first composite index developed for assessing disease activity in RA patients was the Disease Activity Score (DAS or DAS44). Then, another group developed a simplified version based on 28 joints instead of 44, the DAS28. However, the DAS44 and DAS28 are based on complex equations, and their determination requires a calculator. This drawback led to the development of simpler indices, the Simplified Disease Activity Index (SDAI) and its modified version, the Clinical Disease Activity Index (CDAI). The DAS28 is currently the most widely used index and is integrated in EULAR response criteria. The objectives of medical treatment in RA may be formulated as to obtain a therapeutic response at least at 3months and to reach the goal at least at 6months. The ultimate goal is to reach a state of remission, especially in early rheumatoid arthritis. However, several definitions of remission coexist: from the most stringent (ACR-EULAR 2011 definition of remission Boolean or SDAI) to the more permissive, DAS28CRP.

Role of physical activity in the management and assessment of rheumatoid arthritis patients

ObjectivesRheumatoid arthritis (RA) is a chronic inflammatory disease affecting diarthrodial joints, in which patients tend to perform less physical activity (PA) than recommended. This review focuses on the existing evidence about the relationship of PA and RA, specifically how the former influences joint inflammation, disability, quality of life and pain in RA patients, and also how disease activity potentially impacts PA in these patients. MethodsA literature search of EMBASE and MEDLINE databases from January 2000 to January 2015. ResultsThe evidence indicating that PA in RA patients is safe and the benefits from regularly performing, both aerobic and resistance exercises, in these patients include improvement in: quality of life, functionality, pain and number of swollen joints. Interestingly, recent studies suggest that changes in disease activity in RA patients inversely correlate with variations in PA, as assessed by accelerometry. ConclusionsThe regular monitoring of PA in RA patients might facilitate a more objective evaluation of variations in disease activity, helping physicians to make general and therapeutic recommendations that will improve both the health status and the joint functionality of these patients.

Role of physical activity in the management and assessment of rheumatoid arthritis patients

ObjectivesRheumatoid arthritis (RA) is a chronic inflammatory disease affecting diarthrodial joints, in which patients tend to perform less physical activity (PA) than recommended. This review focuses on the existing evidence about the relationship of PA and RA, specifically how the former influences joint inflammation, disability, quality of life and pain in RA patients, and also how disease activity potentially impacts PA in these patients. MethodsA literature search of EMBASE and MEDLINE databases from January 2000 to January 2015. ResultsThe evidence indicating that PA in RA patients is safe and the benefits from regularly performing, both aerobic and resistance exercises, in these patients include improvement in: quality of life, functionality, pain and number of swollen joints. Interestingly, recent studies suggest that changes in disease activity in RA patients inversely correlate with variations in PA, as assessed by accelerometry. ConclusionsThe regular monitoring of PA in RA patients might facilitate a more objective evaluation of variations in disease activity, helping physicians to make general and therapeutic recommendations that will improve both the health status and the joint functionality of these patients.

Increased levels of peptidylarginine deiminase 2 in synovial fluid from anti-CCP-positive rheumatoid arthritis patients: Association with disease activity and inflammatory markers.

Objective. To quantify peptidylarginine deiminase 2 (PAD2) in SF of RA patients and OA patients, and to determine the association between PAD2 levels, disease activity and inflammatory markers in RA. Methods. Blood and SF samples were obtained from 39 RA patients and 40 patients with OA. PAD2 content and PAD activity were measured by means of in-house assays. TNF-α, IL-1β, IL-6, IL-8, IL-10 and IL-12 were measured using flow cytometry. Results. PAD2 levels and PAD activity were higher in SF from RA than OA patients (P < 0.0001 and P = 0.03, respectively), as were all cytokine levels (P < 0.0001–0.05). SF PAD2 levels were higher among anti-CCP-positive patients than among anti-CCP-negative patients (P = 0.005). PAD2 levels in SF from RA patients correlated with disease activity, as assessed by DAS28 (P < 0.005). Moreover, SF PAD2 levels correlated with circulating CRP and anti-CCP levels (P < 0.0006), as well as with leucocyte count, IL-6, IL-8 and IL-10 levels in SF (P < 0.0001–0.02). PAD activity in SF was higher in RA patients than in OA patients, and correlated with PAD2 concentration. Conclusion. Extracellular PAD2 levels in SF correlate with disease activity in RA patients. Anti-CCP-positive RA patients have higher PAD2 levels in SF than anti-CCP-negative RA patients and OA patients. Since we could demonstrate enzymatically active PADs in SF, we propose that free, extracellular PAD is of pathogenic relevance.

A pilot study ofcomorbidities in patients with rheumatoid arthritis at a tertiary care hospital in Northeast India

On an average, rheumatoid arthritis is associated with one or more comorbid conditions and these comorbidities are associated with various risk factors and medications use in patients with RA. The aim of this study was to assess comorbidities in patients with RA at a tertiary care hospital of Northeast India. This cross sectional study was conducted for 8 months from August 2014 to April 2015. The data was collected from medicine (unit-III) outpatient department of Gauhati Medical College and Hospital, Guwahati, Northeast India. Fifty one RA patients were found during study period. Patient’s socio-demographic characteristics, comorbidities, risk factors for comorbidities, laboratory investigations, and past & current medications use were collected during their visit to hospital. DAS28 scale was used to assess the disease activity in RA patients. Descriptive statistics were used. Non-normally distributed continuous variables are presented in median and interquartile range. The median age of RA patients was 45(IQR;15). The disease activity was found high (DAS-ESR>5.1) in 34 (66.67%) patients. The median DAS28 score was 5.64(IQR;1.44). Majority of the patients with RA were anaemic (n=34, 66.67%) followed by infection (n=7, 13.73%), thyroid disease (n=5, 9.80%), renal disease (n=4, 7.84%), osteoporosis (n=3, 5.88%), cardiovascular disease (n=3, 5.88%), lung disease (n=3, 5.88%), and vasculitis (n=1, 1.96%). The commonly reported risk factor was hypertension (19.61%) followed by diabetes (n=5, 9.80%), dyslipidemia (n=4, 7.84%), smoking (n=4, 7.84%), family history of CVD (n=2, 3.92%), and alcohol intake (n=1, 1.96%). Among DMARDS, methotrexate (92.16%) was the most commonly prescribed drug followed by hydroxychloroquine (74.51%) and sulfasalazine (27.45%). Anaemia was the most common comorbid condition found in RA patients. Disease activity was found high in anaemic patients with RA.

Evaluating the Effects of Helicobacter pylori Eradication on Clinical Course of Rheumatoid Arthritis

Objectives: To determine the effects of H. pylori on clinical course of disease, we compared the clinical course and laboratory findings of two groups of RA patients, with and without H. pylori infection, during one year follow up after H. pylori eradication. Patients and Methods: One hundred adult RA patients (diagnosed according to the 2010 Revised ACR/EULAR Criteria) who referred to Rheumatology Clinic of Imam Reza Hospital were evaluated for H. pylori infection. Thirty-nine patients were positive for H. pylori; from them 30 patients underwent H. pylori standard treatment with three drugs including Amoxicillin (1 g/Bid), Clarithromycin (500 mg/Bid) and omeprazole (20 mg/Bid), for 10 days and PPI for one month. Seven H. pylori positive patients were excluded from the study because of inappropriate drug compliance and drug resistance and three patients did not refer for follow up. Overall, frothy RA patients, 20 with H. pylori infection, and 20 without H. pylori infection, were evaluated in the study. Patients' clinical findings and laboratory tests were evaluated in 5 consecutive visits; at the beginning of the study and every 3 months up to one year. H. pylori infection and its eradication were evaluated by fecal antigen test performed with Eliza method. Results: Patients of H. pylori positive group had a higher number of joints inflammation and tenderness during 5 evaluation visits and the difference in number of joints involvement between two groups was statistically significant. The difference between two groups for pain based on visual analog scale (VAS), DAS-ESR and DAS-CRP was also significant and higher in H. pylori positive group. The other clinical and laboratory tests including ESR, CRP, RF and anti-CCP were not significantly different between two groups. H. pylori eradication did not improve clinical course of disease and laboratory tests. Conclusions: Considering the results of this study, although having H. pylori infection in RA patients was accompanied with higher number of inflamed and tender joints, but H. pylori eradication did not improve patients’ clinical symptoms and laboratory tests. It seems that the effect of H. pylori infection eradication over disease activity in RA patients is not remarkable, if it does exist at all.

DAS28, CDAI and SDAI cut-offs do not translate the same information: results from the Rheumatic Diseases Portuguese Register Reuma.pt.

. The 28-joint DAS (DAS28), clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are indices frequently used to assess disease activity in RA patients. Cut-off values were defined to classify the states of RA disease activity: remission, low, moderate and high. The aim of this work was to assess disease activity states classified by DAS28, CDAI and SDAI and to analyse their agreement in the Rheumatic Diseases Portuguese Register Reuma.pt. . A total of 2795 patients and 14 440 visits were selected from Reuma.pt for analysis. Pearson's correlation coefficients (PCCs) were calculated for the three indices. McNemar's chi-squared tests, PCCs and kappa statistics were performed to analyse and compare the distribution of visits among all disease activity states and indices. A strong correlation was found between the three indices throughout the 14 440 visits: r = 0.874 for DAS28/CDAI, r = 0.877 for DAS28/SDAI and r = 0.984 for CDAI/SDAI (all PCCs with P < 0.0001). However, when categorization in the different disease activity states was analysed, McNemar's chi-squared tests and PCCs revealed significant disagreement between the cut-offs of the three indices. DAS28, CDAI and SDAI cut-offs do not translate into the same clinical information in Reuma.pt. Although this might be expected for the original DAS28 cut-offs, when compared with CDAI and SDAI significant disagreement was also found for the DAS28 modified cut-offs. For visits where patients are in CDAI or SDAI remission, we also find disagreement between these two indices, which may contradict previous conclusions that acute phase reactants add little to composite disease activity indices for RA.