Inflammatory Rheumatic Conditions Research Articles

Impact of Exercise Intensity on Calprotectin Levels in Healthy Volunteers and Patients with Inflammatory Rheumatic Diseases.

Exercise influences inflammatory response and immune system performance. The regular practice of a moderate activity positively regulates immunity and the inflammatory process, while intensive training depresses it and enhances inflammatory marker secretion. Calprotectin is involved in the inflammatory process, promoting neutrophil recruitment, cell degranulation, and inflammatory mediators. Furthermore, calprotectin has been associated with various inflammatory diseases, including inflammatory rheumatic diseases. The present review explores the effect of exercise on calprotectin levels in both healthy and inflammatory rheumatic conditions. Data show that the intensity duration and the type of exercise modulate calprotectin levels and participant inflammatory status. The exact role of calprotectin in the exercise response is yet unknown. Calprotectin could constitute an interesting biomarker for monitoring both the effect of exercise on the inflammatory process in healthy volunteers and the efficiency of exercise treatment programs in a patient with inflammatory rheumatic disease.

A Systematic Review of the Inclusion of Non-Inflammatory Ultrasonographic Enthesopathy Findings in Enthesitis Scoring Indices.

Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.

Consultation préconceptionnelle dans les maladies auto-immunes systémiques

Many systemic autoimmune diseases and chronic inflammatory rheumatic conditions affect women of childbearing age. Pregnancy is most often possible, with generally acceptable fetal-maternal risks. So, pregnancy wish must be regularly sought and the optimal timing of pregnancy is essential. Women should be reassured that a good pregnancy outcome is generally possible if conception occurs in a stable remission state. The planification is ideally carried out during a preconception counseling appointment in order to look for possible contraindications (infrequent) and risk factors for obstetrical complications (previous obstetrical complication, antiphospholipid biology or syndrome, activity of the disease at conception, and definite organ failure) in order to optimize the management. The most frequent obstetrical complications are fetal losses and/or consequences of placental insufficiency. Anti-SSA and/or anti-SSB antibodies exposes to a low risk of fetal atrioventricular block. Adequate drugs adjustment should be done before conception to avoid an early relapse and to replace teratogenic drugs. Finally, organization of the follow up of this future pregnancy need to be defined in a multidisciplinary approach and explained to the patient at this time.

A Rare Cause of Interstitial Lung Disease in Rheumatology Clinic: Case Report for Sulfasalazine-Induced Acute Pulmonary Injury

Infection, primary lung pathology, rheumatic involvement, malignancy and drug-induced involvement can be suggested as differential diagnosis of a case with rheumatic disease who applied to an emergency service with pulmonary symptoms.The drugs cause 2.5-3% of interstitial lung diseases.Sulfasalazine has been widely used in the treatment of inflammatory rheumatic conditions and it is an extremely rare reason for interstitial lung disase. Here, we aimed to present the rarely seen sulfasalazine-induced interstitial pulmonary disease and its treatment. Sulphasalazine -induced lung disease can mimic the symptoms of infectious and rheumatic lung involvement and can cause serious diagnostic confusion.

Efficacy and safety of switching from reference adalimumab to SB5 in a real-life cohort of inflammatory rheumatic joint diseases.

SB5 showed comparable efficacy and safety profile in respect to adalimumab originator (ADA) in randomized clinical trials of rheumatoid arthritis (RA) and psoriasis. We aimed to describe the efficacy and safety of SB5 after switching from ADA in RA, axial spondyloarthritis (axSpA), psoriatic arthritis (PsA) and juvenile idiopathic arthritis (JIA) patients. Adult RA, PsA, axSpA, JIA patients treated with ADA for at least 6months, switched to SB5 in stable clinical conditions, were eligible. Data on safety, activity indexes and patient-reported outcomes were collected at baseline, 3 and 6months after switching. Eighty-two patients (19 RA, 28 PsA, 32 axSpA and 3 JIA; 45 females, mean age 54 ± 14years, disease duration 13 ± 7years, ADA duration 6 ± 3years) were enrolled. RA patients showed stable conditions, while PsA patients showed an increase in both HAQ, DAS28(CRP) and DAPSA and axSpA patients an increase in VAS pain, VAS patient disease activity and ASDAS, both at 3months. There were changes in the concomitant medications profile, with regression of activity indexes increases at 6months. Adverse events were reported by 33.7% patients at 3months and 16.6% patients at 6months, mostly disease flares and infectious events. Two patients stopped SB5. Despite temporary changes in the concomitant medication profile for mild disease flares, our real-life data replicate the safety profile of switching from ADA to SB5 in RA, with additional data for its applicability in PsA and axSpA patients, further supporting switching to biosimilars in treating inflammatory rheumatic conditions. Key Points • Switching from adalimumab originator to SB5 is feasible in real life rheumatic inflammatory joint diseases. • Mild disease flares can present after switching from originator adalimumab to SB5, in particular in axial spondyloarthritis and psoriatic arthritis. • Changes in concomitant medications profile allows the control of minor disease flares presenting after switching from adalimumab originator to SB5.

Osteitis condensans ilii: current knowledge and diagnostic approach.

Osteitis condensans ilii is a noninflammatory condition of an uncertain etiology, characterized by sclerotic bone lesions located mainly in the iliac region of the sacroiliac joints. In many patients, osteitis condensans ilii remains an incidental imaging finding; however, it has been associated with lower back pain and may mimic inflammatory rheumatic conditions such as axial spondyloarthritis. The diagnosis is based on the presence of the characteristic sclerotic lesions on radiographs and the exclusion of other conditions that are associated with back pain. Management is usually conservative with the use of physical therapy and analgesics, and it is associated with a favorable prognosis. Herein, we conducted a narrative literature review using the terms osteitis condensans ilii, and we identified case reports, case series, reviews, and original studies associated with the condition. The aim of this article is to raise the awareness of this underrecognized clinicoradiological condition and to enable the health-care providers to recognize clinical and radiological features that should raise suspicion of the osteitis condensans illi, and to describe the treatment options.

P197 Analgesic prescribing in patients with inflammatory arthritis in the NHS

Abstract Background There is little evidence analgesics improve pain in inflammatory arthritis (IA), and substantial evidence they have significant harms. Excepting NSAIDs in ankylosing spondylitis (AS), their long-term use is not recommended in guidelines. Despite this, international data suggest pain management in IA involves the substantial and sustained use of opioids (∼40% of North American patients with rheumatoid arthritis [RA] are chronic opioid users). We evaluated analgesic prescribing practice in NHS-managed patients with IA. Methods This study was undertaken in the Consultations in Primary Care Archive (CiPCA), containing primary care consultation/prescription data from 9 general practices (∼200,000 patients) in North Staffordshire (UK) from 2000-2015. Repeated cross-sectional analyses evaluated annual prevalence of analgesic prescriptions in (a) patients with IA (RA; psoriatic arthritis [PsA]; AS), and (b) five age, sex, and practice-matched controls without inflammatory rheumatic conditions. Patients without full calendar-years of data were excluded. The numerator was the number of patients receiving oral analgesic prescriptions in a calendar-year; the denominator was the number of patients contributing data within that calendar-year. Analgesic prescriptions were classified into basic, opioids, gabapentinoids, and NSAIDs. Patients were grouped into users, or non-users of analgesics. Users were sub-classified into chronic (≥3 prescriptions across a calendar year), or intermittent (1-2 prescriptions) users. Results In all years, the majority (65.1-77.8%) of patients with IA received analgesics, compared with the minority (38.1-42.0%) of controls (Table). Opioid prescribing in IA fell slightly between 2000-2015, but remained common with 45.0% receiving an opioid, and 32.5% being chronic opioid users in 2015. The proportion of patients with IA prescribed gabapentinoids increased from 0% in 2000, to 9.4% in 2015. In contrast, the proportion prescribed NSAIDs fell from 53.3% in 2000, to 24.9% in 2015. In all years, analgesic use was commoner in patients with RA, compared to PsA and AS, and 2-4 times higher in IA than controls. Conclusion Analgesic prescribing - particularly opioids - in IA is commonplace, with most prescribed long-term. This is at variance with existing evidence, and guidelines. Interventions are needed to improve analgesic prescribing in this population. Disclosures I.C. Scott None. J. Bailey None. C. White None. C.D. Mallen None. S. Muller None.

Fibromyalgia interferes with disease activity and biological therapy response in inflammatory rheumatic diseases.

Fibromyalgia is one of the numerous comorbidities that may accompany inflammatory rheumatic diseases. Concomitant fibromyalgia in inflammatory rheumatic conditions can interfere with symptomatology, disease activity and overall management plan. The aim of the present narrative review article was to discuss the current evidence on (i) the prevalence/frequency of comorbid fibromyalgia in inflammatory rheumatic conditions, (ii) the role of fibromyalgia on disease activity, (iii) the impact of concomitant fibromyalgia on biological disease-modifying antirheumatic treatment outcomes and (iv) potential effectiveness of biological disease-modifying antirheumatic drugs on fibromyalgia-related symptoms among patients with inflammatory rheumatic diseases. A literature search was conducted through PubMed/MEDLINE Cochrane and Web of Science databases by using relevant keywords and their combinations. Studies representing different geographical areas of the world revealed that frequency rates of fibromyalgia are higher in inflammatory rheumatic diseases than those in the general population. Comorbid fibromyalgia interferes not only with the disease activity scores but also with the treatment outcomes and management plan. Further evidence is warranted in order to determine the potential benefits of biological disease-modifying antirheumatic drugs on fibromyalgia-related symptoms in patients with inflammatory rheumatic diseases.

Bone Mineral Density and Trabecular Bone Score in Patients with Non-Radiographic Axial Spondyloarthropathy

Background: spondyloarthropathies (SpA) are a group of chronic inflammatory rheumatic conditions that share multiple clinical features including axial and/or peripheral arthritis, enthesitis, absence of serum rheumatoid factor and presence of common extra articular manifestations. Objective: the aim of this work is to study bone mineral density and trabecular bone score at patients with nonradiographic axial spondyloarthropathy. Patients and Methods: this study is a cross sectional study in which 200 patients having chronic back pain selected from those attending the outpatient clinic and inpatient of Al-Azhar University Hospitals, Damietta and were divided into two groups: 1- (Group A, study group): (160) patients had inflammatory low back pain fulfilling Calin criteria for inflammatory low back pain. 2- (Group B, control group): (40) patients had mechanical low back pain not fulfilling criteria of inflammatory back pain. Results: regarding results of clinical examination, there was significant increase of arthritis, dactylitis, enthesitis and psoriasis in Group A when compared to Group B (43.3%, 16.7%, 30.0%, 20.0% vs 3.3%, 0.0%, 3.3% and 3.3% respectively). In addition, there was significant increase of arthritis plus dactylitis and arthritis plus enthesitis in Group A when compared to Group B (16.7%, 30.0% vs 3.3% and 0.0% respectively). Conclusion: results of the present study proved that, both bone mineral density and trabecular bone scores showed early changes in patients with non-radiographic axial spondylo-arthropathy. In addition, both correlated with each other and with results of axial magnetic resonance imaging. Thus, they are advocated in diagnosis of nr. SPA.

Bone Mineral Density and Trabecular Bone Score in Patients with Non-Radiographic Axial Spondyloarthropathy

Background: spondyloarthropathies (SpA) are a group of chronic inflammatory rheumatic conditions that share multiple clinical features including axial and/or peripheral arthritis, enthesitis, absence of serum rheumatoid factor and presence of common extra articular manifestations. Objective: the aim of this work is to study bone mineral density and trabecular bone score at patients with nonradiographic axial spondyloarthropathy. Patients and Methods: this study is a cross sectional study in which 200 patients having chronic back pain selected from those attending the outpatient clinic and inpatient of Al-Azhar University Hospitals, Damietta and were divided into two groups: 1- (Group A, study group): (160) patients had inflammatory low back pain fulfilling Calin criteria for inflammatory low back pain. 2- (Group B, control group): (40) patients had mechanical low back pain not fulfilling criteria of inflammatory back pain. Results: regarding results of clinical examination, there was significant increase of arthritis, dactylitis, enthesitis and psoriasis in Group A when compared to Group B (43.3%, 16.7%, 30.0%, 20.0% vs 3.3%, 0.0%, 3.3% and 3.3% respectively). In addition, there was significant increase of arthritis plus dactylitis and arthritis plus enthesitis in Group A when compared to Group B (16.7%, 30.0% vs 3.3% and 0.0% respectively). Conclusion: results of the present study proved that, both bone mineral density and trabecular bone scores showed early changes in patients with non-radiographic axial spondylo-arthropathy. In addition, both correlated with each other and with results of axial magnetic resonance imaging. Thus, they are advocated in diagnosis of nr. SPA.

040 The incidence of anxiety or depression in patients with and without inflammatory rheumatic conditions

040 The incidence of anxiety or depression in patients with and without inflammatory rheumatic conditions

Free Radicals and Antioxidants in Ankylosing Spondylitis

Free radicals are widely recognized as overloaded atoms, molecules or compounds that become unstable when lacking an electron;they steal an electron from various macromolecules (e.g. DNA, RNA, proteins) to chemically stabilize, while preferred targets remains polyunsaturated fatty acids in their membranes. When electron theft produces a chain reaction, normal cell processes turn into a real chaos that ultimately degrades the normal functioning of the cell. Variance of free radicals existing or formed in nature as a result of many processes (ultraviolet radiation, gamma, action specific particles, etc.) makes extremely difficult their classification. A partof the oxygen molecules (O2) that have entered the body through breathing is divided and oxygen atoms become reactive (free radicals) damaging the cell wall by oxidation. Oxidative stress, a term widely used to characterise inflammatory disorders caused by destructive oxygen molecules called free radicals, may exacerbate inflammation and impair immune system response due to free radicals. Oxidative stress is defined as the imbalance between oxidants and antioxidants, in favour of oxidants, with destructive and pathogenic potential. Depending on intensity, oxidative stress can occur inside or outside the cell. Intracellular stress can lead to cell necrosis or a more or less marked disruption of the cell, and may be catastrophic in the case of a non-reproducible cell; the extracellular oxidative stress is cytotoxic. Although considered in the pathobiology of several inflammatory immune-mediated rheumatic conditions, the exact role of oxidative stress in ankylosing spondylitis is still debatable.

Management of hepatitis B and C infections in rheumatologic disease.

Hepatitis B and C viruses present dual considerations in rheumatic disease as both etiologic factors and important comorbidities that must be assessed and addressed. This review summarizes the link between hepatitis B and arthritis and polyarteritis nodosa as well as hepatitis C and arthritis, Sicca syndrome and cryoglobulinemic vasculitis. Recent data pertaining to the antiviral management in these conditions, especially regarding the use of the direct-acting antivirals in hepatitis C, are also presented. Additionally, guidance on testing and treatment of hepatitis B and C as comorbidities in the context of systemic inflammatory rheumatic conditions and the use of disease-modifying antirheumatic therapy are discussed.

Switching to Biosimilars in Inflammatory Rheumatic Conditions: Current Knowledge

Biosimilars are more affordable versions of previously approved biopharmaceuticals that are designed to reduce healthcare expenditure and increase patient access to this therapeutic class. To achieve their economic potential, many European countries have started to switch patients from reference drugs to biosimilars. The purpose of this article is to provide a comprehensive perspective on the biosimilar switching controversy, to assess interchangeability regulation and switching policies, and to review current evidence on switching and immunogenicity in the context of inflammatory rheumatic conditions. Patients and physicians feel uncertain about switching highly complex and difficult-to-replicate biosimilars of monoclonal antibodies due to a theoretical risk of increased immunogenicity, especially in extrapolated indications and in a multiple switch scenario involving various biosimilars. However, past experience with smaller biosimilars (somatropin, filgrastim, epoetin), the high standards required for approval of biosimilars of monoclonal antibodies in the European market, and current evidence on switching to infliximab and etanercept biosimilars (especially CT-P13 and SB4) are reassuring. Furthermore, no increased immunogenicity has been reported after switching to biosimilars. Decisions on switching and interchangeability are not covered by the European Medical Agency (EMA) guidelines and are left to individual European states, as opposed to the U.S. Food and Drug Administration (FDA), which has set standards to assess interchangeability. In summary, current knowledge is in favour of switching to biosimilars but the authors consider that this should be a physician-led decision with the active contribution of patients and hospital pharmacists to the pharmacovigilance chain.

Management of inflammatory rheumatic conditions in the elderly.

The number of elderly people with chronic inflammatory rheumatic diseases is increasing. This heterogeneous and comorbid population is at particular risk of cardiovascular, neoplastic, infectious and iatrogenic complications. The development of biotherapies has paved the way for innovative therapeutic strategies, which are associated with toxicities. In this review, we have focused on the scientific and therapeutic changes impacting the management of elderly patients affected by RA, SpA or PsA. A multidimensional health assessment resulting in an integrated therapeutic strategy was identified as a major research direction for improving the management of elderly patients.

The INCLUDE study: INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community; identifying multimorbidity: Protocol for a pilot randomized controlled trial.

Background:Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed.Objective:To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care.Design:A pilot cluster randomized controlled trial will be undertaken to test the feasibility and acceptability of a nurse-led integrated primary care review for identification, assessment and initial management of common comorbidities including cardiovascular disease, osteoporosis and anxiety and depression. A process evaluation will be undertaken using a mixed methods approach including participant self-reported questionnaires, a medical record review, an INCLUDE EMIS template, intervention fidelity checking using audio-recordings of the INCLUDE review consultation and qualitative interviews with patient participants, study nurses and study general practitioners (GPs)Discussion:Success of the pilot study will be measured against the engagement, recruitment and study retention rates of both general practices and participants. Acceptability of the INCLUDE review to patients and practitioners and treatment fidelity will be explored using a parallel process evaluation.Trial Registration:ISRCTN12765345.

Isolation and identification of chemical compounds from stem and roots of Sesbania sesban

Sesbania sesban is a small perennial tree with woody stems, yellow flowers which is commonly known as Rawasan, family Leguminosae, is one of the restorative plant for inflammatory rheumatic conditions. This study on identification and characterization of isolated chemical compounds from n-butanol extract of root and stems of the plant S. sesban. This research is continued from previous research which is done by preliminary phytochemical screening and biological evaluations of extracts. The n-butanol extract was selected for compound isolation with column chromatography and identified by UV-VIS Spectrophotometer, FTIR, Mass and NMR Spectroscopic analysis. The results showed the isolated compounds identified as β-Sitosterol and Kaempferol.

New insights into the epigenetics of inflammatory rheumatic diseases.

Over the past decade, awareness of the importance of epigenetic alterations in the pathogenesis of rheumatic diseases has grown in parallel with a general recognition of the fundamental role of epigenetics in the regulation of gene expression. Large-scale efforts to generate genome-wide maps of epigenetic modifications in different cell types, as well as in physiological and pathological contexts, illustrate the increasing recognition of the relevance of epigenetics. To date, although several reports have demonstrated the occurrence of epigenetic alterations in a wide range of inflammatory rheumatic conditions, epigenomic information is rarely used in a clinical setting. By contrast, several epigenetic biomarkers and treatments are currently in use for personalized therapies in patients with cancer. This Review highlights advances from the past 5 years in the field of epigenetics and their application to inflammatory rheumatic diseases, delineating the future lines of development for a rational use of epigenetic information in clinical settings and in personalized medicine. These advances include the identification of epipolymorphisms associated with clinical outcomes, DNA methylation as a contributor to disease susceptibility in rheumatic conditions, the discovery of novel epigenetic mechanisms that modulate disease susceptibility and the development of new epigenetic therapies.

Healthcare utilization for arthritis by indigenous populations of Australia, Canada, New Zealand, and the United States: A systematic review☆.

Indigenous populations of Australia, Canada, New Zealand, and the United States of America (USA) experience a higher prevalence of arthritis conditions. Differences in clinical outcomes and mortality may reflect healthcare service use inequities. The objective of this study was to summarize healthcare service use patterns described in the existing literature in order to identify gaps and inform strategies to limit the pronounced negative impact of arthritis on Indigenous populations. Medline, EMBASE, CINAHL, and Indigenous-specific electronic databases (to June 2015) were used to identify cohort, case-control and cross-sectional studies describing healthcare service use by Indigenous populations with specified inflammatory arthritis, osteoarthritis, or rheumatic disease conditions. We extracted information on the study setting and methodology, primary outcome and assessed study quality, and risk of bias. In total, 19 studies were identified describing three types of healthcare service use: physician visits, hospitalizations, and surgeries. In Canada and New Zealand, Indigenous populations had 36-51% fewer visits to specialists than the non-Indigenous population. Indigenous populations in Canada, New Zealand, and the USA had 37-300% more hospitalizations due to arthritis complications than the non-Indigenous population. Indigenous populations in Australia, Canada, and New Zealand had 27-85% fewer arthroplasties for osteoarthritis than the non-Indigenous population. Indigenous populations had higher hospitalization rates but lower use of specialized services for arthritis conditions. Strategies to improve access to specialized arthritis services might reduce health outcome inequities.

Involvement of the multidisciplinary team and outcomes in inpatient rehabilitation among patients with inflammatory rheumatic disease.

BackgroundThe last decades have for patients with inflammatory rheumatic diseases seen a shift towards more physically active rehabilitation programs, often provided as out-patients with less use of inpatient facilities. There is little research on which effect the multidisciplinary team has on health outcomes for patients with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and connective tissue disease. This study examined patient reported outcomes for patients with inflammatory rheumatic diseases receiving rehabilitation care as inpatients in departments of rheumatology, and studied how number of consultations with the multidisciplinary team affected these clinical outcomes.MethodsPatients with inflammatory rheumatic diseases were included in a multi-center prospective observational study if rehabilitation was considered a focus during an inpatient stay at four departments of rheumatology. At admission, discharge, and after 3 and 6 months, 317 patients were assessed with patients reported outcomes (PRO) including health assessment questionnaire (HAQ), short-form 36 (SF-36), pain, fatigue, patient global assessment of disease activity, self-efficacy scales, rheumatoid arthritis disease activity index (RADAI), and SF-6D utility. Patients stated consultations with the multidisciplinary team.ResultsImprovements were short-lived, and at 6 months follow-up period only mental health, pain and utility remained improved with small effect sizes. Extensive involvement of health professionals was not associated with improved outcomes.ConclusionsPatients with inflammatory rheumatic disease receiving inpatient multidisciplinary rehabilitation had small and mainly short-term improvements in most PROs. High use of the multidisciplinary team did not enhance or preserve rehabilitation outcomes in inflammatory rheumatic conditions when admitted as inpatients.