Disease Activity In RA Patients Research Articles

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.

SAT0595-HPR Real-World Risk of Fall-Related Injuries among Rheumatoid Arthritis (RA) Patients Treated with Tumor Necrosis Factor Inhibitors (ANTI-TNFS) or Methotrexate (MTX)

BackgroundStructural damage and disease activity in RA patients may increase the risk of fall-related injuries (FRIs) due to limited mobility, impaired balance and postural instability.ObjectivesTo compare risks for FRIs between...

AB1095 Identifying Under-Recognised, Clinically Significant Co-Morbidities and Assessing Disease Activity in RA Patients

BackgroundMany patients with RA have under-treated disease and failure to recognise co-morbidities in RA puts our patients at risk of significant increased morbidity and mortality. Complementing the clinical assessment with...

Elevated Level of Interleukin-29: A Proinflammatory Role in Synovial Inflammation of Rheumatoid Arthritis

Background: The multiple pro-inflammatory cascades described in RA lead to persistent synovitis, resulting in articular cartilage and bone damages. The up-regulation of interferon-inducible genes has been found in the synovial lining regions and may play an important role in the pathogenesis of RA. Objective: The aim of the current study is to examine the expression of IL-29 and its receptors IL-28Rα in blood and synovial fluid (SF) in RA patients and investigate the correlation of IL-29 with disease activity and other laboratory characters of RA. Methods: The study was carried out on 108 RA patients, 70 OA patients and 80 healthy control subjects. Clinical assessment of disease activity in RA patients and disease activity score with DAS28 had been done. IL29 was detected in the serum and synovial fluid of all samples by ELISA. Real time PCR was used for human IL-29 and IL-28Rα expression from PBMC. Results: expression of IL-29 mRNA was significantly higher in RA PBMCs when compared to OA and HC (132±13.8, 49± 11.2, 33.3± 10.5; respectively P <0.05). Similarly, IL-28Rα mRNA expression was significantly higher in RA PBMCs when compared to OA and HC (30.5±9.7, 13.3±4.5, 8.5± 3.3; respectively P <0.05). The mean level of IL-29 in SF was increased in RA and found also much higher in RA (17.29 ± 10.19pg/ml) than OA (8.33 ±3.89 pg/ml) (P = 0.01). There is a significant correlation between serum levels of circulating IL- 29 and DAS28, CRP, ESR, RF, and anti-CCP. Conclusion: our data have presented new evidence that IL-29 may contribute to RA pathogenesis

Assessment of global disease activity in RA patients monitored in the METEOR database: the patient's versus the rheumatologist's opinion

The objectives of this study were to compare the patient's (PtGDA) and physician's (PhGDA) assessment of global disease activity and to identify factors that might influence these differences as well as factors that may influence the patient's and the physician's scores separately. Anonymous data were used from 2,117 Dutch patients included in the Measurement of efficacy of Treatment in the Era of Rheumatology database. PtGDA and PhGDA were scored independently on a 100-mm visual analog scale (VAS) with 0 and 100 as extremes. The agreement, intraclass correlation coefficients (ICC), was calculated and a Bland-Altman plot was created to visualize the differences between PtGDA and PhGDA. Linear mixed model analysis was used to model PtGDA and PhGDA. Logistic repeated measurements were used to model the difference in PtGDA and PhGDA (PtGDA > PhGDA versus PtGDA ≤ PhGDA). Gender patient, gender physician, age, swollen joint count (SJC), tender joint count, VAS pain, disease duration, and erythrocyte sedimentation rate (ESR) were considered as possible determinants in both models. Mean (standard deviation) age was 57 (15) years and 67% of the patients were female. Agreement between PtGDA and PhGDA was moderate (ICC, 0.57). Patients scored on average 11 units higher (worse) than rheumatologists (95% limits of agreement, -25.2 to 47.6). Patient's perception of pain (VAS) was positively associated with a PtGDA being higher than PhGDA. Similarly, ESR and swollen joint counts were positively associated with a PtGDA being lower or equal to the PhGDA. Patients rate global disease activity consistently higher than their rheumatologists. Patients base their judgment primarily on the level of pain, physicians on the level of SJC and ESR.

AB0198 Plasma leucine-rich alpha-2 glycoprotein is a useful disease activity biomarker in rheumatoid arthritis

BackgroundLeucine-rich α2-glycoprotein (LRG) is a plasma protein which contains leucine-rich repeats (LRRs). Though physiological functions of LRG have not been clarified yet, it has been reported that LRG could be...

AB0282 DAS28, CDAI and SDAI cutoffs do not translate same information - results from the rheumatic diseases portuguese register, reuma.pt

BackgroundDAS28, CDAI and SDAI are frequently used indexes to assess disease activity in RA patients. Cutoffs were defined to differentiate the states of disease activity that a patient can experience:...

AB0168 Relationship between voice quality parameters and clinical manifestation of rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is a chronic, multisystem autoimmune disease manifested by joint inflammation and damage including also joints and laryngeal cartilages which play an essential role in the process of...

SAT0025 The Association Serum Interleukin 17 and Interleukin 23 Levels with Clinical and Radiological Parameters in Rheumatoid Arthritis Patients

BackgroundRheumatoid arthritis (RA) is a chronic, inflammatory disease which causes symmetrical destructive changes in diartrodial synovial joints (1). Cytokines play an important role in RA pathogenesis. Th 17 cells are...

AB0422 Orofacial evaluation in women with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) can affect any synovial joint. Unlike the hand, ever so valued in the physical examination of patients with RA, the joints in the area of the jaw...

AB1290 Ultrasound evaluation correlates with disease activity in RA patients: Results of the SONAR-SCQM database

BackgroundUltrasound has been shown to be more sensitive than clinical examination for detecting synovitis and many studies have shown that it can be a reliable tool for monitoring RA patients....

AB0179 An innovative histological classification of rheumatoid synovitis and its relationship to clinical disease activity and joint destruction

BackgroundRheumatoid arthritis (RA) is a heterogeneous disease and subtyping of RA may help optimal therapeutic strategies and outcome prediction. However, there has been no available satisfying classification method till now....

Metastasis-inducing S100A4 protein is associated with the disease activity of rheumatoid arthritis

To evaluate the association between metastasis-inducing protein S100A4 and disease activity in patients with RA, and to demonstrate the effect of TNF-alpha blocking therapy on plasma levels of S100A4 in these patients. Plasma levels of the S100A4 protein were analysed in 40 anti-TNF-alpha naive patients with active RA. Of the 40 patients, 25 were treated with adalimumab and monitored over time. The conformational form of S100A4 was analysed using size-exclusion gel chromatography. TNF-alpha mRNA expression and protein synthesis were analysed by RT-PCR and ELISA, respectively. Baseline levels of S100A4 were significantly correlated with disease activity in RA patients (r = 0.41; P < 0.01). After 12 weeks of treatment with adalimumab, there was an obvious shift in the conformations of S100A4 from the multimeric to the dimeric forms, whereas the total levels of the S100A4 protein remained unchanged. This suggests that the bioactive (multimer) S100A4 may decline in response to successful treatment with adalimumab. In addition, we showed significant up-regulation of TNF-alpha mRNA (P < 0.01), and protein release to the cell culture medium of monocytes stimulated with the S100A4 multimer compared with those treated with the dimer and to the unstimulated monocytes (P < 0.001). This is the first study to show that the levels of the S100A4 protein are correlated with RA disease activity. Furthermore, only the bioactive form, but not the total amount of S100A4, decreases after successful TNF-alpha blocking therapy in patients with RA. These data support an important role for the S100A4 multimer in the pathogenesis of RA.

Immune Complexes and Complement in Serum and Synovial Fluid of Rheumatoid Arthritis Patients

Immune Complexes and Complement in Serum and Synovial Fluid of Rheumatoid Arthritis PatientsRheumatoid arthritis (RA) is predominantly an intraarticular inflammatory and autoimmune disease that involves different autoantibodies and effector mechanisms. The aim of the study was to determine the utility of Circulating Immune Complexes (CIC) and complement components (C3c, C4) as possible markers for the disease activity in laboratory diagnostics. In a cross-section study 59 patients, according to the clinical criteria, were categorized into two groups: group with moderate (MA, n=24), and group with severe activity (SA, n=35) of RA. The concentration of CIC, C3c and C4 in sera (S) and synovial fluids (SF) was examined by an immunonephelometric method in both groups and compared with values in the control group (n=15) of patients with lesions of the menisci. Obtained results showed that there was no statistical significance in the values of C3c and C4, in both biological fluids, among all tested groups. Significant differences were found in the levels of CIC in both fluids, while testing the parameters (× ± SD, IU/mL) in the sera of groups with SA and MA of RA: 7.43 ± 13.40; 3.01 ± 2.92 (p&lt;0.05) and SF: 13.47 ± 21.1, 5.33 ± 7.53 (p&lt;0.001), respectively. These differences were higher between the group with SA and CG. Results for the concentrations of CIC were significantly higher in SF compared to sera: in the RA group with SA by 77% and group with MA by about 82%. These data could provide a confirmation of the hypothesis about local, intraarticular autoantibodies and subsequent CIC production. It can be concluded that the examination of CIC concentration in serum, and where it is possible in SF, is a useful marker of disease activity in RA patients, in contrast to the tested components of the complement. This statement does not exclude their consumption within immune effector mechanisms, but elicits the possibility that lower molecular fragments (C3d, C4d), as well as the novel activation products, could be better disease activity markers in RA patients.

Investigation of candidate polymorphisms and disease activity in rheumatoid arthritis patients on methotrexate

We examined the association between candidate single nucleotide polymorphisms (SNPs) and disease activity in RA patients on MTX. Our population was drawn from the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS), a prospective, observational cohort of RA patients. A total of 556 participants were genotyped using the Affymetrix 100K platform. Two hundred and sixty-two participants were on MTX therapy, including 120 on MTX monotherapy. The primary outcome was the disease activity score in 28 joints (DAS28-CRP). High disease activity was defined as DAS28-CRP >3.2. Low disease activity was defined as DAS28-CRP < or =3.2. We studied three candidate alleles in the ATIC, ITPA and MTHFR genes for association with DAS28-CRP. Among participants on MTX monotherapy, those carrying the minor allele of ATIC SNP rs4673993 were more likely to have low disease activity (P = 0.01). None of the other SNPs was associated with disease activity. Among patients on any MTX (combination or monotherapy), the minor allele of ATIC rs4673993 was also associated with low disease activity (P = 0.04). In this cross-sectional analysis, ATIC SNP rs4673993 was associated with low disease activity in patients on MTX. Further studies are needed to clarify the relationship between ATIC polymorphisms, disease activity and treatment response.