Rheumatoid Arthritis Disease Activity Research Articles

Impact of systemic inflammation and disease activity on the incidence of interstitial lung disease in patients with rheumatoid arthritis – a nested case-control study within the German biologics register RABBIT

BackgroundTo investigate the association between the development of incident interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) and the disease activity of RA with its various components, especially C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).MethodsWe analysed data from RA patients, observed in the German biologics register RABBIT between 2001 and 2021. In a nested case-control study, patients with a reported incident ILD diagnosis during follow-up were matched 1:5 to patients without ILD. Matching criteria were sex, age, RA duration, date of enrolment and observation time. Defined by a directed acyclic graph (DAG), we adjusted the conditional logistic regression models for rheumatoid factor, smoking, chronic obstructive pulmonary disease and tuberculosis/chronic viral infections to investigate the impact of disease activity/systemic inflammation. Mean and categorized values were analysed within 12 months prior to ILD and during the entire observation time. Additionally, two sensitivity analyses were performed, using validated ILD cases only and considering ILD cases with an observation time of more than 12 months.ResultsWe identified 139 RA patients with incident ILD and matched them to 686 controls. In 94 cases the diagnosis could be validated, and 98 cases had a follow-up of > 12 months. The averaged DAS28 composite score (including ESR or CRP) was not associated with developing RA-ILD (odds ratios 1.16 [95% confidence interval: 0.97–1.40] and 1.06 [0.86–1.29], respectively). However, single measures of inflammation, log ESR (1.86 [1.35–2.57]) and log CRP (1.55 [1.21–1.97]), were significantly associated with an increased RA-ILD risk. A higher risk for ILD was also revealed for persistently high inflammation. Other DAS28 components showed no significant associations with RA-ILD. These results were consistent for values over the entire observation time of a patient and within 12 months prior to the ILD. Sensitivity analyses confirmed these findings.ConclusionHigher levels of systemic inflammation, as indicated by ESR and CRP, but not joint counts or patient’s global assessment, were significantly associated with the occurrence of incident ILD in patients with RA. As possible predictor for the development of RA-ILD, systemic inflammation should be monitored closely and independently of joint count results.

Association between Rheumatoid Arthritis Disease Activity and Comorbidities

Background and objectives: Rheumatoid arthritis is an autoimmune condition marked by chronic joint inflammation, frequently resulting in substantial impairment and diminished quality of life. However, rheumatoid arthritis rarely occurs in isolation, as individuals with this condition frequently present with comorbidities, such as cardiovascular disease, diabetes, and osteoporosis. Understanding the role of comorbidities in Rheumatoid Arthritis is critical for comprehensive patient care. The aim of this study was to investigate the impact of various comorbidities on disease activity of rheumatoid arthritis. Methods: Patient data for this cross-sectional study was collected at rheumatology outpatient of Rizgary teaching hospital in Erbil city of Kurdistan-Iraq from August 2022 August 2023. Study participants included patients with rheumatoid arthritis with (n=60) and without (n=60) comorbidities and they were matched for age and sex. Results: Our findings revealed that among patients with rheumatoid arthritis, hypertension is the most frequent comorbidity, affecting 27 patients (45%) of them. This is followed by the coexistence of hypertension and diabetes mellitus in 9 (15%) of cases, and hypothyroidism in 8 (13.3%) of cases. Furthermore, the study establishes a strong and statistically significant link between patient age and the presence of comorbidities (p<0.001). Additionally, it demonstrates a significant correlation between the high activity of RA disease and comorbidities (p=0.03). Conclusions: This research is providing insights into the ways in which these accompanying medical conditions affect the activity of rheumatoid arthritis. The results of this current study have important implications for making treatment choices, assessing risks, and crafting customized approaches to managing this disease.

Cystatin D serum level in rheumatoid arthritis and its relation to disease activity

BackgroundRheumatoid arthritis (RA) is a chronic autoimmune condition that causes synovitis and functional impairment. Currently, the most often utilized biomarkers for monitoring disease activity and severity are acute phase proteins, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).However, discrepancies have been found between the clinical inflammation and their levels. Therefore, there is a strong need for a novel biomarker to forecast how RA will proceed clinically and monitor the response to therapy. This study assessed the diagnostic value of serum cystatin D in RA patients and its potential as a biomarker for disease activity monitoring.ResultsRA patients had considerably greater serum levels of cystatin D than the control group. These values showed a positive correlation with Disease Activity Score-28 (DAS28), ESR, CRP, grayscale synovitis, power Doppler synovitis, grayscale tenosynovitis (p < 0.001), and erosions, sum scores (p < 0.05). Nonetheless, no noteworthy association was observed between the serum cystatin D levels and sociodemographic data, rheumatoid factor (RF), and anti-cyclic citrullinated peptide (anti-CCP).ConclusionCystatin D serum levels are higher in RA patients compared to healthy subjects and are strongly correlated with the activity of RA. It can be a valuable biomarker for evaluating RA disease activity.

Correlation between Quality of Life and Erythrocyte Sedimentation Rate with Disease Activity in Rheumatoid Arthritis.

Inflammatory markers are crucial in diagnosing and monitoring rheumatoid arthritis. Patients with rheumatoid arthritis (RA) live with constant pain that limits their daily activities. Our study highlights the effects of disease activity on the quality of life in patients with rheumatoid arthritis. Swollen joint count (SJC), tender joint count (TJC), and visual activity scale (VAS) were utilized to acquire patients' subjective feelings of wellness and their performance of routine daily activities to determine the disease activity. The patient's erythrocyte sedimentation rate (ESR) was measured at the clinical hematology laboratory using the Westergren method. The Quality of Life was rated on a scale of 1 to 10. Our study found that disease activity is inversely proportional to the quality of life. Out of 111 patients, 3 (2.7%) were in remission, 1 (0.9%) had mild disease, 51 (45.9%) had moderate disease, and 56 (50.5%) had high disease activity. The ESR was normal (<20) in 11 patients (9.9%), moderately elevated (20-50) in 56 (50.5%) patients, and very high (>50) in 44 (39.6%) patients. The study revealed that 66% of patients in remission had normal, while 33% had moderately elevated ESR. 12.5% of patients with moderate disease activity had normal ESR, and none with high disease activity had normal ESR. Of 44 patients with high ESR, 7 had moderate disease activity, and 37 had high disease activity. In our study, 60% of patients had a less than 50% quality of life compared to patients with pre-arthritis. High disease activity affects the productivity and quality of life in patients with rheumatoid arthritis. Assessing the impact of different interventions on the QOL should be an essential task that can help define a holistic and integrative treatment and rehabilitation model for RA patients.

Immune nutrition indices are associated with disease activity in rheumatoid arthritis: a cross-sectional study.

This study aimed to evaluate the relationship between immune nutrition indices and disease activity in rheumatoid arthritis (RA). The current study included a cross-sectional analysis of 90 age and gender-matched healthy controls and 116 RA patients who satisfied the 2010 American College of Rheumatology and European League Against Rheumatism categorization criteria. Patients were categorized into remission (disease activity score 28- erythrocyte sedimentation rate (DAS 28-ESR) <2.6) and active disease (DAS 28-ESR ≥2.6) groups. Systemic immune-inflammatory index (SII), controlling nutritional status (CONUT), and fibrinogen-to-albumin ratio (FAR) were higher in the RA group than in controls, whereas CRP-albumin-lymphocyte ratio (CALLY) and prognostic nutrition index (PNI) were considerably lower in RA (p < 0.001). The clinical and simplified disease activity index, DAS 28-ESR had negative correlation with PNI and CALLY (p < 0.001). PNI and CALLY were independently related markers of disease activity (p < 0.001) by regression analysis. According to receiver operating characteristic curve analysis, the ideal cutoff values for the active disease are as follows: CONUT, 0.5; CALLY, 12.5, SII, 579.43, FAR, 90.43, and PNI, 40. CALLY was the most sensitive (84.06%) and specific marker (95.74%). CALLY and PNI may be useful prognostic markers for assessing disease activity in RA patients.

Guizhi Shaoyao Zhimu decoction inhibits neutrophil extracellular traps formation to relieve rheumatoid arthritis via gut microbial outer membrane vesicles

BackgroundRheumatoid arthritis (RA) is a common autoimmune disease with a high disability rate. Accumulating studies suggest that neutrophil extracellular traps (NETs) play a crucial role in the pathogenesis of RA and targeting NETs has emerged as a potential therapeutic strategy for RA. As a traditional Chinese medicine, Guizhi-Shaoyao-Zhimu Decoction (GSZD) has exhibited good efficacy in the treatment of rheumatoid arthritis (RA), while the underly mechanism especially the possibility that GSZD alter NETs formation to relieve RA remains unknown. PurposeOur study aimed to investigate relationship between GSZD and NETs in RA treatment and revealed underlying mechanism. MethodsWe constructed collagen-induced arthritis (CIA) model and treated CIA mice with GZSY to validate therapeutic effects of GSZD and examine whether GZSD could inhibit NETs formation in RA. And 16S rRNA sequencing and Fecal microbiota transplantation (FMT) experiment were performed to determine whether GSZD could reduce NETs formation to alleviate RA in gut microbiota-associated manner and identify crucial bacterium in response to GSZD administration. CIA mice treated with effective bacteria and its outer membrane vesicles (OMVs) with oral administration to investigate protective effect against RA and NETs regulative efficiency. We utilized small interfering RNA in vivo and vitro to silence gene mediating effect of GZSD-gut microbiota-NETs. ResultsGSZD could inhibit NETs formation and relive arthritis in CIA mice. Additionally, GSZD alter gut microbiota composition and significantly increase intestinal Parabacteroides goldsteinii (P.goldsteinii) abundance. Mechanistically, P.goldsteinii enriched by GSZD secreted outer membrane vesicles (OMVs) to translocate into joints and activate Cav-1-Nrf2 axis, leading to reduced NETs formation and alleviate arthritis. In clinical, the abundance of P.goldsteinii exhibited negative correlation with NETs indexes and RA disease activities. ConclusionOur findings suggest that GSZD inhibits NETs formation to relieve RA in P.goldsteinii-Cav-1-Nrf2 associated manner, which could provide new sight of the prevention and treatment of RA.

Dietary habit and risk of rheumatoid arthritis: a mendelian randomization study identifying protective and risk factors.

Dietary habit significantly contributes to the initiation and progression of rheumatoid arthritis (RA). Dietary choices intersect with a range of clinical and societal factors. The utilization of cross-sectional methodologies in numerous studies poses a challenge in establishing definitive causality for the noted associations. Moreover, within identical food categories, specific items may elicit diverse effects on the pathogenesis of RA, and the correlation between several prevalent food items or beverages and RA remains inadequately explored. We performed a two-sample Mendelian Randomization (MR) study to evaluate the causal impact of 27 distinct dietary habits and RA susceptibility. These dietary-related phenotypes encompass both the relative intake of the four macronutrients (fat, protein, carbohydrates, and sugar) and 23 specific single food intake. Several filtering steps were employed to select eligible genetic instruments strongly associated with each of the traits. The random-effects inverse-variance weighted, weighted median, and MR-Egger methods were employed for MR estimations. Sensitivity analyses and power calculations were executed to ensure the robustness of our study. After rigorous single-nucleotide polymorphism (SNP) filtering procedures, 611 SNPs were included in our ongoing investigations. The consumption of dried fruit, bread, and alcohol emerged as protective factors, while beef, processed meat, and coffee intake were identified as risk factors. The robustness of our study was confirmed through the outcomes of sensitivity analysis and power calculation. The ongoing investigations furnish evidence that accentuates the influence of diet on RA disease activity, underscoring the importance of delineating the optimal nutritional lifestyle for RA patients.

Interdisciplinary Rheumatoid Arthritis Research and Patient Care: An Introduction and Critique of the Biopsychosocial Model of Disease Experience in Rheumatoid Arthritis.

Rheumatoid arthritis (RA), a debilitating autoimmune disease, affects approximately 78million people globally. RA is often managed solely by rheumatology providers, but an interdisciplinary approach to RA may be the key to improving health equity and outcomes. An interdisciplinary model is an important step towards this goal. The Biopsychosocial Model of Disease Experience in RA (BDRA) is a conceptual approach that considers individual disease determinants in interdisciplinary research and care. To introduce and critique the evidence-based, interdisciplinary BDRA. Engel's Biopsychosocial Model of Health (BMH) and the Revised Symptom Management Conceptual Model (RSMCM) were blended in the BDRA. A literature search of articles published prior to December 2021 was completed using "disease exacerbation," "disease improvement," and "disease activity" in RA. Results were categorized as biological, psychological, and social determinants of disease activity in RA. These biopsychosocial factors alter biological function and result in the individual RA experience. Model development and critique were completed using guidelines established by Walker and Avant. The BDRA is a visual depiction of RA biopsychosocial factors, disease activity, and individual experience. This model can guide interdisciplinary research and patient care, in efforts to improve RA health equity and rates of sustained remission.

Effect of traditional Chinese Yijinjing exercise on hand dysfunction in rheumatoid arthritis patients: a randomized controlled trial.

Rheumatoid arthritis (RA) patients often experience significant hand dysfunction. Yijinjing, a traditional Chinese exercise, has been recognized for its benefits to mind-body health. This study aimed to evaluate the efficacy and safety of Yijinjing in improving hand dysfunction among individuals with RA. This research was conducted as a single-center, outcome-blinded, randomized controlled trial. A total of 66 eligible RA participants were randomly assigned in a 1:1 ratio to either the Yijinjing exercise group (YJJG) with sessions conducted three times per week over a 12-week period or the control group (CG), which maintained ordinary activities. Various outcomes were assessed, including the Michigan Hand Outcomes Questionnaire (MHQ), handgrip strength, active range of motion (AROM), RA disease activity, the Health Assessment Questionnaire Disability Index (HAQ-DI), levels of anxiety and depression, and wrist ultrasound, all of which were collected at baseline and the week 12. At the end of the 12 weeks, the YJJG demonstrated significant improvements in MHQ scores compared to the CG (p < 0.05), alongside enhancements in handgrip strength and AROM, specifically in wrist extension, radial deviation, and metacarpophalangeal flexion (p < 0.05). Wrist ultrasound scores did not exhibit a significant increase in the YJJG, meaning no inflammation aggravation (p > 0.05). Additionally, morning stiffness duration, Disease Activity Score 28-ESR (DAS28-ESR), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels showed significant improvement in the YJJG (p < 0.05). Both groups reported enhancements in quality of life, as well as reductions in anxiety and depression scores, with the YJJG displaying greater improvements overall (p < 0.05). Importantly, no adverse events or significant abnormalities in vital signs were observed in either group. Yijinjing exercise may effectively enhance hand function, handgrip strength, and flexibility in RA patients with low disease activity. Furthermore, it appears to improve quality of life and reduce anxiety and depression without exacerbating joint inflammation. https://clinicaltrials.gov/study/NCT05527158, Identifier NCT05527158.

Nonlinear association between platelet to albumin ratio and disease activity in patients with early rheumatoid arthritis

The relationship between the platelet to albumin ratio (PAR) and the disease activity of early rheumatoid arthritis (ERA) remains to be elucidated. This cross-sectional study included 372 patients with ERA who were hospitalized at Xingtai People’s Hospital between January 2022 and January 2024. Multiple linear regression analysis was employed to assess the correlation of PAR with Disease Activity Score 28 (DAS28) using erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and then generalized additive models were used to explore their relationship. After accounting for confounding variables, a positive correlation was observed between the PAR and DAS28-ESR and DAS28-CRP in ERA patients (β (95% CI): 0.20 (0.08, 0.32) and 0.20 (0.08, 0.33), respectively), and the general trends were consistent from the lowest tertile group (T1) to the highest tertile group (T3). Furthermore, a nonlinear relationship was identified between PAR and both DAS28-ESR and DAS28-CRP. Threshold effect analysis indicated that a value of 13.73 was a significant inflection point. In brief, PAR has a threshold effect on the disease activity of ERA. Increased PAR levels were independently positive associated with DAS28-ESR and DAS28-CRP among ERA patients with PAR < 13.73.

Effects of green tea based oral health strategies on disease activity in rheumatoid arthritis.

In this study, we aimed to evaluate oral health strategies in rheumatoid arthritis (RA) patients with periodontitis. We enrolled 110 RA patients with periodontitis who were diagnosed in a Grade A tertiary hospital into an oral health strategies program. The control and test groups comprised 55 cases each. The management effect was evaluated by self-care ability, oral health-related quality of life, RA-related clinical indicators, and the DAS28 score. The control group received routine nursing, whereas the test group was in a self-health management program for 3 months. After the intervention, compared to the control group, the test group showed better self-care ability, oral health-related quality of life score, RA-related clinical indicators, and DAS28 score (P < 0.05). Our oral health strategies program slowed down the progression of the disease and can be popularized in patients.

Collagen triple helix repeat-containing 1 protein: an emerging biomarker and its influence on the clinical and sonographic disease severity in Egyptian medicated female rheumatoid arthritis patients

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease of synovial joints, with a multifactorial etiology. Collagen triple helix repeat-containing 1 protein (CTHRC1) is a biomarker produced by fibroblast-like synoviocytes, which was shown to be highly expressed in RA patients. The study aimed to measure serum CTHRC1 level in female RA patients currently on medical treatment and its influence on the clinical and sonographic severity of the disease.ResultsThe patients’ mean age was 43.39 ± 8.55 years and median RA disease duration of 5.5 (0.33–20) years. RA patients showed significantly higher serum CTHRC1 level [89.71 ng/ml (53.95–353.45)] in comparison to controls [87.38 ng/ml (44.47–110.3)] (U = 430, P = 0.014). Furthermore, higher serum CTHRC1 levels were recorded in seropositive versus seronegative patients (U = 76, P = 0.022) and in RA patients with severe disease activity compared to those with lower disease activity (H = 9.79, P = 0.007). Furthermore, serum CTHRC1 levels were lower in RA patients receiving biological therapy compared to those receiving conventional therapy; however, this difference did not reach statistical significance.Significant positive correlations were found between CTHRC1 and disease activity, acute-phase reactants, serological markers, functional assessment, fatigue, and erosions detected by ultrasound, while a significant negative correlation was recorded between CTHRC1 and duration of biologic intake (rs = − 0.45, P = 0.036). Furthermore, on multivariate linear regression analysis, serum CTHRC1 was the only significant predictor for higher disease activity (P = 0.028, B = 0.009, 95% CI 0.001 to 0.017).ConclusionRA patients showed higher CTHRC1 serum levels compared to healthy controls, especially those with seropositivity and highly active disease. Furthermore, it was positively associated with poor patient functional outcome, fatigability, and erosive findings by ultrasound, thus suggesting that serum CTHRC1 can be a good predictor for high RA disease activity and possibly severity. Moreover, biological therapy could influence serum CTHRC1 levels in these patients.

Application of superb microvascular imaging technology in clinical disease activity of rheumatoid arthritis.

Detection of synovitis is essential for assessing the activity and predicting the prognosis of rheumatoid arthritis (RA). The aim of this study was to investigate the diagnostic performance of superb microvascular imaging (SMI) in RA patients with high, moderate, and low activity. One hundred four patients with active RA were selected from the hospital between May 2022 and August 2023. The study observed the correlation between bone erosion of the carpal joint, joint cavity effusion, thickness of synovial hyperplasia of the carpal joint, positivity rate of synovial blood vessels, and their semiquantitative scores with the clinical disease activity of RA using SMI examination. The detection of synovial hyperplasia thickness and joint effusion in the high-activity group was higher than that in the low-activity group, and the difference was statistically significant (P < 0.05). The quantitative SMI test demonstrated that the synovial blood flow grading and semiquantitative grade increased gradually with activity level (P<0.05). During the high, moderate, and low-activity groups, the vascular index (VI) value of the hyperplastic synovial membrane decreased gradually, showing statistical significance both between and within the groups (P<0.05). SMI technology exhibited high sensitivity and accuracy in assessing disease activity in RA. It holds significant clinical application value as a reliable auxiliary tool for assessing disease activity in RA and treatment. Key Points • Super micro-vascular imaging (SMI) demonstrated higher detection rates of microvesselsin RA patients with high disease activity compared to those with low activity, showing statistical significance. • The quantitative SMI test revealed a clear correlation between synovial blood flow grading and disease activity levels in RA patients, highlighting the potential of SMI as a valuable tool for disease activity and treatment of rheumatoid arthritis.

Optimal timing of recombinant herpes zoster virus vaccination for a JAK inhibitor treatment in rheumatoid arthritis: a multicentre, open-label, randomised comparative study (STOP-HZ study): study protocol

IntroductionJanus kinase (JAK) inhibitors are an important therapeutic option in the treatment of rheumatoid arthritis, but increase the risk of developing herpes zoster. Although a dry recombinant zoster vaccine (RZV)...

Scavenger receptor-A is a sensitive disease activity biomarker in ESR and CRP normal rheumatoid arthritis.

Identification of rheumatoid arthritis (RA) patients in active disease with normal ESR and CRP is a challenge in disease activity assessment. The objective of this study was to evaluate the performance and clinical significance of Scavenger receptor-A (SRA) as a disease activity biomarker in RA, especially in ESR and CRP normal patients. One hundred and sixty-two RA (40 discovery cohort; 122 validation cohort), 20 osteoarthritis (OA), and 36 healthy controls (HCs) were recruited. Ten disease activity markers were evaluated by Bio-Plex Pro Human Cytokine Assay in the discovery cohort. SRA levels were measured by enzyme-linked immunosorbent assay (ELISA) in the validation cohort. The association between SRA and clinical phenotypes was also analyzed. ROC analysis was performed for disease activity prediction. SRA was found to be correlated with disease activity in the discovery cohort. The serum SRA level was verified by ELISA in the validation cohort, and was found to be correlated with disease activity index in RA patients, including DAS28-ESR (r = .477, p < .001), swollen joint counts, and tender joint counts; as well as inflammation markers, including ESR and CRP. In ESR and CRP normal RA, there was a strong correlation between SRA and DAS28-ESR ( = 4.564, p = .003). In addition, area under the ROC of SRA was higher than AUCESR and AUCCRP in ESR and CRP normal RA patients, suggesting that serum SRA could be more sensitive than ESR and CRP for disease activity assessment in this group of patients. In the low DAS28-ESR (≤3.2) group, the AUC of SRA for disease activity measurement was higher than that of ESR and CRP, indicating that SRA was also more sensitive than ESR and CRP in low-disease activity RA. SRA was correlated with RA disease activity and may be a sensitive serum biomarker for disease activity evaluation, especially in ESR and CRP normal patients, as well as in the low-disease activity group. SRA could be a promising marker for disease activity assessment.

Altered serum metabolome is associated with disease activity and immune responses in rheumatoid arthritis

Rheumatoid arthritis (RA) is widespread globally, with the emergence of metabolites derived from both the host and microbes playing a pivotal role in its pathogenesis. This study aims to elucidate the relationships between serum metabolites and the immunological and clinical features of RA. Serum samples were collected from 35 RA patients and 37 healthy controls (HC). Metabolite profiling was performed using gas chromatography-mass spectrometry (GC/MS). Principal component analysis revealed a significant distinction between the RA and HC cohorts. Employing univariate statistical analysis, we identified 36 differential metabolites. Among these, 9 metabolites, including galactose and glucose, were found to be enriched, while the remaining metabolites, such as citric acid, fumaric acid, and inosine, were depleted in RA. These diverse metabolites encompassed various metabolic processes, including the biosynthesis of fatty acids, amino acids, and glucose. The enrichment of glucose and galactose in RA exhibited a substantial correlation with elevated IgG levels, as determined through correlation analysis. Conversely, the depletion of citric acid was correlated with elevated levels of C3 and CRP. Methionine, which also declined in RA patients, displayed a negative correlation with ESR. Furthermore, galactose and glucose exhibited significant positive correlations with naïve B cells, while the decreased eicosanoic acid level in RA was significantly associated with an increase in natural killer cells. Our findings suggest that the altered serum metabolite profile in RA is closely linked to disease severity and the dysregulated immune responses observed in RA patients. Key Points• Identified nine metabolites with upregulated expression and twenty-seven metabolites with downregulated expression.• Established a correlation between alterations in serum metabolite levels and inflammatory markers in RA patients.• Discovered a significant association between changes in serum metabolites and immune cell profiles in RA patients.

Symptom Severity and Glucocorticoid Dosing in Patients With Polymyalgia Rheumatica and Obesity.

Polymyalgia rheumatica (PMR) is an inflammatory disorder of the elderly characterized by girdle pain and stiffness. Obesity has an influence on disease activity and outcome in rheumatic diseases like osteoarthritis and rheumatoid arthritis. We aimed to investigate the relationship between high BMI and the severity and outcome of PMR, which is incompletely understood. In a post hoc analysis, 83 patients with recent-onset PMR were studied over 6 months using clinical examination, laboratory evaluation, and girdle ultrasound (US). The modified Health Assessment Questionnaire (mHAQ), 36-item Short Form Health Survey (SF-36), and PMR visual analog scale (VAS) scores, as well as prednisone therapy data, were recorded. Patients were grouped according to their BMI. At baseline, the 12 patients with obesity had significantly more shoulder pain (P = 0.03), global pain (P = 0.03), PMR VAS (P < 0.01), and fatigue (P = 0.03); higher mHAQ (P = 0.01); and lower SF-36 physical component summary (P = 0.048) and SF-36 pain index (P < 0.001). The mean initial prednisone dose was similar among groups, but patients with obesity received a lower dose/kg (1.9 [SD 0.7] mg vs 2.2 [SD 0.7] mg; P < 0.01). At 6 months, patients with obesity were being treated with higher mean daily prednisone doses (8.5 [SD 3.2] mg/d vs 6.2 [SD 5.2] mg/d; P = 0.02), and 40% of them were receiving higher daily prednisone doses than the standard protocol compared with 14% patients without obesity (P = 0.048). Clinical features, laboratory results, and US results were similar between patients with and without obesity. Obesity affects both symptom severity and prednisone utilization in patients with PMR. The reason for this may relate to different subjective pain perception rather than increased inflammation in patients with obesity. BMI should be considered when interpreting symptoms in patients with PMR and deciding their prednisone doses.

Using patient reported outcomes measurement information system (PROMIS®) measures in rheumatoid arthritis clinical care, research, and trials

Patient-reported outcomes (PROs) are reports coming directly from patients about how they feel and function. PROs in the Rheumatoid Arthritis (RA) Core Set include the patient global assessment, and self-ratings of pain and physical function. As a result, these outcomes are widely collected in trials. The patient global assessment is a component included in several RA disease activity indices including the clinical disease activity index (CDAI) and the disease activity score (DAS28), which guide clinical decision-making for the initiation, maintenance, and change of disease modifying anti-rheumatic drugs (DMARDs).

A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease

BackgroundDrugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors.AimTo determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions.MethodsA modified international 3-tier Delphi exercise was performed. Tier 1 determined patient and drug variables that physicians perceive to be risk factors. Tier 2 determined degree of risk associated with the Tier-1 derived variables. Tier 3 aimed to internally validate and stratify exemplar cases into risk categories.Results134 pulmonologists and 49 rheumatologists responded to Tier 1;157 physicians completed all tiers. Perceived risk factors included: drug type; history of previous pneumotoxicity; age; smoking; underlying rheumatic disease type and activity; renal function; pulmonary hypertension; left ventricular failure;presence, nature, severity and progression of pre-existing interstitial lung disease. Tier 2 data stratified these variables into risk profiles e.g. never versus current smoking was perceived as low and high risk respectively. An example of perceived high risk resulting from Tier 3 is a 75-year-old current smoker with high-activity rheumatoid arthritis (RA) with severe, progressive ILD being started on methotrexate. A perceived low risk is a 75-year-old currentsmoker with moderate-activity RA and emphysema with no cardiac or renal disease and no pre-existing ILD being started on rituximab. A risk prediction scoring tool is being developed to be used in validation studies.ConclusionThis modified Delphi exercise defined and stratified the perceived risk factors for developing pneumotoxicity. Age, current smoking, high underlying rheumatological disease activity, HRCT definite UIP and honeycombing, severity and progression of pre-existing ILD were perceived to be the highest risk-factors.

Effective Assessment of Rheumatoid Arthritis Disease Activity and Outcomes Using Monocyte Chemotactic Protein-1 (MCP-1) and Disease Activity Score 28-MCP-1.

The effectiveness of monocyte chemotactic protein-1 (MCP-1) and Disease Activity Score 28 (DAS28)-MCP-1 (DAS28-MCP-1) in assessing rheumatoid arthritis (RA) disease activity is unclear, although some studies have demonstrated their potential usefulness. The present study investigated relationships between MCP-1 and different DAS28 measures, the occurrence of residual swollen joints in different DAS28 remission statuses, changes in medication dosage in relation to the 2005 modified American Rheumatism Association and 2011 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) remission definitions, and the correlations between different DAS28-related scores and Health Assessment Questionnaire Disability Index (HAQ-DI) scores in two RA patient cohorts. The results revealed that the MCP-1 level was correlated with five disease activity measures (DAS28-erythrocyte sedimentation rate [DAS28-ESR], DAS28-C-reactive protein [CRP], Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and DAS28-MCP-1) in multivariable regression analysis (all p < 0.05; ESR, CRP, and MCP-1 as independent variables). However, ESR was not significantly associated with SDAI and CDAI scores (p = 0.343 and 0.323, respectively). Residual swollen joints were more frequently observed in patients who met the DAS28-ESR remission criteria (<2.6) compared with those meeting the other four remission criteria, with a difference ranging from 71% to 94%. Among patients meeting the DAS28-ESR remission criteria (<2.6), medication changes (dose increase by ≥30% or new medications prescribed) were less frequent in those who also met the 2011 ACR/EULAR remission criteria than in those who did not meet them (p = 0.006). Moreover, the correlation coefficients for the relationship between DAS28-ESR and HAQ-DI scores were the lowest among the five disease activity measures. In conclusion, MCP-1 and DAS28-MCP-1 are effective in assessing RA disease activity, with less residual joint swelling and less frequent medication increases observed in the DAS28-MCP-1 remission < 2.2 subgroup.