Disease Activity Score 28 Score Research Articles

OA40 Clinical and psychological factors associated with adherence based on a patient self-reported questionnaire: results from the biologics in rheumatoid arthritis genetics and genomics study syndicate (BRAGGS) cohort

Abstract Background/Aims To explore the relationship of clinical and psychological factors with adherence based on a patient self-reported questionnaire from a prospective longitudinal study of patients receiving TNFi biologic treatment for rheumatoid arthritis, recruited since 2008. Methods Analysis of data collected from a prospective longitudinal UK study (Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate [BRAGGSS]) of patients with moderate to severe RA commencing TNFi biologic treatment. Clinical data including Disease Activity Score-28 (DAS28), serological status (Rheumatoid Factor positivity) and body mass index (BMI) were collected. Patients also completed self-reported questionnaires, the health assessment questionnaire (HAQ), hospital anxiety and depression scale (HAD), beliefs about medicine questionnaire (BMQ), brief illness perception score (B-IPQ) and a self-reported adherence questionnaire. Adherence was defined as any deviation from prescribed medication regime such as altering the dose, forgetting a dose, stopping treatment, missing a dose, and taking less than instructed. Associations between demographic and psychological variables and adherence were evaluated using regression models and a multivariable logistic regression model was used to further evaluate associations, controlling for BMI. Results 1,513 patients (75.7% female, age 58.1 [IQR 16.0], disease duration 9.6 ± 9.6 years and pre-treatment DAS28 scores 5.7 ± 0.8) were included. 70% of patients self-reported adherence to their medication. When comparing the different TNFi treatments, etanercept had the lowest levels of adherence at the 3 and 6 month time-points. Adherence was higher in those with older age (β = 0.03, p< 0.01), higher baseline CRP levels (β = 0.01, p= 0.03) and higher necessity beliefs (β = 0.04, p= 0.03). Adherence was lower in those with higher tender joint counts at baseline (β=-0.03, p= 0.04) and 3 months (β = 0.03, p= 0.02) (Table I). These associations persisted after controlling for the effects of BMI using a multivariable logistic model. Conclusion Self-reported adherence was 70% in this BRAGGS population. Factors associated with non-adherence included higher tender joint counts and lower necessity beliefs pre-treatment, which may allow targeting of interventions to optimise adherence in these groups. Disclosure T.K.Y. Chong: None. N. Nair: None. A.W. Morgan: None. J.D. Isaacs: None. A.G. Wilson: None. K.L. Hyrich: Honoraria; Abbvie. Grants/research support; K.H has grants from BMS and Pfizer. D. Plant: None. A. Barton: Grants/research support; A.B has received funding/speaker fees from BMS, Pfizer and Galapagos.

Individualized treatment strategy for patients with rheumatoid arthritis based on imaging evaluation

Purpose: To study the effect of individualized treatment strategy based on imaging evaluation in patients with rheumatoid arthritis (RA).
 Methods: Eighty patients with RA of the wrist treated in the Second Affiliated Hospital of Nanjing Medical University, China from January 2018 to December 2022 were assigned to control and study groups. Conventional methods were used for treating control subjects, based on RA laboratory index results, while the study group received individualized treatment based on RA laboratory index results and results of imaging evaluation. Before and after treatment, serum levels of rheumatoid factor (RF) and C-reactive protein (CRP) were assayed using immunoturbidimetry. Erythrocyte sedimentation rate (ESR) was determined by Wei method. Imaging examination - ultrasound or magnetic resonance imaging (MRI) - was carried out in study group before and after treatment. Disease activity score 28 (DAS28) and score on the visual analogue scale (VAS) were evaluated before and after treatment, and the curative effect in the two groups was compared based on curative effect evaluation.
 Results: In both groups, post-treatment values of RF, CRP and ESR were lower than the corresponding pre-treatment levels, but were significantly smaller in study group (p < 0.05). The DAS28 and VAS scores of the two groups after treatment were significantly lower (p < 0.05) than the pretreatment levels, but the DAS28 and VAS scores were significantly lower in study group (p < 0.05). Treatment efficacy in study group (95.0 %) was significantly higher than in control patients (77.5 %, p = 0.0476). The results of imaging indicators showed significantly reduced post-treatment synovial thickness and joint effusion in study group patients when compared with control patients (p < 0.01).
 Conclusion: Individualized treatment strategy for RA patients based on imaging results enhances curative effectiveness, reduces disease activity, relieves pain, and improves the quality of life of patients.

Vatari Guggulu, Hingvashtaka Churna, and Brihat Saindhavadya Taila in the management of rheumatoid arthritis: An open-label, prospective, single-arm multi-center study

Abstract Background: Despite significant advances in the diagnosis and treatment of rheumatoid arthritis (RA), the clinical outcomes remain unsatisfactory in a significant proportion of patients. Ayurveda management for RA (Amavata) has shown promising clinical outcomes in routine clinical practice and as per published research studies. Objective: The study was designed to assess the therapeutic effect and safety of Ayurveda interventions, Vatari Guggulu (VG), Hingvashtaka Churna (HC), and Brihat Saindhavadya Taila (BS) in the management of RA. Materials and Methods: An open-label, prospective, single-arm multicenter study was conducted at Ayurveda Research Institutes in Patna, Bhubaneswar, and Guwahati with a sample size of 180 participants. Patients of any gender aged 20–60 years with clinically diagnosed RA as per the revised American College of Rheumatology criteria and willing to provide written informed consent to participate in the study were included in the study. Ayurveda interventions, VG, HC, and BS, were administered to the study participants for 12 weeks, with a follow-up at four weeks without intervention. The primary outcome measure was a change in the Disease Activity Score-28 (DAS28) from baseline. The other outcome measures included change in the Indian Health Assessment Questionnaire Disability Index score (HAQ-DI), changes in the acute phase reactants (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]), and change in the quality of life parameters (assessed through the SF-36 questionnaire). Results: A total of 180 participants were enrolled in the study, and data of 179 participants were considered for the final analysis. A statistically significant difference was observed in the outcome parameters, such as a mean change in the DAS28 score, HAQ-DI score, SF-36 score, and ESR and CRP levels (P < 0.001) after 12 weeks of treatment. The mean DAS28 score changed from 6.50 ± 0.790 at baseline to 4.21 ± 1.286 on week 16 follow-up (P < 0.001). No participant withdrew from the study due to adverse events. The trial interventions were well-tolerated and safe. Conclusion: The study outcomes provide preliminary evidence of the safety and potential benefits of the Ayurveda interventions in the management of RA. Further, randomized controlled studies may be planned to generate robust evidence on the therapeutic potential of these interventions so that they can be recommended for use in routine clinical practice. Trial registration: CTRI/2014/12/005242.

Clinical and immunological responses to COVID-19 vaccination in rheumatoid arthritis patients on disease modifying antirheumatic drugs: a cross-sectional study.

This study was conducted to investigate the immunological and clinical response to COVID-19 vaccination in rheumatoid arthritis (RA) patients receiving disease modifying antirheumatic drugs (DMARDs). A cross-sectional study was conducted among RA patients who received two doses of COVID-19 vaccine within 6 months to one year. Demographic information, comorbidities, vaccination details, and past COVID-19 infection details were collected. Hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) levels were estimated. Disease Activity Score-28 (DAS-28) was calculated for RA patients. Anti-spike antibody (ASA) concentrations were measured, and compared with a healthy control population. Correlations of ASA with age, sex, disease parameters, medication use, and comorbidities were assessed. A total of 103 RA patients and 185 controls were included in the study. RA patients had higher mean age, lower mean Hb, higher ESR, and elevated IL-6 levels. Both groups showed positive results for anti-spike antibodies, with a higher percentage in controls. Among RA patients majority had low DAS-28 score. The number of DMARDs used showed a negative correlation with antibody levels. There was a slight positive correlation between ASA concentration and DAS-28 score. Comorbidities did not significantly influence antibody concentration. No significant differences were found in antibody levels based on the type of COVID-19 vaccine or previous COVID-19 infection or booster dose vaccination among RA patients. The study revealed that RA patients showed a reduced antibody response following COVID-19 vaccination compared to the control group and potentially influenced by immunosuppressive treatments and disease-related factors.

Association Between Serum Chemokine Ligand 20 Levels and Disease Activity and Th1/Th2/Th17-Related Cytokine Levels in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a type of arthritis autoimmune disease characterized by systemic chronic inflammation. C-C Chemokine ligand 20 (CCL20) is the same as most chemokines with immunomodulatory and inflammatory processes. The correlation of CCL20 in RA remains unclear. This study aimed to explore the association among levels of CCL20, T helper cell (TH) subset (Th1/Th2/Th17)-related cytokine levels, and clinical indices of RA disease activity. Serum CCL20 levels were quantified by enzyme-linked immunosorbent assay, and a flow-fluorescence technique was used to assess Th1/Th2/Th17-related cytokine levels. The serum CCL20 levels in patients were significantly higher than those in healthy controls and positively associated with C-reactive protein levels, erythrocyte sedimentation rate, and disease activity score-28 (DAS28). Patients with RA were categorized into 4 major groups, including remission, low, moderate, and high disease activity, with related DAS28 scores for each group. CCL20 levels of the disease moderate/high activity group were moderately positively correlated with IL-6 levels, but not with the other Th1/Th2/Th17-related cytokines. Serum CCL20 levels correlate strongly with RA disease activity and clinical inflammation and were significantly elevated in patients compared to healthy individuals. CCL20 plays a key role in the immune response of patients with RA and is, therefore, a potential biomarker of disease activity.

Bone mass density in patients with rheumatoid qrthritis: Influence of disease activity

Rheumatoid arthritis (RA) can affect bone density. Given the significant risk of low bone mass density (BMD) in RA patients, the present study aims to investigate the BMD in these patients. The present cross-sectional study included 415 RA patients from the Rafsanjan Rheumatology Clinic. The patients were included in the study by census based on the inclusion criteria, which included a physician's diagnosis of RA according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria, at least three months of disease history, and age between of 35 and 70 years. The BMD was measured using the dual-energy x-ray absorptiometry method in both the hip and the spine, and the RA severity was determined using the disease activity score-28 (DAS-28) index. The mean age of RA patients was 56.49 ± 11.73 years, with females accounting for 86.7% (300 people). The frequency of osteoporosis was 7.5% (26 people), and osteopenia was 43.6% (151 people) based on hip bone density, and 33% (137 people) and 38.1% (158 people) based on spine density, respectively. Age, fracture history, and DAS-28 score increased the probability of developing osteopenia or osteoporosis based on hip and spine bone density. According to the findings of a study in RA patients, increasing age, history of bone fracture, and DAS-28 score increase the probability of osteopenia or osteoporosis. Therefore, it is advised to pay close attention to the mentioned factors to prevent complications in these patients.

Patient and physician assessment in difficult-to-treat rheumatoid arthritis: patterns of subjective perception at early stages of b/tsDMARD treatment

ObjectivesTo analyse the trajectories of Disease Activity Score 28 (DAS28), patient global assessment (PGA) and physician global assessment (PhGA) and to assess their predictive capabilities on difficult-to-treat rheumatoid arthritis (D2TRA)...

Moxibustion combined with western medication for rheumatoid arthritis with blood stasis obstruction and its effect on platelet activation

To investigate the clinical efficacy and action mechanism of moxibustion combined with western medication for rheumatoid arthritis (RA) with blood stasis obstruction. Fifty-six patients of RA with blood stasis obstruction were randomly divided into an observation group and a control group, with 28 patients in each group. The patients in the control group were treated with oral administration of leflunomide tablets and celecoxib capsules, while the patients in the observation group were treated with moxibustion in addition to the treatment used in the control group. Moxibustion was performed at bilateral Zusanli (ST 36), Shenshu (BL 23), Xuehai (SP 10), and ashi points, once every other day, three times a week. The treatment duration for both groups was 12 weeks. The TCM syndrome score, disease activity score-28 (DAS-28), rheumatoid factor (RF), hypersensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), hemorheological indexes (whole blood viscosity high shear, whole blood viscosity low shear, plasma viscosity), serum calcium ion (Ca2+) level, and platelet count (PLT) were observed before and after treatment, and the clinical efficacy was evaluated after treatment in the two groups. Compared with those before treatment, the TCM syndrome scores, DAS-28 scores, RF, hs-CRP, ESR, whole blood viscosity high shear, whole blood viscosity low shear, plasma viscosity, and PLT were decreased after treatment in both groups (P<0.01), with the observation group showing lower values compared with those in the control group (P<0.05). Compared with those before treatment, the serum Ca2+ levels were increased after treatment in both groups (P<0.01), and the observation group showed a higher increase than that in the control group (P<0.05). The total effective rate was 85.7% (24/28) in the observation group, which was higher than 67.9% (19/28) in the control group (P<0.05). Moxibustion combined with western medication could alleviate clinical symptoms in patients with RA of blood stasis obstruction, and its mechanism may be related to the inhibition of platelet activation.

Association of IL-17A rs2275913, IL-23R rs11209026 polymorphisms and serum level of IL-17A with rheumatoid arthritis in Egyptian patients

Several studies have reported genetic polymorphisms at the IL-23/IL-17 axis linked to rheumatoid arthritis (RA) in many populations. We aimed to investigate the association of IL-17A rs2275913 and IL-23R rs11209026 polymorphisms with susceptibility to RA and, disease clinical features and the serum level of IL-17A in Egyptian patients. This case-control study included 94 RA cases and 74 controls. TaqMan genotyping assays were used for detection of gene polymorphism and the enzyme-linked immunosorbent assay was used to quantify IL-17A serum level. There was significant difference between RA patients and controls in genotypic distribution and allelic frequency of IL-17A rs 2275913 (p &lt;0.0001). The GG genotype had 7 times higher risk for RA development (OR=7.04: 95% CI 2.11:23.46, p value= 0.001). Also, GG genotype was associated with higher level of serum IL-17 A compared to GA and AA genotypes (p&lt;0.0001). Moreover, patients carrying the GG genotype had higher disease activity score 28 (DAS28) score (4.99±0.84) compared to patients with GA (2.73±0.52, p&lt;0.0001) and patients with AA genotypes (2.67±0.41, p&lt;0.0001). Genotypic distribution of IL-23R rs11209026 was significantly different between RA patients and controls (p &lt;0.0001), but there was no difference between the allelic frequency in both groups (p=0.08). IL-23R rs11209026 SNP was not a risk for RA development. However, DAS28 was lower in AA genotype than AG and GG genotypes (p=0.002, p=0.009 respectively). The mean serum IL-17A level was higher among the RA patients (39.07±10.47 pg./ mL) compared to controls (15.23±1.88 pg/ mL; p &lt;0.0001). Also, there was a positive correlation between IL-17A serum level and DAS28 score (Spearman r = 0.42; p value &lt;0.0001). We concluded that the variant IL-17A (rs2275913) genotype could be a risk factor for RA in our population and IL-17A may play a crucial role in the development and pathogenesis of RA.

Value of tumor necrosis factor-alpha and high-sensitive cardiac troponin-I as early predictors of subclinical atherosclerosis and their relation to disease activity in patients with rheumatoid arthritis: A case-control study

Patients with rheumatoid arthritis (RA) have a higher risk of cardiovascular disease (CVD) compared to the general population, which leads to increased morbidity and mortality. Inflammation is the key in RA and CVD. Our study aimed to refine cardiovascular (CV) risk assessment in RA patients by using carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis. We also explored whether proinflammatory cytokines represented by tumor necrosis factor-alpha (TNF-α) and high-sensitivity cardiac troponin I (hs-cTnI), a biomarker of myocardial injury, could be correlated in RA patients. The study included 80 RA patients and 80 control subjects. TNF-α and hs-cTnI levels were measured. Subclinical atherosclerosis was evaluated by cIMT by means of carotid ultrasound. Disease activity score 28 (DAS28) was used to evaluate disease activity. hs-cTnI and TNF-α serum levels were higher in RA patients compared to controls (p=0.001). There was a significant difference in the median of cIMT between cases and controls (median (IQR) 0.9 (0.2) for cases, 0.7 (0.1) for controls, (p=0.001). A significant correlation was found between the level of TNF-α and hs-cTnI (p=0.002). Also, there was a significant correlation between the cIMT level and TNF-α and hs-cTnI (p=0.003 and p=0.002, respectively). Significant correlation was found between cIMT, TNF-α, and hs-cTnI in relation to the DAS28 score (p&lt;0.001, p&lt;0.001, and p=0.001, respectively). In conclusion, patients with RA are more likely to develop subclinical atherosclerosis, as reflected in increased cIMT. Higher levels of hs-cTnI in RA patients may correlate with the presence of occult cardiovascular disease. TNF-α and hs-cTnI correlations can reveal the interplay between disease activity and CVD. Thus, inflammation must be the primary target of various therapeutic approaches.

Short-Term Efficacy and Safety of Subcutaneous Tocilizumab in Rheumatoid Arthritis Patients in Pakistan: A Real-World Experience

Objective: To determine the real-world efficacy and safety of subcutaneous Tocilizumab in patients with rheumatoid arthritis.&#x0D; Study Design: Case series.&#x0D; Place and Duration of Study: Department of Rheumatology, National Hospital and Medical Centre, Lahore Pakistan, from Aug 2019 to Dec 2020.&#x0D; Methodology: In this study, 33 patients receiving subcutaneous Tocilizumab 162 mg every two weeks as monotherapy or with conventional synthetic disease modifying anti-rheumatic drugs were followed per standard study protocol. Increasing or decreasing the dosing interval was allowed according to disease activity at the discretion of the treating rheumatologist. The primary outcome was patients achieving Low Disease Activity as per Clinical Disease Activity Index (&gt;2.8-10.0) and Disease Activity Score-28(&gt;2.6-3.2). The secondary outcome was a clinically meaningful improvement in Disease Activity Score -28 (reduction of ≥1.2 units in Disease Activity Score-28 score). Adverse events were recorded at each follow-up visit.&#x0D; Results: Of the 33 patients, 25(75.8%) were biologics-naive, 9(27.2%) patients achieved the target of Low Disease Activity as per Clinical Disease Activity Index (2.9-10.0) and 8(24.2%) patients achieved Low Disease Activity as per Disease Activity Score-28(2.7-3.2). At six months, the proportion of patients achieving clinically meaningful improvement (decrease ≥1.2) in Disease Activity Score -28 was 13(54.2%). Overall, 14(42.4%) patients developed adverse events and 3(9.1%) patients discontinued Tocilizumab owing to adverse events.&#x0D; Conclusion: Tocilizumab has been seen to be an effective biologic in only one-third of patients, and it was tolerated in twothirds of the patients.Keywords: Conventional synthetic disease modifying anti-rheumatic drugs, Efficacy, Rheumatoid arthritis, Safety, Subcutaneous tocilizumab.

Endocan as an Early Predictor of Endothelial Dysfunction and Atherosclerosis in Egyptian Patients with Rheumatoid Arthritis.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. Inflammation leads to endothelial cells activation. Activated endothelial cells with increased leukocytes adhesion molecules expression, which can induce endothelial dysfunction (ED) and atherosclerosis.&#x0D; Aim: to measure the serum level of Human endothelial cell-specific molecule-1 (endocan) in patients with rheumatoid arthritis and to evaluate its relation to endothelial dysfunction and atherosclerosis.&#x0D; Materials and methods: the study included 30 consecutive RA patients, and 30 healthy control subjects. RA disease activity was measured by the DAS-28 score. Serum endocan was measured by enzyme-linked immunosorbent assay (ELISA). The collected data were statistically analyzed using SPSS program version 16.&#x0D; Results: There was a significant elevation in Endocan level in RA patients (1.81 ± 0.66 ng/ml) compared to control group (1.41 ± 0.59ng/ml) (P= 0.012). Serum endocan levels showed significant positive correlation with disease activity score-28(DAS-28), ESR, CRP, LDL and carotid intima media thickness (cIMT) (P = 0.015, 0.004, &lt;0.001, 0.008, 0.005 respectively). Linear regression analysis revealed that the serum endocan level, age and disease activity were independent predictors for cIMT, and atherosclerosis development in RA patients. &#x0D; Conclusion: Endocan is a useful marker to predict endothelial dysfunction and atherosclerosis in patients with rheumatoid arthritis.

Relationship Between Protein Tyrosine Phosphatase Non-Receptor Type 22 1858&gt;C Gene Polymorphism with Rheumatoid Arthritis Disease Activity Score-28

Background: Rheumatoid arthritis (RA) is one of the systemic inflammatory autoimmune diseases. A number of previous studies showed the potency of Protein Tyrosine Phosphatase Non-Receptor Type 22 (PTPN22) 1858c&gt;T gene polymorphism with the incidence of rheumatoid arthritis. Objective: To know the relationship of PTPN22 1858C&gt;T gene polymorphism with disease activity score-28 (DAS-28) in rheumatoid arthritis patients at H. Adam Hospital Medan. Method: 69 rheumatoid arthritis patients were conducted in this study by consecutive sampling who were treated at H. Adam Malik General Hospital, Medan from February-August 2022. The PTPN22 gene polymorphism was genotyped using polymerase chain reaction. Results: Majority of the subject in the study was female, around 65 people (94.2%). The mean age of the subjects was 42.35 ± 12.28 years old. The most ethnic group was Batak with 34 people (49.3%). Mean DAS-28 score was 3.45 ± 0.79. All CC genotypes and C alleles were found in 69 (100%) subjects. Statistical analysis found no correlation between PTPN22 1858C&gt;T gene polymorphism and DAS-28 score with p value &lt;1.0 Conclusion: PTPN22 1858C&gt;T gene polymorphism has no significant relationship DAS-28 in rheumatoid arthritis. Keywords: PTPN22 1858C&gt;T gene polymorphism, Disease Activity Index-28, rheumatoid arthritis

Factors Leading to Diagnostic and Therapeutic Delay of Rheumatoid Arthritis and Their Impact on Disease Outcome.

Objective To identify the factors which leadto delay in diagnosis and initiation of disease-modifying anti-rheumatic drugs (DMARDs) inrheumatoid arthritis (RA) patients and their impact on disease outcome and functional ability. Methodology This cross-sectional study was conducted from June 2021 to May 2022 at the Department of Rheumatology and Immunology, Sheikh Zayed Hospital, Lahore. Inclusion criteria were patients aged >18 years who were diagnosed with RA, based on American College of Rheumatology (ACR) criteria 2010. Delay was defined as any sort of delay which leads to delay in diagnosis or initiation of treatment of more than three months. The factors and impact on disease outcome were measured by using Disease Activity Score-28 (DAS-28) for disease activity and Health Assessment Questionnaire-Disability Index (HAQ-DI) for functional disability. The collected data were analyzed with Statistical Package for Social Sciences (SPSS) version 24 (IBM Corp., Armonk, NY, USA). Results One hundred and twenty patients were included in the study. Mean delay in referral to a rheumatologist was 36.75±61.07 weeks. Fifty-eight (48.3%) patients with RA were misdiagnosed before presentation to a rheumatologist. Sixty-six(55%) patients had the perception that RA is a non-treatable disease. Delay in diagnosis of RA from onset of symptoms (lag 3) and delay in start of DMARDs fromonset of symptoms (lag 4) were significantly associated with increased DAS-28 and HAQ-DI scores (p-value 0.001). Conclusion The factors which led to diagnostic and therapeutic delay were delayed consultation with a rheumatologist, old age, low education status and low socioeconomic status. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies had no role in diagnostic and therapeutic delay. Many RA patients were misdiagnosed with gouty arthritis and undifferentiated arthritis before consulting a rheumatologist. This diagnostic and therapeutic delay compromises RA management leading to high DAS-28 and HAQ-DI in RA patients.

Association of New Generation Anti-CCP Antibodies with Disease Severity and Functional Status in Rheumatoid Arthritis Patients

Introduction: Detection of anti-cyclic citrullinated peptide (anti-CCP) antibodies in patients with rheumatoid arthritis (RA) is associated with higher disease activity and lower functional ability. This study investigated the presence of the new generation of anti-CCP antibodies (anti-CCP2 IgG, anti-CCP2 IgA and anti-CCP3.1 IgG/IgA) and their association with disease severity and functional status of RA patients. Methods: A total of 46 RA patients and 40 healthy controls participated in this cross-sectional study that was conducted at the Rheumatology Clinic, Hospital Universiti Sains Malaysia. Blood samples were taken from all participants for anti-CCP2 IgG, anti-CCP2 IgA, and anti-CCP3.1 IgG/IgA analysis. Disease severity and functional status of RA patients were measured using the Disease Activity Score-28 (DAS28) and the modified Health Assessment Questionnaire (mHAQ) respectively. Results: Significantly higher proportion of RA patients were found with positive anti-CCP2 IgG (63.0%), anti-CCP2 IgA (37.0%), and anti-CCP3.1 IgG/IgA antibodies (63.0%) than the healthy controls. No significant association was found between anti-CCP antibodies status and mean DAS28 score of the RA patients. However, RA patients with negative anti-CCP2 IgG status had higher mean mHAQ score than patients with positive anti-CCP2 IgG status. Conclusion: Our study has demonstrated detection of the new generation anti-CCP antibodies in RA patients, supporting the use of autoantibodies in RA diagnosis. While no significant association was found between the presence of anti-CCP antibodies and disease severity of RA patients, the absence of anti-CCP2 IgG was associated with worse function and greater disability of the patients.

Clinical evaluation of Vyoshadi Guggulu and Panchasama Churna in the management of rheumatoid arthritis: An open-label, single-arm, prospective study

Abstract BACKGROUND: Rheumatoid arthritis (RA) is a chronic, degenerative disease of the connective tissue, mainly involving the synovial joints, characterized by swelling, pain, and tenderness in multiple joints, associated with morning stiffness, fever, and weakness. RA treatment aims to reduce patients’ clinical symptoms, reduce or prevent joint damage, prevent progression, and improve quality of life. Due to complex RA pathogenesis, multiple interventions are usually required to control the symptoms. Ayurveda offers a wide range of therapeutic interventions that have a potential role in RA. The present study was planned to explore the role of Ayurveda interventions, Vyoshadi Guggulu (VG) and Panchasama Churna (PC), in managing RA. MATERIALS AND METHODS: An open-label, single-arm, prospective clinical study was conducted at Central Ayurveda Research Institute, Bhubaneswar, on 90 trial participants between the ages of 20 and 60 years having the clinical symptoms of RA according to the American College of Rheumatology. The trial drugs, viz., VG 1.5 g (3 tablets of 500 mg each) and PC 3 g, twice daily (in the morning and night after food) with lukewarm water, were administered for 84 days. Paired sample t test was used to compare the mean change in the subjective and objective parameters from baseline day to 84th day. The primary outcome measure was Disease Activity Score-28 (DAS-28), and the secondary outcome measures were Disability Index Score (The Indian Health Assessment Questionnaire), change in acute phase reactants—erythrocyte sedimentation rate (ESR), C-reactive protein, and change in Health Questionnaire short form (SF)-36 score. RESULTS AND DISCUSSION: Data from a total of 89 participants were subjected to statistical analysis, and significant change (P value &lt; 0.001) was observed in the DAS-28 score, Disability Index Score, ESR scoring, and in all the domains of SF-36 Health Survey from baseline day to 84th day. The laboratory assessment parameters, such as liver function test, renal function test, and complete blood count, were within the reference range during the entire study duration, indicating that the interventions VG and PC were safe for the given dose and duration of consumption. CONCLUSION: Based on relief observed in the Ayurveda and modern clinical parameters, DAS-28 score, ESR, and Disability Index Score, it is concluded that VG and PC are effective in the management of RA and were found safe in the given dose and duration of consumption.

Evaluation of Depression and Anxiety in Rheumatoid Arthritis Patients During COVID-19 Pandemic.

Rheumatoid arthritis (RA) disease activity, associated comorbidities, and therapy-related side effects impair the physical, social, and emotional dimensions of the patient's health. Presently, the ongoing COVID-19 pandemic has been associated with a broad range of psychosocial disorders in various populations. Patients with RA are especially vulnerable to such effects. Detect the prevalence of recent COVID-19 infection among patients with RA, assess depression and anxiety in these patients and their associated factors during the COVID-19 pandemic and their potential relation to disease activity. This is a cross-sectional study conducted on 120 adult Egyptian patients diagnosed with RA during the COVID-19 pandemic. The prevalence of recent COVID-19 infection among the patients was evaluated. The patients underwent psychological assessment using the Hamilton Depression Rating Scale (Ham-D) and the Hamilton Anxiety Rating Scale (Ham-A) to measure levels of depression and anxiety levels. The RA disease activity was assessed using Disease Activity Score (DAS) Das-28-ESR. This study encompasses a total of 120 RA patients. The prevalence of patients with a recent history of COVID-19 infection was 40.8%. Both groups exhibited significantly elevated mean scores on the Das-28-ESR scale and also scored higher on measures of depression and anxiety. Interestingly, the COVID-19 group exhibited a higher percentage of unmarried individuals, had educational attainment below the university level, and were unemployed. Patients with recent COVID-19 had significantly lower numbers of children, higher disease duration, higher Das-28-ESR scores, and elevated depression and anxiety scores. The statistical analysis revealed that the COVID-19 infection and disease duration were significant predictors of depression and anxiety. The results also exhibited that the depression score was positively correlated with age and DAS scores. It was observed that patients diagnosed with RA revealed a higher prevalence of COVID-19 infection. The occurrence of depression and anxiety was observed to be widespread among patients diagnosed with RA and, more significantly, prevalent in RA patients who had a recent COVID-19 and had a higher level of disease activity. The occurrence of COVID-19 and disease duration were identified as factors that can anticipate the development of depression and anxiety.

Late-onset rheumatoid arthritis has a similar time to remission as younger-onset rheumatoid arthritis: results from the Ontario Best Practices Research Initiative

BackgroundThe prevalence of rheumatoid arthritis (RA) in persons 60 years or older is estimated to be 2%. Late-onset rheumatoid arthritis (LORA) is traditionally defined as the onset of RA after the age of 60 years. Compared to younger-onset rheumatoid arthritis (YORA) which occurs before the age of 60 years, LORA has unique characteristics and disease manifestations. To date, few reports have addressed LORA and the prognosis of LORA patients remains unclear. We compared the clinical characteristics, time to remission and treatment regimen at remission between LORA and YORA patients.MethodsThis prospective cohort study used a registry database in Ontario, Canada from 2008 to 2020. Patients were included if they had active rheumatoid arthritis (RA) disease (≥1 swollen joint) and were enrolled within 1 year of diagnosis. LORA was defined as a diagnosis of RA in persons 60 years and older and YORA as a diagnosis of RA in persons under the age of 60. Remission was defined by Disease Activity Score 28 (DAS28) ≤2.6. A multivariable Cox proportional hazards model was used to estimate time to remission.ResultsThe study included 354 LORA patients and 518 YORA patients. The mean (standard deviation) baseline DAS28 score was 5.0 (1.3) and 4.8 (1.2) in LORA and YORA patients, respectively (p=0.0946). Compared to YORA patients, the hazard ratio for remission in LORA patients was 1.10 (95% confidence interval 0.90 to 1.34 p=0.36) after adjusting for other prognostic factors. For patients who reached remission, LORA patients were less likely to be on a biologic or Janus kinase (JAK) inhibitor (16% vs. 27%) and more likely to be on a single conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) (34% vs. 27%) than YORA patients (p=0.0039).ConclusionLORA and YORA patients had similar prognosis in terms of time to remission. At remission, LORA patients were more likely to be on a single csDMARD without a biologic or JAK inhibitor.

An investigation of coronaphobia and physical activity among patients with rheumatoid arthritis.

This study aims to investigate coronaphobia and physical activity levels in patients with rheumatoid arthritis (RA). Between December 2021 and February 2022, a total of 68 RA patients (11 males, 57 females; mean age: 48.3±10.1 years; range, 29 to 78 years) and 64 age- and sex-matched healthy individuals (4 males, 60 females; mean age: 47.9±10.2 years; range, 23 to 70 years) were included in this cross-sectional study. Demographic, physical, lifestyle, and medical characteristics of all participants were recorded. The COVID-19 Phobia Scale (C19PS) and the International Physical Activity Questionnaire-Short Form (IPAQ-SF) were administered to all participants. The RA patients were divided into two groups as: patients treated with biological and non-biological agents. The Disease Activity Score-28 (DAS28) and Clinical Disease Activity Index (CDAI) were used to measure disease activity. The total and subgroup scores of the C19P-S were found to be statistically significantly higher in both the biological and non-biological RA groups than in the control group (p=0.001). However, there was no statistically significant difference between the RA groups in terms of total and subgroup C19P-S scores. The mean IPAQ score was significantly lower in the RA group using biological drugs than in the control group (p=0.002). A significant correlation was found between DAS28 and total C19P-S scores (r:0.63, p<0.05), and CDAI and total C19P-S scores (r:0.79, p<0.05). Patients with RA have an increased risk of coronaphobia and disease activity is correlated with coronaphobia. Patients treated with biological agents seem to have lower activity levels compared to other RA patients and healthy controls. These results should be considered in the management of RA during COVID-19 pandemic and preventive intervention strategies should be formulated to cope with coronaphobia.

Association between dietary inflammatory index scores and the increased disease activity of rheumatoid arthritis: a cross-sectional study

BackgroundDiet plays an important role in regulating inflammation, which is a hallmark of rheumatoid arthritis (RA). Our aim was to investigate the association between the Dietary Inflammatory Index (DII) scores and RA activity.MethodsThis cross-sectional study was conducted on 184 patients with RA in rheumatology clinic in Kermanshah city, Iran, in 2020. RA was diagnosed according to the criteria of the 2010 American College of Rheumatology/ European League against Rheumatism. The overall inflammatory potential of the diet was extracted from a validated 168-item food frequency questioner (FFQ) using the DII. RA disease activity was assessed using Disease Activity Score 28 (DAS-28) scores. Logistic regression and one-way ANOVA/ ANCOVA were conducted.ResultsIndividuals in the highest DII quartile had the significantly higher odds of positive C-reactive protein than those in the lowest quartile of the DII scores (OR 4.5, 95% CI 1.16 – 17.41, P = 0.029). A statistically significant downward linear trend in fat-free mass and weight were observed with increasing the DII quartiles (P = 0.003, P = 0.019, respectively). Patients in the highest DII quartile had higher DAS-28 scores than those in the first quartile (Mean difference: 1.16, 95% CI 0.51 – 1.81, P < 0.001) and second quartile of the DII scores (Mean difference: 1.0, 95% CI 0.34 – 1.65, P < 0.001).ConclusionOur results indicated that reducing inflammation through diet might be one of the therapeutic strategies to control and reduce the disease activity in RA patients.