High Levels Of Rheumatoid Factor Research Articles

Influence of rheumatoid factor levels and TNF inhibitor structure on secondary nonresponse in rheumatoid arthritis patients.

The EXXELERATE study revealed poorer clinical outcomes in patients treated with adalimumab (ADL) and baseline rheumatoid factor (RF) above 203 IU/mL. However, responses were similar in patients treated with certolizumab pegol (CZP) regardless of RF levels. This study investigated the impact of RF levels >203 IU/mL on TNF inhibitors (TNFi) serum levels and the association with secondary nonresponse in RA patients treated with TNFi. We performed an observational ambispective study with RA patients treated with infliximab (IFX), ADL, or CZP. Patients were stratified according to baseline RF levels: ≤ or >203 IU/mL. After 6 months, serum drug levels and antidrug antibodies were measured, and reasons for discontinuation were collected. We included 170 RA patients: 90 (53%) received IFX, 48 (28%) ADL, and 32 (19%) CZP. While CZP serum levels did not differ between RF groups at 6 months (p = 0.6), RF levels >203 IU/mL were linked to lower serum drug levels in patients treated with IFX (p = 0.09) or ADL (p = 0.02). Secondary nonresponse was 3.6 times higher in patients with high versus low RF levels in patients under IFX or ADL. However, the reasons for withdrawal were not affected by RF levels in patients treated with CZP. Baseline RF above 203 IU/mL is associated with lower serum drug levels and an increased risk of discontinuation due to secondary nonresponse in patients treated with IFX or ADL. In contrast, drug levels and clinical outcomes are not significantly impacted by baseline RF levels in patients under CZP.

Impact of high rheumatoid factor levels on treatment outcomes with certolizumab pegol and adalimumab in patients with rheumatoid arthritis.

To assess the impact of baseline RF level on drug concentrations and efficacy of certolizumab pegol [CZP; TNF inhibitor (TNFi) without a crystallizable fragment (Fc)] and adalimumab (ADA; Fc-containing TNFi) in patients with RA. The phase 4 EXXELERATE study (NCT01500278) was a 104-week, randomized, single-blind (double-blind until week 12; investigator-blind thereafter), head-to-head study of CZP vs ADA in patients with RA. In this post hoc analysis, we report drug concentration and efficacy outcomes stratified by baseline RF quartile (≤Q3 or >Q3). Baseline data by RF quartiles were available for 453 CZP-randomized and 454 ADA-randomized patients (≤Q3: ≤204 IU/ml; >Q3: >204 IU/ml). From week 12, the area under the curve (AUC) of ADA concentration was lower in patients with RF >204 IU/ml vs patients with RF ≤204 IU/ml; the AUC of CZP concentration was similar in patients with RF ≤204 IU/ml and >204 IU/ml. For patients with RF ≤204 IU/ml, disease activity score (DAS28)-CRP was similar between CZP- and ADA-treated patients through week 104. For patients with RF >204 IU/ml, mean DAS28-CRP was lower in CZP- vs ADA-treated patients at week 104. The proportion of patients with RF >204 IU/ml achieving DAS28-CRP low disease activity at week 104 was greater in CZP- vs ADA-treated patients. CZP was associated with maintained drug concentration and efficacy in patients with RA and high RF and may therefore be a more suitable therapeutic option than TNFis with an Fc fragment in these patients. Clinicaltrials.gov, http://clinicaltrials.gov, NCT01500278.

Evaluating the Performance of Two Automated Anti-drug Antibodies Assays for Infliximab and Adalimumab Without Acid Dissociation

Monitoring anti-drug antibodies (ADAs) to infliximab and adalimumab is critical to treatment management in various autoimmune disorders. The growing need for proactive therapeutic monitoring further requires the detection of ADAs in the presence of measurable concentrations of infliximab or adalimumab. To provide robust analytical assays for clinical application, we evaluated two automated immunoassays developed using ImmunoCAP™ technology and based on the bridging format to measure serum ADAs to infliximab and adalimumab respectively. Without an acid-dissociation step, these research prototype assays can detect a positive control monoclonal ADA towards infliximab and adalimumab, ranging from < 25 ng/ml to 10,000 ng/mL. Both assays exhibit imprecision less than 20% at different ADA titer levels and can distinguish ADAs towards different drug targets. In method comparison using authentic patient samples, the quantitative results of the ADA assays are not directly comparable to two existing clinical immunoassays for ADAs (correlation coefficient rs = 0.673 for infliximab ADAs; rs = 0.510 for adalimumab ADAs), presumably due to the lack of commutable ADA standards and the polyclonal nature of ADAs. Nevertheless, there is qualitative agreement between the methods when evaluating putative positive and negative patient samples (overall agreement 0.83 for infliximab ADAs; 0.76 for adalimumab ADAs). Biotin and high levels of rheumatoid factors may interfere with the performance of the automated assays due to competitive binding with the biotinylated drug and non-specific formation of bridging complexes. The two ImmunoCAP assays can provide new analytical methods for proactive therapeutic monitoring of adalimumab and infliximab.Graphical

Clinical characteristics and labial gland pathological features in children with systemic lupus erythematosus complicated by Sjögren's syndrome

To study the clinical manifestations, laboratory features, and labial gland pathological features in children with systemic lupus erythematosus (SLE) complicated by Sjögren's syndrome (SS). A retrospective analysis was conducted on 102 children with SLE who underwent labial gland biopsies at Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2013 to December 2022. The children were divided into two groups based on the presence of SS: the SLE with SS group (SLE-SS; 60 children) and the SLE-only group (42 children). According to the focus score (FS) of the labial glands, children in the SLE-SS group were further subdivided into FS≥4 subgroup (26 children) and FS<4 subgroup (34 children). The clinical data of the groups were compared. Compared to the SLE-only group, children in the SLE-SS group had less skin and mucosal involvement, were more likely to have positive anti-SSA and anti-SSB antibodies, and had higher levels of rheumatoid factor (P<0.05). There was no significant difference in treatment protocols between the two groups (P>0.05). Compared to the FS<4 subgroup, the FS≥4 subgroup had more frequent musculoskeletal involvement (P<0.05), but there was no significant difference in SLE disease activity or other major organ involvement between the subgroups (P>0.05). Children with SLE complicated by SS are less likely to have skin and mucous membrane involvement and exhibit specific serological characteristics. The SLE-SS children with an FS≥4 are more likely to experience musculoskeletal involvement. However, FS is not associated with disease activity or other significant organ damage.

Clinical and laboratory characteristics of salivary gland ultrasonography-positive patients with primary Sjögren's syndrome.

This study aimed to investigate the clinical and laboratory characteristics of salivary gland ultrasonography (SGUS)-positive patients with primary Sjögren's syndrome (pSS) compared to SGUS-negative patients and to analyse the diagnostic value of SGUS and labial salivary gland biopsy (LSGB) grading in pSS. A retrospective analysis of patients admitted to the Affiliated Hospital of Yangzhou University between May 2019 and November 2023 was conducted. According to the OMERACT scoring system, patients with pSS were divided into an SGUS-negative group (score <2) and an SGUS-positive group (score ≥2). The patient's age, gender, clinical symptoms, laboratory parameters and diagnostic examinations were compared and analysed, and Spearman correlation analysis was used to analyse the correlation between SGUS, LSGB and influencing factors. There was no significant difference in dry mouth, dry eyes, tooth loss, fever, joint pain, fatigue, interstitial lung disease or renal tubular acidosis between the two groups, although there were more patients with salivary gland enlargement in the SGUS-positive group (p < 0.05). In terms of high levels of immunoglobulin G (IgG), high levels of rheumatoid factor (RF), anti-nuclear antibody ≥1:320, anti-Sjögren's syndrome A-52KD and anti-Sjögren's syndrome B, the number of cases in the SGUS-positive group was greater than that in the SGUS-negative group (p < 0.05). LSGB samples were graded per the Chisholm-Mason system with significant differences between multiple groups. SGUS score negatively correlated with age and positively correlated with LSGB grade. This study showed that the SGUS score positively correlated with LSGB grade in pSS patients and negatively correlated with patient age. Thus, SGUS and LSGB are consistent in the diagnosis of pSS to reflect the degree of salivary gland involvement, and patients who are SGUS positive have high RF and IgG levels, a variety of autoantibodies positive and a tendency toward salivary gland enlargement.

The Serological Evidence of Positive Rheumatoid Factor in Morphea Patients and Its Relation to Disease Severity.

Background and objective Morphea, or localized scleroderma (LS), is an autoimmune skin disorder characterized by inflammation and sclerosis. Its potential causes include infections, genetic predisposition, and trauma. The disease involves cycles of inflammation and fibrosis, leading to skin hardening and scarring, which can cause deformities ifuntreated. Researchexploring the link between morphea and rheumatoid factor (RF), a marker associated with other autoimmune conditions, is ongoing. This study aimed to examine the less-explored role of RF, a marker typically linked to rheumatoid arthritis (RA), in the severityof morphea. It focused on assessing the levels of RFamong morphea patients and its correlation with disease severity, intending to provide deeper insights intothe condition and its management. Methods This study involved a simple randomized cross-sectional analysis to evaluate the role of the RF in measuring morphea severity among patients at the Dermatology and Venereology Department of Al-Sader Teaching Hospitalfrom October 2022 to December 2023. We included participants with clinically and laboratory-confirmed morphea while excluding those with other autoimmune dermatological diseases, recent systemic steroid or immunosuppressive therapy, and pregnant women. The assessment of disease severity was done by utilizing the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT).Statistical analyses were performed using SPSS Statistics version 27 (IBM Corp., Armonk, NY), with a significance threshold of p<0.05. Results Elevated RF levels were significantly associated with increased morphea severity, with severe cases showinghigher RF levels (mean: 30.34 U/mL) compared to moderate (25.83 U/mL) and mild cases (21.56 U/mL) (p = 0.028). However, no significant correlation was found between RF levels and demographic factors such as age, gender, or occupation. Patients with high RF levels had a longer disease duration (mean: 57.15 years) compared to those with normal levels (25.83 years, p = 0.020). Significant differences were observed in lesion distribution on the back (p = 0.002). Logistic regression indicated that severe morphea patients were more likely to have elevated RF levels [odds ratio (OR): 1.158, p = 0.014]. Conclusions This study enriches our understanding of RF's role in morphea, revealing no significant correlation with demographic factors but suggesting its potential role in disease chronicity and severity.

Radiological insights into rheumatoid meningitis - a rare central nervous system manifestation of rheumatoid arthritis: a retrospective review of six cases.

The objective is to analyze and review the clinical, laboratory, and neuroimaging characteristics of rheumatoid meningitis (RM) in six patients with known rheumatoid arthritis (RA). We performed a retrospective review of patients diagnosed with RM from August 2012 to June 2023. To identify the cases, we used medical term search engines and the hospital´s radiology case database. Clinical information and laboratory findings were gathered from the medical records. A neuroradiologist with five years of experience reviewed and analyzed the RM to determine the characteristics findings of RM. Six patients with RM are included. Seizures along with headaches were among the clinical signs that were documented. All the patients had high levels of rheumatoid factor (RF) and anti-cyclic citrullinated peptides (ACPA) in the peripheral blood. Biopsy in two cases confirmed typical rheumatoid nodules. Leptomeningeal enhancement was found bilaterally in all cases and was predominantly found in the frontoparietal region. "Mismatch DWI/FLAIR" was found in five patients. Bilateral subdural collections could be found in two patients. Brain PET scan revealed increased metabolism in two cases. Rheumatoid meningitis is a rare complication of rheumatoid arthritis (RA) with challenging clinical diagnosis due to non-specific symptoms. This study highlights the importance of MR in detecting characteristic neuroimaging patterns, including "mismatch DWI/FLAIR", to aid in early diagnosis. Increased awareness of this condition may facilitate timely intervention and improve prognosis. These results still need to be verified by large studies.

SPECIFIC BIOCHEMICAL INDICATORS AND INFLAMMATORY MARKERS IN RHEUMATOID ARTHRITIS (RA)

It is acknown that Rheumatoid inflammation is a chronic systemic autoimmune disease developing on the background of infection. Damages mainly the heart, blood vessels, musculoskeletal system and other internal organs. Multiple joints may be affected, primarily the knee, ankle and elbow undergoing destruction leads to pain, mainly symmetrical. Damaged joints swollen and skin in these foci reddens; joint morning stiffness lasts for an hour or more, this sign is accompanied by low fever and fatigue. As a result of the rheumatic process, the heart is damaged, leading to cardiovascular manifestations. Analysis of blood parameters allows the severity of the disease to be determined based on a relatively new method using Das28. The obtained results for ESR and CRP are used to calculate DAS28, which also allows monitoring of RA treatment. Most patients with rheumatoid arthritis (RA) are seropositive—they have abnormally high levels of rheumatoid factor (RF) or anti-citrullinated peptide antibodies (anti-CPP) in the blood. The article examines aspects of synthetic, chemical and alternative medicine impact on treating patients with RA as well. The article discusses comparative aspects of pharmacological and herbal medicine in the therapeutics. According to the literature, patients who have not received the expected results after treatment with pharmacological preparations successfully use herbal remedies as a means of body restoring and healing. To date, the success of traditional medicine is ahead of those of conventional using synthetic drugs.

Exploring the influence of baseline rheumatoid factor levels on TNF inhibitor retention rate in patients with rheumatoid arthritis: a multicentre and retrospective study

ObjectiveTo assess whether the retention rate of certolizumab pegol (CZP) was longer than that of other tumour necrosis factor inhibitors (TNFi) based on baseline rheumatoid factor (RF) levels.MethodsLongitudinal, retrospective and...

Rheumatoid Arthritis and Pericardial Effusion - A Unique Major Manifestation.

Pericardial effusion is common in the setting of rheumatoid arthritis (RA); however, it is rarely its first manifestation. An 82-year-old male presented with abdominal pain, vomiting and fever. Blood analysis revealed elevated systemic inflammatory markers, and an abdominal computed tomography scan revealed non-specific alveolar condensation of the right pulmonary base and pericardial effusion subsequently quantified as medium size by transthoracic echocardiography. A large aetiological panel was requested, with the autoimmunity study revealing high levels of rheumatoid factor (RF) and anti-citrullinated cyclic peptide (anti-CCP) antibodies. Since the patient did not present articular involvement, the initial hypothesis was pericardial effusion due to pneumonia and no specific treatment for RA was started. At follow-up, the pericardial effusion recurred and a pericardiocentesis was performed. The pericardial fluid analysis was sterile, and no malignant cells were identified. A new serological study confirmed high levels of RF and anti-CCP antibodies, and immunomodulatory treatment was initiated. After one year, the pericardial effusion recurred due to non-compliance with immunomodulatory therapy. A surgical pleuro-pericardial window was performed, and the cytological study of the pericardial patch revealed submesothelial thickening and foci of perivascular lymphocytic infiltrate. The patient remained asymptomatic. After exclusion of a large spectrum of infectious and non-infectious causes and the relapse after suspension of immunomodulatory treatment, the most probable aetiology for the pericardial effusion remains RA. Pericardial syndromes can be the first manifestation of AR even in the absence of articular symptoms and this disease must be considered in the aetiological investigation. The occurrence of pericardial effusion in the setting of rheumatoid arthritis (RA) is a usual finding but this form of extra-articular manifestation is possibly the first and only presentation of the disease.In the case of recurrent pericardial effusion, the diagnosis of RA must be considered in the aetiological investigation even in the absence of more common manifestations of the disease.

Autoantibodies Serum Level and 10-Year Risk of Fractures Evaluated by FRAX® Tool in Rheumatoid Arthritis Patients.

FRAX® is a tool used for evaluation of risk of fracture in RA and non-RA patients and to identify those eligible for intervention. One of the limitations of FRAX in RA settings is that it does not consider factors known to contribute to osteoporosis such as autoantibodies. This study analysed the association of anti-mutated citrullinated vimentin antibody (anti-MCV), anti-cyclic citrullinated peptide antibody (anti-CCP), IgM rheumatoid factor (RF), IgA RF with 10-year risk of major osteoporosis and hip fracture. FRAX® tool was used to estimate 10-year risk of major osteoporosis fracture and hip fracture in 189 RA patients over 40 years of age. Anti-MCV, anti-CCP, IgM RF and IgA RF were tested using enzyme immunoassay and analysed at different levels. Results were adjusted for various confounders including disease activity. Fifty-one (26.9%) RA patients had high (≥20%) 10-year risk of major osteoporosis fracture and 67 (35.4%) had high (>3%) 10-year risk of hip fracture. Among all the tested autoantibodies, only IgM RF at elevated levels was associated with high 10-year risk of major osteoporosis fracture (adjusted OR = 4.1, 95% CI = 1.5-11.3, p = 0.006) and of hip fracture (adjusted OR = 17.4, 95% CI = 3.7-81.3, p < 0.0001). There was no agreement between FRAX and femoral neck (FN) BMD. None of the autoantibodies tested were associated with FN osteopenia or osteoporosis including IgM RF at high levels. Our study highlights the importance of quantitative measurement of autoantibodies in assessment of risk for fractures among RA patients. Our preliminary findings need to be assessed in prospective studies to determine the actual predictive value of high IgM RF levels among patients with RA.

Clinical and Prognostic Significance of p-ANCA Positivity in Idiopathic Pulmonary Fibrosis: A Retrospective Observational Study.

Perinuclear Anti Neutrophil Cytoplasmic Antibody (p-ANCA) is a serological marker of Microscopic Polyangiitis (MPA), a vasculitis associated with lung involvement potentially mimicking Idiopathic Pulmonary Fibrosis (IPF). In this study, we evaluated the role of p-ANCA in predicting clinical evolution and prognosis in a cohort of IPF patients. In this observational, retrospective, case-control study, we compared 18 patients with an IPF diagnosis and p-ANCA positivity with 36 patients with seronegative IPF, matched for age and sex. IPF patients with and without p-ANCA showed similar lung function decline during the follow-up, but IPF p-ANCA+ showed better survival. Half of IPF p-ANCA+ patients were classified as MPA for the development of renal involvement (55%) or skin signs (45%). The progression towards MPA was associated with high levels of Rheumatoid Factor (RF) at baseline. In conclusion, p-ANCA, mainly when associated with RF, could predict the evolution of Usual Interstitial Pneumonia (UIP) towards a definite vasculitis in patients, with a better prognosis compared with IPF. In this view, ANCA testing should be included in the diagnostic workup of UIP patients.

Tomographic pleuropulmonary manifestations in rheumatoid arthritis: a pictorial essay.

Rheumatoid arthritis (RA) is an autoimmune inflammatory and heterogeneous disease that affects several systems, especially the joints. Among the extra-articular manifestations of RA, pleuropulmonary involvement occurs frequently, with different presentations, potentially in all anatomic thoracic compartments, and may determine high morbidity and mortality. The most common pleuropulmonary manifestations in patients with RA include interstitial lung disease (ILD), pleural disease, pulmonary arterial hypertension, rheumatoid lung nodules, airway disease (bronchiectasis and bronchiolitis), and lymphadenopathy. Pulmonary hypertension and ILD are the manifestations with the greatest negative impact in prognosis. HRCT of the chest is essential in the evaluation of patients with RA with respiratory symptoms, especially those with higher risk factors for ILD, such as male gender, smoking, older age, high levels of rheumatoid factor, or positive anti-cyclic citrullinated peptide antibody results. Additionally, other etiologies that may determine tomographic pleuropulmonary manifestations in patients with RA are infections, neoplasms, and drug-induced lung disease. In these scenarios, clinical presentation is heterogeneous, varying from being asymptomatic to having progressive respiratory failure. Knowledge on the potential etiologies causing tomographic pleuropulmonary manifestations in patients with RA coupled with proper clinical reasoning is crucial to diagnose and treat these patients.

Anti-drug antibodies and rheumatoid factor level in patients with rheumatoid arthritis using the infliximab biosimilar CT-P13

BackgroundThis study evaluated the existence of anti-drug antibodies (ADAs) before and 52 weeks after switching from intravenous infliximab (IFX) to intravenous CT-P13 in patients with rheumatoid arthritis (RA).MethodsWe performed a prospective observational study. Twenty-eight patients (7 males and 21 females) received intravenous CT-P13 after intravenous IFX, and the clinical data were collected from medical records. Rheumatoid factor (RF) and anti-CCP antibody were examined at baseline. At baseline and 52 weeks after the start of CT-P13 treatment, the Disease Activity Score based on the 28-joint count and the levels of C-reactive protein, matrix metalloproteinase-3, and ADA, as well as the erythrocyte sedimentation rate were evaluated. ADAs were measured using an enzyme-linked immunosorbent assay kit.ResultsSeven (25%) and 6 (21.4%) cases were positive for ADAs at baseline and 52 weeks after, respectively. One case became newly positive for ADAs at week 52. Two of the ADA-positive cases became ADA-negative 52 weeks after. The ADA-positive group showed significantly higher RF values at baseline than the ADA-negative group (p = 0.03). No difference was observed between the ADA-positive group and the ADA-negative group regarding other clinical parameters.ConclusionsThe positive rate of ADAs did not increase after switching from intravenous IFX to intravenous CT-P13. Among the patients with ADAs, a high level of RF was observed at baseline.

Defining the clinical characteristics of Q fever endocarditis: A case-control study in China.

Q fever is a worldwide zoonosis caused by Coxiella burnetii. Atypical presentations of Q fever can cause diagnostic difficulty or be misdiagnosed. Here we compared the clinical and diagnostic features of Q fever endocarditis and endocarditis caused by other bacteria to identify features of Q fever endocarditis that might facilitate early diagnosis. This was a retrospective case-control study of eight cases of Q fever endocarditis diagnosed between 2000 and 2018 at Peking Union Medical College Hospital in China and 24 age- and gender-matched patients diagnosed with bacterial endocarditis over the same period. Clinical and laboratory data were collected and compared between groups. The median time interval between symptoms and diagnosis was significantly longer in the case group than the control group (8.0 months (IQR 7.0-16.0) vs. 4.0 months (IQR 1.0-7.0); p = 0.002). Patients in case group had significantly lower white blood cell counts (5.8 ± 2.4 × 109/L vs. 10.0 ± 3.4 × 109/L; p = 0.003), percentage of neutrophil (62.4 ± 14.7% vs. 79.1 ± 9.2%; p = 0.014), high-sensitivity C-creative protein levels (21.1 mg/L (IQR 18.5-32.8) vs. 45.3 mg/L (IQR 32.9-54.3); p = 0.038), and platelet counts (133 ± 73 vs. 229 ± 65; p = 0.001) but higher levels of rheumatoid factor (104.3 U/L (IQR 99.0-132.8) vs. 10.2 U/L (IQR 6.9-32.5); p = 0.011) than controls. Elevated creatinine (50.0% vs. 12.5%; p = 0.047) and liver enzymes (50.0% vs. 0%; p = 0.002) were more common in cases than controls. Q fever endocarditis was less frequently diagnosed than controls before cardiac surgery (62.5% vs. 100%; p = 0.011), with negative blood cultures in all cases. The diagnosis of Q fever endocarditis can easily be delayed compared to other causes of infectious endocarditis. Patients with chronic fever and new valve dysfunction require careful assessment, especially when presenting with negative blood cultures and high rheumatoid factor levels. Clinical and laboratory evaluation of these patients should include routine serological testing for C. burnetii.

Elevated Rheumatoid Factor Associates with Dry Eye in Patients with Common Autoimmune Diseases.

PurposeTo investigate the association and application value of rheumatoid factor (RF) in diagnosis of dry eye among patients with common autoimmune diseases.Patients and MethodsA retrospective case-control study was conducted from Jan 1st 2019 to Dec 31st 2020, and 117 patients with common autoimmune diseases were enrolled. The concentrations of serum RF were detected. The receiver operating characteristics (ROC) curve was plotted to evaluate the values of RF in diagnosis.ResultsCompared with no dry eye patients, patients with dry eye (n = 59, 50.43%) had higher levels of RF (P < 0.001). Moreover, Pearson’s correlation analysis showed that RF levels were negatively correlated with Schirmer-I tear test (P = 0.004) and invasive tear film break-up time (P = 0.002), respectively. The statistically significant threshold value (cut-off points) of the RF levels for dry eye was 21.4 (IU/mL), and the areas under the curve (AUC) of RF was 0.73 (95% confidence interval [CI]: 0.639–0.821; P < 0.001) (sensitivity = 78%; specificity = 58.6%) for dry eye among patients with common autoimmune diseases.ConclusionSerum levels of RF may be an independent factor for dry eye among patients with common autoimmune diseases, and they may have a high significant value and clinical application value.

English

BACKGROUND RA Factor positivity is one of the criteria for diagnosis of Rheumatoid arthritis. High levels of rheumatoid factor (generally above 20 IU/mL. 1:40 or over the 95th percentile) are indicative of Rheumatoid arthritis (present in 80 %). Rheumatoid Factor positivity is associated with more severe and more active disease and extraarticular disease. This study was done in Rheumatoid arthritis patients to assess the proportion of ocular manifestations in them and also an association between RF positivity and ocular manifestation and treatment-related ocular complications among Rheumatoid arthritis patients. METHODS A cross-sectional study was conducted among the patients attending the rheumatology clinic at Government Medical College, Trivandrum. Patients in the age group of 18-60 years who satisfied the American Rheumatism Association criteria were selected for the study and all of them underwent complete ophthalmic examination as well as RA Factor assessment by latex agglutination. The qualitative variables were expressed in proportion. The chi-square test was used to determine the association between qualitative variables. RESULTS A total of 67 RA patients were screened of which 26 (38.8 %) had ocular manifestations and among the total patients, 57 (85 %) were rheumatoid factor positive. Among the total patients with ocular manifestations, 24 (92 %) patients were rheumatoid factor positive. The association between RF positivity and ocular manifestation was found to be statistically not significant (P-value -0.33). In the present study, no other treatment-related ocular complications were seen except for one patient on long term steroids who had subcapsular cataract. CONCLUSIONS The presence of the RA factor does not show a positive association with the occurrence of ocular manifestation and the use of a low dose of methylprednisolone and DMARDs in RA has reduced the incidence of steroid-related complications. The more commonly used DMARDs -methotrexate, salazopyrin and hydroxychloroquine were found to be safe since no drug toxicity was noted in the present study. KEY WORDS RA Factor, Rheumatoid arthritis, Ocular Manifestation.

Иммунологические и биохимические особенности ревматоидного артрита

The article presents the results of studies of immunological and biochemical characteristics of diseases of the osteoarticular system among residents of Bishkek. The studies were carried out on residents of Bishkek, men and women aged 21–74, in the spring of 2019, in the fall of 2019 and in the fall of 2020. A total of 1358 people were examined for ACCP, of which 282 residents of Bishkek were found to have an ACCP content higher than the norm, among which 238 were women and 44 were men. The level of antibodies to cyclic citrullinated peptide (ACCP) was determined in blood serum by immunochemiluminescence analysis. Biochemical studies aimed at identifying the activity of the process and immune inflammation consisted of determining the levels of rheumatoid factor (RF), C-reactive protein (CRP), Antistreptolysin-O (ASL-O) and uric acid (MC) according to generally accepted methods. Out of the selected 282 Bishkek residents, 17 men and 82 women belong to the confirmation group, while 27 men and 156 women are in the group of people with increased levels of ACCP were first established. ACCPs mainly belong to the IgG class and are found in the blood at the earliest stages of rheumatoid arthritis disease (1–2 years before the onset of the first symptoms) and their specificity in rheumatoid arthritis is about 97%. They are detected at very early stages of the disease, which explains the distribution of the surveyed residents of Bishkek by groups. Analysis by sex distribution showed that in all groups women prevail than men, since it is known from scientific literature source that diseases of the osteoarticular system, in particular rheumatoid arthritis, are more susceptible to women than men. Women get sick more often than men 2–5 times more, which was found in our studies, the ratio of men and women is on average 1:3.4–5.6. It has been proven that damage to the osteoarticular system can occur at any age. According to our data, 47.7% of the total number of surveyed men were aged 35–60 years, 45.5% were men aged 61–74 years. At the same time, among women, 37% were aged 35–60 years, 36.3% were women aged 61–74 years. According to scientific literature sources, the incidence of rheumatoid arthritis increases with age, over 60 years old reaches its maximum value (more than 2%), the population is aging when RA grows. Gender differences are also lost, the ratio of women to men is 2:1 or less. At the same time, rheumatoid arthritis can develop at any age, most often from 35 to 50 years, but it can also be in childhood and in the elderly. According to our results, among women under 35 years of age in the confirmation group, the prevalence of RA was 28.3%, at the age of 36-60 years 58.8%, and at the age of over 61 years — 43.6%. And in the group of primary confirmation, women under 35 years old accounted for 16.7%, at the age of 36-60 they make up 20.4% and over 60 years old — 28.5%. As you know, ACCP can be detected in 30% of cases of seronegative rheumatoid arthritis (negative for rheumatoid factor), which is advisable in the diagnosis of early seronegative RA, in differential diagnosis with other rheumatic diseases. Elevated ACCP levels in healthy individuals indicate a significant increase in the risk of developing RA. Rheumatoid factor is an autoimmune antibody, an immunoglobulin protein (IgM) produced by the body's immune system. Autoantibodies attack their own tissues, mistaking them for foreign ones. Although the nature of rheumatoid factor is still poorly understood, its presence is an indicator of inflammatory and autoimmune processes. With rheumatoid arthritis symptoms, high rheumatoid factor levels are likely to indicate seropositive rheumatoid arthritis. However, even a negative test result does not exclude that the patient has these diseases. Antibodies to cyclic citrullinated peptide and RF are currently recognized as an informative serological marker of rheumatoid arthritis. Based on studies carried out at different times of the year (spring, autumn 2019, autumn 2020), it was found that the season does not have a significant effect on the content of the ACCP level, although residents of Bishkek (men and women) often complain of pain in the joints in the fall. than in the spring. This is confirmed by the highest content of ACCP among women, as well as men over 35 years old to 74 years old.

Prevalence and predictive factors of difficult-to-treat rheumatoid arthritis: the KURAMA cohort

Difficult-to-treat rheumatoid arthritis (D2T RA) is a multifactorial condition in which disease activity of RA persists despite consecutive treatment with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). To evaluate the prevalence and predictive risk factors of D2T RA in our institution, a single-center, retrospective study was conducted. Medical records of RA patients, who visited our hospital from 2011 to 2020 and had a follow-up of more than 6 months, were retrospectively reviewed. D2T RA was defined as RA with a disease activity score of 28 – erythrocyte sedimentation rate (DAS28-ESR) of 3.2 or higher at the last visit, despite the use of at least two b/tsDMARDs. A logistic regression model was used to identify risk factors. A total of 672 patients were enrolled. The mean age at disease onset was 52.1 years and females were dominant (76.3%). After a mean follow-up of 46.6 months, patients with D2T RA accounted for 7.9% of overall patients. Multivariate analysis identified high rheumatoid factor (RF) levels (≥156.4 IU/mL, odds ratio [OR]: 1.95), DAS28-ESR (OR: 1.24), and coexisting pulmonary disease (OR: 2.03) as predictive risk factors of D2T RA. In conclusion, high RF levels, high DAS28-ESR, and coexisting pulmonary disease at baseline can predict the development of D2T RA.

Clinical Performance of SARS-CoV-2 IgG and IgM Tests Using an Automated Chemiluminescent Assay.

SummarySerology tests for viral antibodies provide an important tool to support nucleic acid testing for diagnosis of the novel coronavirus disease 2019 (COVID-19) and is useful for documenting previous exposures to SARS-CoV-2, the etiological agent of COVID-19. The sensitivities of the chemiluminescent SARS-CoV-2 IgG/IgM immunoassay were assessed by using serum samples collected from 728 patients testing positive for SARS-CoV-2 RNA. The specificity was evaluated on a panel of 60 serum samples from non-COVID-19 patients with high levels of rheumatoid factor, antinuclear antibody, or antibodies against Epstein-Barr virus (EBV), cytomegalovirus (CMV), mycoplasma pneumonia, human respiratory syncytial virus (RSV), adenovirus, influenza A or influenza B. The imprecision and interference were assessed by adopting the Clinical and Laboratory Standards Institute (CLSI) EP15-A2 and EP7-A2, respectively. Sensitivities between 1 and 65 days after onset of symptoms were 94.4% and 78.7%, for IgG and IgM test, respectively. The sensitivity increased with the time after symptom onset, and rose to the top on the 22nd to 28th days. The total imprecision (CVs) was less than 6.0% for IgG and less than 6.5% for IgM. Limited cross-reactions with antibodies against EBV, CMV, mycoplasma pneumonia, human RSV, adenovirus, influenza A or influenza B were found. These data suggested the chemiluminescent SARS-CoV-2 IgG and IgM, assay with reliable utility and sensitivity, could be used for rapid screening and retrospective surveillance of COVID-19.