Rheumatoid Arthritis Duration Research Articles

Cardiovascular Risk Factors and Disease in Patients with Rheumatoid Arthritis

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the synovial joints, leading to progressive joint damage, deformities, and functional disability. Objective: The basic aim of this technical report is to find the cardiovascular risk factors and disease in patients with rheumatoid arthritis. Methodology: This cross-sectional study was conducted at Shalamar Hospital, Lahore, from 01 May 2024 to 31 October 2024. A total of 145 patients were included in the study. Patients were recruited from a rheumatology clinic over 6 months. Results: Data include 145 patients with a mean age of 52.4 ± 12.1 years, and a majority were female (76.6%). The average duration of RA was 8.3 ± 5.4 years. Most patients had a BMI of 27.4 ± 4.2 kg/m², indicating a high proportion of overweight individuals. A significant percentage of patients had cardiovascular risk factors: 62.1% had hypertension, 78.6% had dyslipidemia, and 34.5% had diabetes or insulin resistance. Additionally, 29.7% reported a family history of cardiovascular disease. Systolic and diastolic blood pressure (BP) levels were highest in the high disease activity group, with systolic BP increasing from 135.5 ± 15.2 mmHg in the low activity group to 152.2 ± 19.4 mmHg in the high activity group (p < 0.01), and diastolic BP also rising from 85.4 ± 9.2 mmHg to 93.2 ± 12.3 mmHg (p < 0.05). LDL cholesterol levels were significantly higher in patients with high disease activity (157.3 ± 47.8 mg/dL) compared to those with low disease activity (138.9 ± 39.8 mg/dL, p = 0.04). Conclusion: It is concluded that rheumatoid arthritis (RA) significantly increases the risk of cardiovascular disease, with a high prevalence of hypertension, dyslipidemia, and insulin resistance among RA patients.

Evaluating the Role of Disease Duration in Fatigue and Quality of Life Among Rheumatoid Arthritis Patients

Objective: The duration of a disease plays a critical role in understanding its progression and impact on an individual's quality of life and symptom severity. The aim was to investigate the impact of disease duration on fatigue and quality of life in patients with rheumatoid arthritis (RA). Material and Methods: The study analyzed 92 (female:71, male:21) patients with RA. Clinical and demographic characteristics of patients were recorded. Disease activity (Disease Activity Score in 28 joints with CRP (DAS28-CRP)), fatigue (Bristol Rheumatoid Arthritis Fatigue-Multidimensional Questionnaire (BRAF-MDQ)), and quality of life (Short Form-36 questionnaire (SF-36)) were evaluated in the study. RA patients were categorized into two groups based on the disease duration: duration of the disease 10 years. Results: Significant differences were demonstrated in SF-36 subdomains of pain (p=0.022), general health (p=0.028), and health change (p=0.020). However, BRAF-MDQ scores and its subdomains showed no significant differences across groups. Conclusion: While the duration of RA significantly affects certain aspects of quality of life such as pain and general health, it does not appear to influence fatigue levels. This highlights the persistent and debilitating nature of fatigue in RA patients regardless of disease duration, emphasizing the need for targeted interventions to address this symptom.

Spectrum of Thyroid Disorders in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory arthritis involving 0.5-1% of the global population. Coexistence of RA and thyroid dysfunction is now increasingly being recognized. This is due to the shared factors involved in the pathogenesis of RA and autoimmune thyroid disease. Thyroid disorder is an important amplifier of disease activity, thereby impairing the quality of life. To study the prevalence and pattern of thyroid dysfunction in RA patients, to compare the disease activity among RA patients with thyroid dysfunction and those without thyroid dysfunction, and to study the possible association between severe RA and thyroid dysfunction. A hospital-based analytical cross-sectional study was done in 165 RA patients attending the General Medicine and Rheumatology outpatient facilities of the Department of General Medicine, Government Medical College, Kozhikode, from January to December 2019. Study subjects were selected based on the inclusion and exclusion criteria. Relevant investigations were done, which included serum thyroid stimulating hormone (TSH), free thyroxine (free T4), free triiodothyronine (free T3), and anti-thyroid peroxidase antibody (anti-TPO) antibody levels. Data were analyzed using MS Excel and Statistical Package for the Social Sciences (SPSS) software. The prevalence and pattern of thyroid disorders in RA patients were assessed. The association of thyroid dysfunction with disease activity was tested. The prevalence of thyroid dysfunction among RA patients was 38.2%. The most common thyroid disorder observed was subclinical hypothyroidism, which was seen in 33.3% (55) of the study population, followed by overt hypothyroidism in 3.6% (6) of patients. Both subclinical hyperthyroidism and clinical hyperthyroidism were found in only 0.6% of RA patients. There was a significant difference in mean age between RA patients with thyroid dysfunction and euthyroid patients (p-value = 0.001). No significant association was found between the duration of RA and thyroid dysfunction (p-value = 0.253). RA patients with thyroid dysfunction had elevated inflammatory markers compared to those with normal thyroid function. The prevalence of autoimmune thyroid disorder in RA patients is 24.8%. There was a significant association between disease activity and thyroid dysfunction (p-value = 0.001). Patients with thyroid disorders had severe disease compared to euthyroid patients. A significant positive correlation was noted between serum TSH and Disease Activity Score-28 (DAS-28) (Pearson coefficient = 0.768, p-value = 0.000), and between anti-TPO antibody and DAS-28 (Pearson coefficient = 0.794, p-value = 0.000). Thyroid dysfunction is prevalent in 38.2% of RA patients, with subclinical hypothyroidism being the most common thyroid disorder encountered. RA patients with thyroid dysfunction had higher disease activity than euthyroid patients. Hence, thyroid function tests should be a routine investigation in all RA patients, and if found abnormal, they should be treated appropriately.

Association of Rheumatoid Arthritis With Progression of Cognitive Impairment and Risk of Mortality in People With Dementia.

Rheumatoid arthritis (RA) has been linked to an increased risk of dementia, yet little is known about how RA affects the progression of cognitive impairment and the risk of mortality in people with dementia. We aimed to investigate whether RA is linked to an accelerated cognitive decline and a higher risk of all-cause mortality in patients with dementia. We conducted a propensity score-matched register-based cohort study based on the Swedish Registry for Cognitive/Dementia Disorders-SveDem. Patients diagnosed with dementia and registered in SveDem between May 1, 2007, and October 16, 2018, were included. The main outcome for the study was cognitive decline, measured by Mini-Mental State Examination (MMSE) score changes over years. The secondary outcome was all-cause death. We used mixed-effects models to examine the association between RA and cognitive decline, and Cox proportional hazards models to investigate the risk of all-cause mortality. We also conducted subgroup analyses to explore the potential effects of sociodemographic, baseline MMSE, comorbidities, and the use of dementia medications on the association between RA and outcomes. We included 1,685 dementia patients with RA (mean [SD] age, 79.9 [6.7] years; 73.4% were women) and 5,055 dementia patients with non-RA (80.1 [7.5] years; 73.1% were women). The median follow-up was 2.9 years (interquartile range, 1.5-4.6 years) for non-RA and 2.6 years (interquartile range, 1.4-4.2 years) for RA. In total, 111,266 MMSE measurements were available for analysis. Compared with non-RA patients, patients with RA presented faster cognitive decline (β = -0.24 points/y; 95% CI -0.38 to -0.10) and an increased risk of death (hazard ratio 1.15; 95% CI 1.06-1.24). In subgroup analysis, significant interactions were observed between RA and baseline MMSE scores as well as living conditions regarding cognitive decline (p for interaction <0.05). We identified a worse cognitive function and an increased mortality risk in dementia patients with RA compared with non-RA. However, we lacked information on the duration of RA before the onset of dementia and on disease activity, which could influence our findings. Further studies are needed to validate these results in comparable populations.

Correlates of oral health-related quality of life in a sample of patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is a prevalent chronic inflammatory joint disease that might exert significant effects on oral health-related quality of life (OHRQoL). This study aimed to investigate OHRQoL in patients with RA.MethodsThis descriptive-analytical study involved 228 RA patients visiting the Jundishapur Dentistry School, Ahvaz, and dental clinics in Ahvaz, south west of Iran, in 2023. Data collection instruments included a demographic and clinical characteristics form, the Oral Health Impact Profile-14 (OHIP-14), the Health Assessment Questionnaire-Disability Index (HAQ-DI), the General Health Questionnaire (GHQ), and clinical oral examinations. The collected data were analyzed using Spearman’s correlation test and linear regression analysis in SPSS version 22.ResultsThe mean age of the participants was 49.23 ± 10.83 years, and the majority were females. The DMFT index was 14.44 ± 6.63, the mean OHRQoL score was 24.72 ± 5.33, the mean general health score was 5.71 ± 2.21, and the mean disability severity score was 11.62 ± 62.11. Of all variables examined, gender, age, duration of RA, Khuzestan nativity status, smoking, anemia, hyperlipidemia, DMFT index, general health, disability, diabetes, acute kidney disease, and hypertension were significantly associated with OHRQoL(p > 0.05).ConclusionThe findings of this study indicate that OHRQoL is compromised in patients with RA. It is recommended that oral health receive greater attention from healthcare professionals managing RA patients and should be taken into account in daily practice of clinicians. Clinicians should develop multi-faceted care including oral health, dental health, general health and quality of life in addition to medical care for RA.

Risk factors for interstitial lung disease in early rheumatoid arthritis and external validation of screening strategies: Baseline results of SAIL-RA.

Risk factors and screening strategies for rheumatoid arthritis-associated interstitial lung disease (RA-ILD) have received limited evaluation in patients with early RA. We investigated RA-ILD prevalence, risk factors, and the performance of proposed RA-ILD screening methodologies in a multicenter, prospective study of patients with early RA. Participants with early RA, defined as being within two years of RA diagnosis, were enrolled at five US sites and assessed with high-resolution computed tomography (HRCT) chest imaging, pulmonary function tests, and autoantibodies. RA-ILD presence was determined through independent HRCT review by thoracic radiologists. We investigated RA-ILD risk factors using multivariable logistic regression and reported the predictive performance of RA-ILD screening strategies (ANCHOR-RA, 2023 ACR/CHEST, Four Factor Score, and ESPOIR). Among 172 participants (74% female, 82% seropositive, median RA duration 0.79 years, mean age 55.3 years), 19 (11%) had ILD on HRCT. Moderate/high RA disease activity by DAS28ESR (OR 7.00 [1.95, 25.1]) and age ≥60 years (OR 3.87 [1.33, 11.3]) were associated with RA-ILD. Sensitivity and specificity of screening strategies ranged from 0.32-0.95 and 0.32-0.81, respectively. The number of early RA patients needing screening to detect one ILD case ranged from 3.6 to 6.4. In this prospective, multicenter study, ILD prevalence in early RA was 11%. Disease activity and older age were strongly associated with ILD in early RA, and several proposed ILD screening strategies performed showed promise for enabling ILD screening in early RA.

Exploring Anticitrullinated Antibodies (ACPAs) and Serum-Derived Exosomes Cargoes.

Autoantibodies such as rheumatoid factor (RF) and anticitrullinated protein autoantibodies (ACPAs) are useful tools for rheumatoid arthritis (RA). The presence of ACPAs against citrullinated proteins (CPs), especially citrullinated fibrinogen (cFBG), seems to be a useful serological marker for diagnosing RA. RA patients' sera were found to be enriched in exosomes that can transmit many proteins. Exosomes have been found to express citrullinated protein such as cFBG. We conducted this study in two stages. In the first phase, we aimed to evaluate the association between autoantibodies and risk factors. In the next step, ACPA-positive serum samples from the first phase were subjected to exosomal studies to explore the presence of cFBG, which is a frequent target for ACPAs. We investigated the autoantibodies in one hundred and sixteen Saudi RA patients and correlated with host-related risk factors. Exosomes were extracted from patients' sera and examined for the presence of cFBG using monoclonal antibodies. The study reported a high female-to-male ratio of 8:1, and seropositive RA (SPRA) was more frequent among included RA patients. The frequency and the levels of ACPAs were similar in both genders. Autoantibodies incidences have a direct correlations with patient age, while the average titers decreased as the age increased. Further, the highest incidence and levels of autoantibodies were reported in patients with RA duration between 5 and 10 years. Smoking and family history have no impact on autoantibody, except for ACPAs titers among smokers' RA. Our analysis of serum exosomes revealed that about 50% of SPRA patients expressed cFBG. The female-to-male ratio is 8:1, which is higher than the global ratio. We can conclude that patients' age and disease duration contribute to the autoantibodies, particularly RF and anti-MCV, whereas smoking and family history had no effects on autoantibodies. We detected cFBG in all exosomes from SPRA patients; thus, we suggest that the precise mechanism of exosomes in RA pathogenesis can be investigated to develop effective treatment strategies.

Prevalence and Complications of Metabolic Syndrome among Rheumatoid Arthritis Patients in Aswan

Objectivity: Rheumatoid Arthritis (RA) is the most common inflammatory rheumatic disease. Prevalence of metabolic syndrome (MetS) varies widely in the literature. We conducted this study to detect the prevalence and complications of metabolic syndrome among RA patients and its association to disease activity and chronicity. Methods: This Cross-sectional study was conducted between January 2023 and December 2023, included 200 patients who were diagnosed as RA. Data collected from the eligible patients included full medical history and investigations included complete blood count, lipid profile, fasting blood glucose (FBG), uric acid, urea, creatinine, Alanine Aminotransferase, Aspartate aminotransferase, alkaline phosphates, electrocardiography and echocardiography. Patients were allocated to four groups (50 for each group) based on RA disease activity and duration. Group 1: acute active RA patients, Group 2: acute inactive RA patients, Group 3: chronic active RA patients and Group 4: chronic inactive RA patients. Results: The present study was conducted on 200 patients with RA; the majority of them were females (152). The patient’s mean age was 47±11 years, the mean± SD of their waist circumference was 101.6± 13.96. MetS prevalence in RA patients was 52% (104 patients), with a higher occurrence in chronic RA cases (30%) compared to acute RA (22%). Our study demonstrates a significant difference in MetS prevalence among the four groups. Conclusions: MetS prevalence among RA patients is associated with disease activity and duration. Hyperuricemia, increased liver enzymes and renal chemistry are the most prevalent factors linked to MetS in RA.

Morning Stiffness Correlates with Disease Activity, Blood Pressure and Cholesterol Levels in Patients with Seropositive Rheumatoid Arthritis

Introduction. Morning stiffness (MS) is the hallmark of rheumatoid arthritis (RA) and it has important implications on daily life of the patients. There are conflicting reports of its association with disease activity. Methods. This observational study included 125 patients with seropositive RA from Health Care Center, Visoko. We obtained data on patient’s gender and age, duration of RA, pain in hands and feet, MS and its duration, hospital admission, blood pressure, laboratory values and treatment modalities. Results. MS lasted up to 30 minutes in 71 (56.8%) patients, 30 to 60 minutes in 40 (32%) patients, and more than 60 minutes in 14 (11.2%) patients. There was no difference in the duration of MS between genders. Patients with longer MS were younger and had a longer duration of illness. Patients with MS longer than 30 minutes had higher blood pressure and cholesterol levels. ESR in the second hour and CRP correlated with a duration of MS. Patients on methotrexate had a longer duration of MS. No significant differences in the duration of MS were observed for leflunomide, corticosteroids and supportive treatment modalities. Conclusion. Duration of MS correlates with RA disease activity and remains an important burden for patients. Usage of newer treatment options, such as biologic disease-modifying antirheumatic drugs (DMARDs), may be required. Keywords: biomarkers, disease activity, rheumatoid arthritis.

Fractures of vertebrae and peripheral bones in patients with rheumatoid arthritis (based on long-term observation)

Introduction. In rheumatoid arthritis (RA), fractures occur on average 2–3 times more often than in the general population. Data on the incidence of vertebral fractures in RA is controversial and depends on the detection method. Aim. To determine the incidence of vertebral and peripheral bone fractures in patients with RA during long-term prospective follow-up. Materials and methods. A prospective multi-year cohort non-interventional study included 120 women with RA (mean age at enrollment 54.3±8.9 years), with a follow-up of 9.5±1.9 years. Initially and then repeatedly, a clinical, laboratory and radiological examination was performed: X-ray morphometry of the spine according to the Genant method, X-ray densitometry of the lumbar spine (LI-LIV) and femoral neck. Results. During the follow-up period, there were 104 low-energy fractures in 64 (53%) patients: 69 (66%) vertebral fractures and 35 (34%) peripheral fractures. Two or more fractures occurred in 25 (39%) subjects. In 30 (25%) patients, 52 fractures occurred repeatedly. Among peripheral fractures, the most frequent localization was fractures of the distal forearm and lower leg bones. Patients with fractures during the follow-up period were also more likely to have fractures before enrollment in the study, had an initially longer duration of RA, a mean daily dose, cumulative dose, and duration of glucocorticoid administration, and a lower bone mineral density in the main parts of the skeleton, determined by densitometry. There was no effect of RA activity on DAS-28, rheumatoid factor positivity, or antibodies to cyclic citrullinated peptide on fractures. Conclusion. More than half of the patients had low-energy fractures during the observation period, the most common being fractures of the vertebrae, distal forearm, and lower leg bones; a high frequency of repeated fractures was reported. The analysis of risk factors showed that a long duration of RA, a mean daily dose, cumulative dose, and prolonged use of glucocorticoids, a history of low-energy fractures, and low bone mineral density were associated with the occurrence of fractures in patients with RA.

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.

Prevalence of dry eye disease in rheumatoid arthritis patients and its correlation with duration of rheumatoid arthritis

Abstract Background: Dry eye is a condition of the tear film and ocular surface that causes discomfort, visual disturbance, and tear film instability. The subjective symptoms in dry eye disease (DED) are often nonspecific. More or less common are conjunctival redness and damage to the ocular surface with punctate epithelial erosions. Rheumatoid arthritis (RA) is a systemic autoimmune disease with approximately 25% of patients having ocular manifestations. Methodology: A prospective observational study was carried out in the ophthalmology outpatient department of a tertiary care center. There were 200 RA patients enrolled. Dry eye workup was done using various tests and the Ocular Surface Disease Index questionnaire. RA patients were divided on the basis of duration of illness into two groups. The results of dry eye tests were compared between these two groups. Results: Out of 200 RA patients, 89% were females. The overall prevalence of dry eye was 52.5% according to Schirmer’s test without anesthesia. There were 112 patients who were suffering from RA for &lt;5 years and another group of 88 patients who were suffering for ≥5 years. Schirmer’s test and corneal fluorescein staining suggested that the patients with longer duration of RA are more prone to DED. Conclusion: The prevalence of dry eyes in patients with RA is high. Chronic ocular surface changes were observed with the longer duration of RA disease activity which affects the quality of life in such patients.

Real-Life Use of Filgotinib in Rheumatoid Arthritis: A Retrospective Cohort Study.

Background: Janus kinase inhibitors (JAKis) are a novel class of drugs interfering with intracellular signaling of type I and type II cytokines, which play a crucial role in immune dysregulation associated with several chronic inflammatory diseases. Filgotinib (FIL), in particular, is the newest member of the JAKi class and exerts its therapeutic effects by selectively targeting and inhibiting the kinase activity of JAK1. While the efficacy of FIL in rheumatoid arthritis (RA) has been confirmed in clinical trials, real-world evidence may provide better insights into its effectiveness and safety in routine clinical practice. Methods: We performed a multicenter, retrospective cohort study investigating the real-life effectiveness and safety of FIL in adult patients with RA. Demographic information, disease characteristics, prior treatment history, and comorbid conditions were retrieved from clinical records at baseline (M0) and after 3 (M3) and 6 months (M6) of treatment. Results: A total of 82 patients (63 women) agreed to participate in the study, of whom 39 (47.6%) were older than 65 years. The average RA duration was 13 ± 9 years; 19 patients (23.1%) were current or former smokers, and 4 patients (4.9%) had a history of cardiovascular events. Most patients had previously received at least one biologic disease-modifying antirheumatic drug (range: 1-6+); in addition, 11 patients (13.4%) had been already exposed to another JAKi. During the follow-up, 7 patients discontinued treatment due to primary failure (n = 3) or adverse events (n = 4). Significant reductions in pain and number of tender and swollen joints were observed at M3 and M6. A relevant proportion of patients achieved DAS28-CRP remission at M3 and M6 (46.3% and 66.2%, respectively). Conclusions: Our data provide additional insight into the effectiveness of filgotinib in a real-world setting, even among patients with difficult-to-treat RA and a high prevalence of cardiovascular risk factors.

Risk Attribute Analysis and Risk of Adherence to Taking Medication for Pulmonary TB Patients at the Jayapura Regency Office

This study aims to analyze the Risk Attributes and risks of medication adherence in patients with pulmonary TB. Type of survey research designed by cross sectional. A sample of 81 people was taken using the purposive sampling technique. The results of the study were with the variable value of RA = -21%, RP=1(0.19-5.9), gender RA=18%, PR 1.7(0.9-3.3), education RA=-16%, PR =0.57. Work RA = 19%, RP = 2.12 (0.72-6.22). TB MDR RA =62%, RP=16 (5.2-48.4). Side effects of RA Drug = 30%, PR = 2.5 (1.2-4.88), History of Comorbidities RA = 61%, PR = 3.6(2.02-6.6), duration of treatment RA = 50% PR = 3.8 (2-7). The variable that contributes the most to medication adherence is MDR TB status.

Risk Attribute Analysis and Risk of Adherence to Taking Medication for Pulmonary TB Patients at the Jayapura Regency Office

This study aims to analyze the Risk Attributes and risks of medication adherence in patients with pulmonary TB. Type of survey research designed by cross sectional. A sample of 81 people was taken using the purposive sampling technique. The results of the study were with the variable value of RA = -21%, RP=1(0.19-5.9), gender RA=18%, PR 1.7(0.9-3.3), education RA=-16%, PR =0.57. Work RA = 19%, RP = 2.12 (0.72-6.22). TB MDR RA =62%, RP=16 (5.2-48.4). Side effects of RA Drug = 30%, PR = 2.5 (1.2-4.88), History of Comorbidities RA = 61%, PR = 3.6(2.02-6.6), duration of treatment RA = 50% PR = 3.8 (2-7). The variable that contributes the most to medication adherence is MDR TB status.

Analysis of periodontal status in Polish patients with rheumatoid arthritis treated with biological therapies.

Periodontitis, characterized by inflammation affecting the tooth-supporting tissues, may increase the risk of rheumatoid arthritis (RA) or cardiovascular diseases. The aim of the study was to evaluate the periodontal status in RA patients and its impact on the inflammatory markers and red cell parameters obtained from complete blood laboratory tests to study the risk of cardiovascular disease development. The cross-sectional study included 50 patients with RA treated with biological therapies: tumor necrosis factor inhibitors, interleukin-6 blockers. Rheumatoid arthritis disease activity was assessed with Disease Activity Score with 28-joint count (DAS28). The periodontal indices modified Approximal Periodontal Index, modified Papillary Bleeding Index, and Periodontal Screening Index (PSI) were used to assess patients' periodontal status. Serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used as inflammatory markers and a potential cardiovascular risk factor. No statistically significant correlation was found between the periodontal status and RA activity. However, a statistically significant correlation was found between the CRP results and the PSI scores (R = -0.264510, p = 0.048837). Evaluation of the red cell parameters showed statistically significant differences in the markers of inflammation ESR (R = 0.369398, p = 0.008289) and CRP (R = 0.367405, p = 0.008672). Red cell distribution width values were also correlated with RA activity (R = 0.286387, p = 0.043769) and duration of the disease (R = 0.339425, p = 0.015889). A satisfactory periodontal status was found in most of the study group. Increased CRP levels in patients with periodontitis may indicate the negative impact of periodontal status on the general clinical condition of the patient.

Study of Interleukin 6 in Rheumatoid Arthritis and Anemic Patients in Sudan

Rheumatoid arthritis is considered one of the most common, and particularly attacks the joint causing significant individual and community burden and resulting from immunological abnormalities. It has been found that IL-6 plays a key role in the development of this disease. Overall anemia of chronic disease and iron deficiency anemia are frequent causes of anemia in RA patients. This study to analysis serum IL6 and to detect frequency of anemia/non-anemia and Rheumatoid arthritis (RA) patients and establish relationship between blood parameters and disease activity among Sudanese patients suffering from rheumatoid arthritis and deficiency anemia in Khartoum State. Methods It is a descriptive case-control study that involved 74 patients of both genders of RA, Anemia and non-anemic disease duration was two years. This study was conducted in Khartoum State. Complete Blood Count (CBC) was performed using the Auto Hematology Analyzer. Serum concentrations of IL-6, was measured in all patients and healthy individual using CLIA. The data collection was simple questionnaire and self-interview. Results The frequency of the RA within anemic and non- anemic patients was found higher in females 46(62.16%) than in males 28(37.83%). The overall analysis showed significant changes in most of blood parameters between the age groups. A statistically significant association was found between the WBCs, RBCs and MCH blood parameters with IL6 among RA/anemia's patients with Chi square p-value = 0.001,0.013 and 0.014, respectively. The statistic odd ratio was found 5.828 and 5.703 for WBCs and RBCs. This increase was highly significant among RA-Anemia patients in particular. Conclusion Our study reported the blood parameters isolates which harbored the IL6 and their association with rheumatoid arthritis and Anaemia which possibly cause the disease symptoms. Anemia is an important complication in rheumatoid arthritis (RA) which is associated with physical disability and increased mortality. Among various mechanisms, recent studies suggest the central role of hepcidin and IL-6 for the pathophysiology of Anemia.

Prevalence and aggravation of cervical spine instabilities in rheumatoid arthritis during over 10 years: a prospective multicenter cohort study.

We designed a prospective multicenter cohort study to clarify along-term, > 10-year prevalence and aggravation of cervical spine instabilities in rheumatoid arthritis (RA). In 2001-2002, 634 outpatients were enrolled, and 233 (36.8%) were followed for > 10 years. Cervical spine instability was defined as atlantoaxial subluxation (AAS, > 3-mm atlantodental interval), vertical subluxation (VS, < 13-mm Ranawat value), and subaxial subluxation (SAS, ≥ 2-mm irreducible vertebral translation). The aggravation was determined as ≥ 2mm decrease of the Ranawat value in VS, ≥ 2-mm increase of slippage in SAS, and these new developments. The prevalence of VS and SAS increased during both the initial and last > 5 years (all, p ≤ 0.049). While VS aggravation was associated with pre-existing AAS (p = 0.007) and VS (p = 0.002), SAS aggravation correlated with pre-existing VS (p = 0.002). Multivariable analysis found hand mutilating changes (odds ratio [OR] = 4.048, p = 0.008), RA duration ≥ 5 years (OR = 3.711, p = 0.013), C-reactive protein (CRP) level ≥ 3.8mg/dL (OR = 2.187, p = 0.044), and previous joint surgery (OR = 2.147, p = 0.021) as predictors for VS aggravation. Pre-existing VS (OR = 2.252, p = 0.024) and CRP ≥ 1.0mg/dL (OR = 2.139, p = 0.013) were disclosed as predictors for SAS aggravation. Low disease activity and clinical remission before the development of VS and advanced peripheral joint destruction are essential to prevent progressive cervical spine instability in RA.

"Atherosclerotic" phenotype of rheumatoid arthritis. What do we know about it?

Several studies have shown that systemic rheumatoid inflammation may cause induction and accelerated progression of atherosclerotic vascular lesions, which in turn may lead to more frequent development of cardiovascular diseases (CVD) in patients with rheumatoid arthritis (RA) compared to the general population.Objective. To evaluate the presence, nature and role of conventional and RA-specific risk factors for the development of CVD in patients with active RA in real-life clinical practice.Material and methods. Data from 967 patients with confirmed active RA were analyzed. Biologic disease-modifying antirheumatic drugs (DMARDs) or targeted DMARDs were prescribed/switched due to the ineffectiveness of previous therapy. Patients were divided into two groups: with and without CVD. In addition, comparable age subgroups of elderly (60–74 years) and middle-aged (45–59 years) patients were formed in each group. In all patients, clinical and laboratory parameters of RA activity, presence of extra-articular manifestations, the severity and progression of RA and characteristics of pharmacotherapy were analyzed. In addition, concomitant diseases and several traditional risk factors for the development of CVD were analyzed in all RA patients.Results and discussion. In patients with similar RA activity and duration, there is a parallel, tatistically significant accumulation of traditional CVD risk factors with increasing age-related CVD. The incidence of arterial hypertension, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, thyroid pathology, anemic syndrome, dyslipidemia, hyperuricemia and obesity was significantly higher in the group of elderly RA patients with CVD than in the group of middle-aged patients.Conclusion. It seems appropriate to identify a specific variant of RA that is closely associated with atherosclerosis.

Progression of TMJ disorders in patients with rheumatoid arthritis

Relevance. The literature highlights the significant impact of rheumatoid arthritis (RA) on the onset of musculoskeletal dysfunction symptoms in the temporomandibular joint (TMJ). However, the risk factors that influence the clinical manifestations of TMJ disorders in RA patients remain insufficiently explored.Objective: To examine the impact of rheumatoid arthritis on the onset and progression of TMJ disorders.Materials and methods. At the Dental Clinic of the Central Research Institute of Stomatology and Maxillofacial Surgery, 180 patients from St. Petersburg State Clinical Rheumatology Hospital No. 25, diagnosed with rheumatoid arthritis, were examined. Standard clinical assessments and detailed medical history collection were performed.Results. Patients with long-standing RA (over 5 years) were more likely to experience TMJ disorder symptoms, with a relative risk of 1.342 (95% CI) [1.106; 1.628]. No statistically significant correlation was found between RA activity and TMJ disorders. The symptom pattern varied by timing: prior to RA, patients predominantly experienced TMJ clicking and crepitus (66%); during RA onset, pain and restricted jaw movement were more common (80% and 72%, respectively). After RA manifestation, pain became the dominant symptom, though its intensity diminished over time (to 60%).Conclusions. The duration of RA has a notable impact on both the frequency and nature of TMJ disorder symptoms. While RA treatment reduces symptom intensity over time, their frequency remains high.