Involvement In Rheumatoid Arthritis Patients Research Articles

What is the Link between Lung Involvement and Anti-CCP Antibodies in Rheumatoid Arthritis: A Cross-sectional Study.

In Rheumatoid Arthritis (RA), pulmonary involvement is one of the most frequent extra-articular manifestations. Several studies have demonstrated an association between RA-related lung disease and the positivity of anti-cyclic citrullinated peptide (anti-CCP) antibodies. Our aim is to describe the frequency of pulmonary involvement in the RA population and investigate the association between anti-CCP antibodies and diverse lung compartment involvement in RA patients. An observational retrospective cross-sectional study was conducted, during which data were collected from the medical records of the patients with RA who had been tested for anti-CCP antibodies and had thoracic high resolution computerized tomography (HRCT) evaluation from January 2011 to March 2022. The univariate and multivariate analyses using logistic regression models was performed to calculate odds ratios (ORs) with 95% CIs. A total of 390 patients with RA were included, the mean age of patients was 58.99 ± 12.44 years, with a predominance of females (85.9%). Two hundred and fifty-two (64.6%) patients were positive for anti-CCP antibodies. The frequency of RA-related lung diseases was 14.4% (n=56). The different manifestations observed in the thoracic HRCT included Nodules (67.9%), Interstitial lung disease (ILD) (28.6%), bronchiectasis (25%), fibrosis (21.4%), obliterative bronchiolitis (7.1%), and pleuritis (1.8%). In univariate and multivariate analysis, pulmonary involvement was associated with positive anti-CCP antibodies with an odds ratio (OR) of 5.25 (95% CI: 2.17-12.70, p < 0.0001). The study demonstrated a positive association between anti-CCP antibodies and pulmonary involvement in RA and highlighted the importance of tight monitoring in RA patients with positive anti-CCP for pulmonary complications.

Pulmonary functions test in asymptomatic rheumatoid lung disease patients: a hospital-based study

BackgroundAs a common extra-articular symptom of rheumatoid arthritis (RA), pulmonary involvement affects 20–67% of patients and accounts for 10–20% of RA-related deaths. This study aimed to assess the impact of RA on pulmonary function tests (PFTs) in Sudanese RA patients attending the rheumatology clinics of the Omdurman Military Hospital.MethodsThis was an analytical, cross-sectional, hospital-based study of 32 RA patients who met the 2010 Rheumatoid Arthritis Classification Criteria of the American College of Rheumatology (RA ACR/EULAR) and who were nonsmokers and free of known respiratory or chronic diseases. Pulmonary function parameters (PFTs), including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the FEV1/FVC ratio, and the peak expiratory flow rate (PEFR), were measured for each participant using a digital spirometer. A control group of Sudanese subjects of similar age, sex, and height was matched, and the results were compared with normal reference values.ResultsA high prevalence of lung function abnormalities (93.8%) was observed in RA patients, and 6.2% of them had normal PFT parameters. Restrictive lung disease was recorded in 78.1% of the patients, and obstructive lung disease was observed in 15.7% of the patients. All measured PFT parameters in the RA patients were significantly lower than the published reference normal values for Sudanese subjects, except for the FEV1/FVC ratio. The mean values of FEV1, FVC, the FEV1/FVC ratio, and the PRFR in RA patients were 1.8 ± 0.3 L/min, 2.1 ± 0.4 L/min, 87.1 ± 12.2%, and 223.6 ± 86.2 L/min, respectively, compared to 2.4 ± 0.1 L/min, 2.7 ± 0.1 L/min, 90.81 ± 2.6%, and 345.4 ± 16.2 L/min, respectively, in the control group (P values of 0.001, 0.001, 0.299, and 0.001, respectively). There was no statistically significant correlation between PFT results and disease duration, age, or BMI.ConclusionsRegardless of the duration of RA, restrictive lung abnormalities are frequent in asymptomatic RA patients. The PFT can serve as an indicator of RA. Spirometry has been advised as a baseline examination and for follow-up and to promote the early detection and management of pulmonary involvement in RA patients.

The assessment of atlantoaxial joint involvement in patients with rheumatoid arthritis, results from an observational “real-life” study

Atlantoaxial joint is a possible affected site during rheumatoid arthritis (RA) and, in this work, we evaluated its occurrence and associated characteristics in a “real-life” cohort. By a medical records review study of RA patients longitudinally followed-up, the occurrence of severe atlantoaxial joint involvement was estimated (incidence proportion and incidence rate per 1000 person-years at risk). Regression analyses were also exploited to evaluate possible associated factors. Based on these findings, a prospective recruitment was performed to build a descriptive cross-sectional study in evaluating a subclinical atlantoaxial joint involvement in patients with the same clinical characteristics. Retrospectively, 717 patients (female 56.6%, age 64.7 ± 12.3 years) were studied. The incidence proportion of severe atlantoaxial joint involvement was 2.1% [1.5–2.5], occurring in 15 out of 717 patients, and identified by both MRI and CT scan. Considering over 3091 person-years, an incidence rate of 5.2 × 1000 [2.9–8.3] person-years was estimated. Regression analyses suggested that male gender, a longer disease duration, ACPA positivity and extra-articular manifestations resulted to be significantly associated with a severe atlantoaxial joint involvement. Given these findings, 30 asymptomatic patients were selected according to these clinical characteristics and underwent MRI of cervical spine. To date, almost 50% of these asymptomatic patients showed a subclinical atlantoaxial joint involvement. The occurrence of the severe atlantoaxial joint involvement in RA patients was estimated in a “real-life” setting. Male gender, ACPA positivity, long disease duration, and extra-articular manifestations could be associated with the severe atlantoaxial joint involvement in RA. MRI could provide a useful clinical tool to early evaluate the atlantoaxial joint involvement in RA, also in asymptomatic patients.

Causal effects of rheumatoid arthritis or ankylosing spondylitis on membranous nephropathy: a two-sample Mendelian randomization study.

Membranous nephropathy (MN) is the leading cause of adult-onset nephrotic syndrome, with primary MN of unclear cause accounting for 80% of cases. Retrospective clinical research reported that MN occurring in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients was triggered by nephrotoxic drugs or of unknown cause. However, whether RA or AS itself increases the risk of developing MN is unknown. We conducted mendelian randomization (MR) analysis to evaluate the causal effects of RA or AS on MN using genome-wide association study (GWAS) statistics. The inverse variance weighted (IVW) method was the primary analysis, and several supplementary analyses and sensitivity analyses were performed to test the causal estimates. We obtained 30 valid instrumental variables (IVs) of RA and 16 valid IVs of AS from large-scale open-access GWASs. The genetically predicted RA significantly increased the risk of MN [IVW odds ratios (OR)=1.327, 95% confidence interval (CI)=(1.124, 1.565), P=8.051×10-4]. Three supplementary MR analyses provided the consistent positive causal effect of RA on MN (all P<0.05). No horizontal pleiotropy was detected by MR Egger intercept analysis (P=0.411). However, the genetically predicted AS had no causal effect on MN by IVW and supplementary analysis (all P>0.05). Genetically predicted RA could increase the risk of MN, but genetically predicted AS was not associated with MN. Screening for kidney involvement in RA patients should be noted, and active treatment of RA will reduce the public health burden of MN.

Application of impulse oscillometry to detect interstitial lung disease and airway disease in adults with rheumatoid arthritis

BackgroundWe conducted a retrospective observational study to explore the potential application of impulse oscillometry (IOS) as an alternative to high-resolution computed tomography (HRCT) for detecting pulmonary involvement in patients with rheumatoid arthritis (RA) because clinically evident interstitial lung disease (ILD) and airway involvement are common in this population.MethodsWe enrolled 72 patients with RA who underwent pulmonary function tests (PFTs) and IOS between September 2021 and September 2022. We aimed to identify the PFT and IOS variables associated with lung diseases shown on HRCT images.ResultsIn our cohort of 72 patients, 48 underwent HRCT; of these, 35 had airway disease or ILD and 13 showed no obvious abnormalities on HRCT. Abnormal IOS and PFT parameters were observed in 34 and 23 patients, respectively, with abnormal HRCT images. The predicted percentages for forced vital capacity, the ratio of forced expiratory volume in the first one second to forced vital capacity, and forced mid-expiratory flow value were significantly lower in patients with abnormal HRCT. Lung resistance at 5 Hz, difference in resistance between 5 and 20 Hz, resonant frequency (Fres), and reactance area were higher in these patients and reactance at 5 Hz was lower. Compared to other parameters, Fres > 14.14 was significantly associated with alterations in HRCT and may be used as an indicator for monitoring disease.ConclusionFres > 14.14 is significantly associated with lung involvement in RA patients. Performance of spirometry with IOS is more beneficial than spirometry alone for evaluating lung involvement in RA patients.

Cost and Complications in Rheumatoid Arthritis Patients Undergoing Primary Hip Arthroplasty: A National Inpatient Sample-Based Study.

Rheumatoid arthritis (RA) is an autoimmune disease that affects multiple synovial joints in the body, including the hip. Hip involvement in RA patients is fairly common, but the current literature is lacking large-scale studies on the surgical outcomes of RA patients undergoing total hip arthroplasty (THA). The aim of the study is to examine the outcomes and hospital costs associated with THA in patients with RA and compare them to patients without RA using the National Inpatient Sample (NIS) database. We analyzed the NIS database to identify patients undergoing THA between 2016 and 2019 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Multiple variables including demographics, medical comorbidities, total hospital costs, length of stay, and perioperative complication rates were then compared between patients with and without RA. Further, the two groups were matched for demographic differences, if any, using a 1:1 propensity match algorithm. Patients with RA undergoing THA were significantly younger and predominantly female when compared to patients without RA. There was also a lower incidence of obesity and the percentage of elective THAprocedures were smaller in the RA group. The RA group had a longer length of stayand increased incidences of blood loss anemia, blood transfusion, and periprosthetic fractures. These differences persisted despite matching the two groups for demographic differences, elective procedures, diabetes, obesity, and tobacco usage. THA in RA is associated with an increased incidence of blood loss anemia, blood transfusion, and periprosthetic fractures, as well as a longer length of stay in THA patients.

Pulmonary Manifestations In Patients With Rheumatoid Arthritis Visiting Tertiary Care Hospital.

Rheumatoid arthritis is a common problem in elderly individuals. It is reported that lung involvement in these patients is widely present. This study was done with the purpose to assess the burden and characteristics of lung involvement in rheumatoid arthritis patients attending rheumatology clinic. This descriptive cross-sectional study, in which data was retrospectively collected, was carried out from April 2019 to December 2020 at the Rheumatology Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All adult rheumatoid arthritis individuals, irrespective of gender or duration of disease, were consecutively enrolled. Information regarding the baseline characteristics, medication history for rheumatoid arthritis, findings of immunological tests along with the frequency of lung involvement and its pattern were observed. Of 254 patients, the mean age was 37.46 ±12.39 years. Females were predominantly higher as compared to males, i.e., 232 (91.3%) vs. 22 (8.7%) respectively. Current smoking status was found positive in 7 (2.8%) patients. The mean disease duration was 4.41±3.96 years. Furthermore, frequency of pulmonary manifestation was observed in 45 (17.7%) patients. A significantly higher mean difference of age (p-value <0.001) and disease duration (p-value <0.001) was observed among patients with and without pulmonary manifestation. Moreover, a significant association of current smoker was also observed with pulmonary manifestation. A considerable number of patients with rheumatoid arthritis had pulmonary manifestation. Furthermore, a significant relationship was observed with age, duration of disease, and current smokers.

Awareness of temporomandibular joint involvement in rheumatoid arthritis patients by physicians dealing with rheumatology

The aim of this study is to evaluate the attitudes and awareness of physicians dealing with rheumatology about temporomandibular joint (TMJ) involvement while evaluating rheumatoid arthritis (RA) patients with the TMJ questionnaire we created. For this purpose, an online TMJ evaluation questionnaire consisting of 10 questions was prepared and completed by the physicians via the Google Forms application. Among those who participated in the survey; the percentage of correct answers to the question of whether the TMJ joint is a synovial joint was 95.5%. While the rate of those who correctly knew that more than half of the RA patients had TMJ involvement remained at 35.5%, the rate of those who correctly identified that RA rarely affected the first TMJ was 75.5%. The rate of those who knew that TMJ involvement is frequently bilateral in RA was 62.7%. The number of participants who answered the question of what the clinical findings are in TMJ involvement correctly was over 60%. When asked about radiological findings in TMJ involvement in RA, more than 75% of the participants expected joint space narrowing, erosion, and mandibular destruction. On the other hand, the number of physicians who expected radiological findings such as ostephitis and sclerosis as radiological findings was below 40%. While the number of physicians who performed TMJ inquiries and examinations in RA patients was only 15.5%, if there was a TMJ complaint, this rate increased to 80%. The number of participants using objective tests for the evaluation of TMJ was below 30%. Also, 85.5% of the participants ignored TMJ involvement in RA. In conclusion, our study showed that physicians dealing with rheumatology have low awareness of TMJ involvement in RA.

Corneal complications of rheumatoid arthritis.

Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects the joints. Extra-articular manifestations (EAMs) are common and may affect up to 40.6% of patients. Ocular EAM can occur in 39% of the patients. The cornea is involved by different pathogenic mechanisms and corneal disease varies from mild symptoms to severe corneal ulceration and melting with visual loss. Severe corneal involvement is associated with increased mortality in RA patients. We aimed to review the prevalence, mechanisms, management and overall impact of corneal involvement in RA patients. Corneal involvement is frequent among RA patients. With the wider use of systemic immunosuppression, in particular the disease-modifying antirheumatic drugs (DMARDs), and with improvement of surgical techniques, spontaneous and surgery-related corneal ulceration and melting is becoming less common. However, RA patients are still at risk and should be carefully managed. RA-related corneal complications are associated with a decreased quality of life and poor ocular and systemic prognosis. Prompt recognition and a multidisciplinary approach involving topical ophthalmic management and systemic immunosuppression are the key factors to maintain ocular integrity and avoid a lethal outcome.

Rheumatoid arthritis overlapping systemic sclerosis with interstitial lung disease

Lung disease is the second most frequent extra articular manifestation in rheumatoid arthritis (RA) patients. It can be present in up to 80% RA cases and represents a major cause of morbidity and mortality. One of the most common types of lung involvement in RA patients is the interstitial lung disease (ILD). Computed tomography studies show evidence of ILD in a large proportion of patients with RA (over 50% in some studies) and it can be clinically symptomatic in 5% of cases. The CT aspect classifies four forms of ILD, listed in order of frequency: usual interstitial pneumonia (UIP) - the most common form, non-specific interstitial pneumonia (NSIP), organizing pneumonia (OP) and diffuse alveolar damage (DAD) which is the least common form. We present a long-standing case of rheumatoid arthritis overlapping systemic sclerosis with interstitial lung disease.

Rheumatoid Arthritis and Associated Lung Diseases: A Comprehensive Review

Rheumatoid arthritis (RA) is a prevalent autoimmune disorder affecting 0.5-1% of the population in North America and Europe. Pulmonary manifestations in rheumatoid arthritis patients result in significant morbidity and mortality. Management of these pulmonary manifestations in RA patients causes various challenges for the physicians. This review article has discussed the current state of knowledge of these pulmonary manifestations, including interstitial lung diseases, airway-related diseases, pulmonary vasculature, and pleural involvement in RA patients. This review article has also explored various pharmacological options, including steroids, disease-modifying antirheumatic drugs (DMARDs), immunosuppressive drugs, and biologic agents. Non-pharmacological options include conservative treatment, supplemental oxygen, pulmonary rehabilitation, smoking cessation, and lung transplantation.

Subclinical entheseal involvement in patients with rheumatoid arthritis

BackgroundEnthesopathy is a common feature of Spondyloarthritis (SpA) but can also be found in rheumatoid Arthritis (RA). Recognizing enthesopathy could be challenging because of low sensitivity and specific clinical testing. To detect enthesopathy, The European League Against Rheumatism (EULAR) recommends magnetic resonance imaging (MRI) or ultrasonography (US). Aim of the workTo investigate the frequency and distribution of entheseal involvement in RA patients and its relation to disease activity. Patients and methods100 RA patients with any symptom in foot and ankle were enrolled. Disease activity score (DAS28), Visual analogue scale (VAS), Health assessment questionnaire-Disability index (HAQ-DI) and Glasgow Ultrasound Enthesitis Scoring System (GUESS) were assessed. ResultsThe mean age of patients was 44.1 ± 12.2 years, disease duration was 7 ± 5.8 years and 86% were females. The mean DAS28 score was 4.3 ± 1.2 and GUESS score was 7.2 ± 4.2; all patients had variable degrees of enthesitis: 30% of patients had mild enthesitis, 42% had moderate enthesitis and 28% had marked enthesitis. GUESS was significantly higher in patients with moderate (7.8 ± 4.9) and high (7.2 ± 3.2) disease activity than in patients with low disease activity (5.2 ± 3.9) and those in remission (6.5 ± 1.9) (p = 0.015). HAQ, Age and ESR significantly correlated with GUESS score (r = 0.19, p = 0.049; r = 0.23, p = 0.023; r = 0.33, p = 0.001 respectively). ConclusionSubclinical enthesitis is remarkable in RA patients. Quadriceps tendon enthesis was mostly affected. Enthesitis is significantly related to age, ESR and HAQ. The presence of enthesitis in RA may represent a potential marker for disease activity.

Frequency of distribution of joint involvement in rheumatoid arthritis patients.

Objectives: To determine the frequency of joint distribution in rheumatoid arthritis presenting at Independent University Hospital Faisalabad. Assessment of joint involvement in RA patients is not only important to determine the disease activity but also to assess the future joint damage. Study Design: Cross Sectional Study. Setting: Independent University Hospital Faisalabad. Period: July 2019 to Jan 2020. Material &amp; Methods: 384 consecutive RA patients fulfilling inclusion and exclusion criteria, of either sex between age of 17- 60 years were enrolled from Rheumatology division of Independent University Hospital Faisalabad from July 2019 to Jan 2020. Frequency of joint distribution was assessed. Chi square test was used to compare the frequency of joint distribution among different treatment groups, age groups and gender, disease duration. A p-valve of &lt; 0.05 was considered statistically significant. Results: In this study 384 patients with RA were studied. Joint distribution was determined according to pattern of joint involved at presentation. More patients (178) were noted in oligoarticular group, with predominant small joint involvement 111 (28.9%). 173 patients were noted in poly-articular group with 102 (26.6%) were in predominant small joint involvement. Conclusion: Pattern of joint distribution in RA patients is very important especially if there is monoarthritis or oligoarthritis, along with its association with gender, age of onset, disease duration, investigations.

Assessment of cervical spine involvement in rheumatoid arthritis patients in the era of biologics: a real-life, cross-sectional MRI study

Cervical spine involvement may lead to severe complications in rheumatoid arthritis (RA). In the era of modern therapies, atlantoaxial subluxation (AAS) may be rare; however, it may still be detected in asymptomatic patients. The onset of myelopathy can occur at any time. Altogether 49 female RA patients were included. Among them, 15 were methotrexate treated, biologic free, while 34 patients received biologics. The patients had no cervical pain or any neurological symptoms. We assessed the first (C1) and second (C2) cervical vertebrae by 3 T magnetic resonance imaging (MRI). In addition to AAS, we also determined odontoid erosion or periodontal soft tissue thickening. We associated our MRI findings with clinical, laboratory parameters, and hand radiography. We detected anterior AAS and soft tissue thickening in one-quarter, while odontoid erosions in eight (16%) of RA patients. There were no significant differences among the therapeutic subgroups. No posterior or vertical AAS was seen. Anterior AAS was associated with higher degree of inflammation, soft tissue thickening was seen at younger age, while odontoid erosions were associated with van der Heijde–Sharp scores of the hand. None of the patients had any lesions requiring surgery. The presence of cervical involvement in RA patients with 10–11 years of disease duration is still an important and frequent phenomenon. Higher disease activity and erosive disease are associated with atlantoaxial involvement. 3 T MRI is a sensitive method to assess AAS, as well as soft tissue lesions and odontoid erosions.

Rheumatoid Arthritis Related Interstitial Lung Disease: Patterns of High-resolution Computed Tomography.

Background and aimRheumatoid arthritis (RA) is a chronic inflammatory systemic disease characterized by bilateral involvement of mostly small joints of hands and feet. There can be various extra-articular manifestations of the disease including lung parenchymal disease. Pulmonary involvement in RA patients leads to increased morbidity and mortality. The overall burden of RA related pulmonary disease is underestimated due to the limitation of resources in underdeveloped countries. High-resolution computed tomography (HRCT) is an important tool used to diagnose different abnormalities in RA related interstitial lung disease (ILD). The objective of the study was to evaluate HRCT findings in patients of RA related ILD and categorize the radiological findings according to clinical findings.MethodThis descriptive prospective observational study was conducted at Mayo Hospital, Lahore from June 2014 to June 2015. Patients of RA suspected of lung disease after selection underwent HRCT chest on 128-slice Hitachi CT scanner (Hitachi Global, Tokyo, Japan) in the radiology department. Images were reconstructed and evaluated by experienced radiologists. Findings were recorded on a questionnaire. Data was analyzed on SPSS version 21 (IBM Corp, Armonk, US).ResultsOut of the 54 patients scanned, interlobular septal thickening was the most common finding found in 22 of the patients. Ground-glass opacification was recognized in 21 patients, honeycombing in nine and bronchiectasis in two patients. Regarding zonal predilection of disease pattern, lower zones of lungs were found involved in most of the cases. The disease was found to be bilateral in 15 patients. Based on these findings, usual interstitial pneumonitis (UIP) was diagnosed in six patients and non-specific interstitial pneumonitis (NSIP) in 14 others.ConclusionThis study concluded that HRCT images are very useful in diagnosing interstitial lung disease related to rheumatoid arthritis.

The prevalence of temporomandibular joint involvement in rheumatoid arthritis patients: A cross-sectional study

Objectives: Temporomandibular joint (TMJ) involvement in rheumatoid arthritis (RA) patients has been described in the literature; however, its incidence varies greatly. In this study, we aimed to determine the prevalence and clinical characteristics of TMJ involvement in RA patients.Materials and Methods: The present study consisted of 60 individuals with RA. The patients were assigned to two groups, based on TMJ involvement: patients with TMJ involvement and patients without TMJ involvement. We defined TMJ involvement based on the findings of the questionnaires and clinical examination by a rheumatologist. The symptoms and signs were recorded by a single trained dentist.Results: The majority of the participants were women (n=49, 81.66%), with the mean age of 43.9±15.52 years (range: 21-78 years). Thirty-five patients (58.3%) had clinical evidence of TMJ involvement. The levels of C-reactive protein (CRP) and rheumatoid factor (RF) were found to be correlated with TMJ involvement. There was no significant correlation between TMJ involvement and erythrocyte sedimentation rate (ESR), age, gender, treatment duration, and disease duration.Conclusion: The high level of CRP in RA patients with TMJ involvement was reported. TMJ pain was reported in almost half of the patients. There was also a significant correlation between TMJ involvement and RF.

Radiographic changes in TMJ in relation to serology and disease activity in RA patients.

This study was undertaken as an attempt to assess radiographic temporomandibular joint (TMJ) changes in relation to rheumatoid factor (RF), anticitrullinated protein (ACCP) antibodies and disease activity score 28 (DAS28) in rheumatoid arthritis (RA) patients to find the best predictor of rheumatoid affection of the TMJ with the ultimate goal of maintaining TMJ function and preventing joint damage. 20 Rheumatoid Arthritis patients as well as 20 volunteers were included in this study. RA group were assessed for RF, ACCP, DAS28. Both groups were assessed by CBCT for TMJ dimensions and radiographic osteoarthritic changes. All data were statistically analyzed. Rheumatoid Arthritis group showed significantly less condylar height and more radiographic osteoarthritic changes than the control group. RF showed no significant correlation with either TMJ measurements or TMJ radiographic osteoarthritic changes. ACCP showed significant inverse correlation with condylar height and anteroposterior (AP) dimensions, but non-significant relation with mediolateral dimension and radiographic osteoarthritic changes. DAS28 showed significant inverse correlation with condylar AP and mediolateral dimensions. It also showed significant correlation with flattening of the TMJ condylar head and flattening of the articular fossa. Patients with high and moderate disease activity showed significantly smaller AP TMJ dimension than patients with low disease activity. Disease activity showed statistically significant direct correlation with all osteoarthritic changes except for erosions of the glenoid fossa and condyle. Disease Activity Score28 score and disease activity are strong indicators of TMJ affection in RA patients when compared to RF and ACCP. ACCP is a better indicator of changes in condylar measurements than TMJ osteoarthritic changes. While RF is the least efficient indicator of TMJ involvement in RA patients.

Central nervous system involvement in rheumatoid arthritis patients and the potential implications of using biological agents.

Central nervous system (CNS) involvement is quite unusual in patients with rheumatoid arthritis (RA), although cerebral vasculitis, rheumatoid nodules and meningitis have all been reported, and patients with RA may also have CNS comorbidities such as stroke and neuro-degenerative and demyelinating syndromes. It has been found that biological drugs, especially anti-tumour necrosis factor-alpha (anti-TNF-α) drugs, slightly increase the risk of developing demyelinating diseases, and they are consequently discouraged in patients with multiple sclerosis and related disorders. Furthermore, the risk of opportunistic CNS infections is increased in immunosuppressed patients. To review the current literature concerning CNS involvement in patients with RA (including RA-related forms and comorbidities) and the incidence of new-onset CNS diseases in patients with RA undergoing biological treatment (anti-TNF or non-anti-TNF drugs), the Medline database was searched using the key words 'rheumatoid arthritis', 'central nervous system', 'anti-TNF', 'abatacept', 'tocilizumab', 'rituximab' and 'anakinra'. Abstracts not in English were excluded. We selected 76 articles published between 1989 and 2017, which were divided into four groups on the basis of whether CNS involvement was RA-related or not and according to the type of biological agent used (TNF inhibitors or other agents). The RA-related diseases included aseptic meningitis, vasculitis and cerebral rheumatoid nodules, which benefit from immunosuppressive treatments. CNS comorbidities included stroke, seizures, dementia and neuropsychiatric disorders, which have been frequently described in biological agent-naïve patients with RA, and other rarely reported neurological diseases, such as extra-pyramidal syndromes and demyelinating disorders. CNS comorbidities are relatively frequent among patients with RA and may be related to systemic inflammation or concomitant medications. The use of anti-TNF drugs is associated with the risk of developing demyelinating diseases, and CNS infections have been described in patients treated with anti-TNF and non-anti-TNF agents. Non-anti-TNF drugs may be preferred in the case of demyelinating diseases, cerebral vasculitis or neurolupus. Patients with RA may suffer from CNS involvement as a manifestation of RA or as a comorbidity. The treatment of such medical conditions should be guided on the basis of their etiopathogenesis: steroids and immunosuppressants are useful in the case of RA-related CNS diseases but are often detrimental in other situations. Similarly, the choice of biological agents in patients with RA with CNS complications should be guided by a correct diagnosis in order to prevent further complications.

Pattern of pulmonary function test in rheumatoid arthritis patients

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by a painful symmetrical peripheral polyarthritis. Extra-articular involvement in RA is a common condition. Pulmonary involvement occurs in 20 to 67 % of RA patients and it is responsible for about 10-20 % of mortality in RA patients. Objectives: To evaluate the extent and pattern of pulmonary involvement in RA patients by using spirometry. Methods: A case control study conducted at the rheumatology unit of Al Sader teaching hospital, forty RA patients [33(82.5%) female and 7(17.5%) male] and sixty apparently healthy subjects {50(83.3%) female and 10(16.7 %) male} were included in the study. All subjects had subjected to a pulmonary function test (PFT) for pulmonary function evaluation using MIR spirolab III. Measured and predicted forced vital capacities (FVC), forced expiratory volume in the first second (FEV1) and FEV1 / FVC ratio were considered as the parameters in this study for both groups. Results: Nine patients were found to have a restrictive pattern of pulmonary function test, while obstructive pattern was found in only one patient. On the other hand, the pulmonary function tests were normal in all of sixty healthy control. The mean of FEV1 in patient group (2.07 ± 0.56L) and of FEV1% (95.8%  25.2) are significantly lower than those in the control group (2.46 ± 0.65 L; 105.3%  13.09). In addition, mean FVC in the patient group (2.35 ± 0.62L) and its mean percentage (92%  22.68) showed a clear significant reduction compared to those in control group (2.71 ± 0.67 L; 100.53  12.12). No significant difference (P = 0.173) has been observed in FEV1 / FVC ratio between patient (88.17  7.47) and control group (89.87  4.99). Conclusions: Different pattern of pulmonary function abnormalities could be manifested in RA patients and the restrictive pattern represents the most common feature. Spirometry is indicated as a baseline assessment and for follow up of RA patient to enhance early detection and management of the pulmonary involvement.

Evaluation of anti-mutated citrullinated vimentin antibodies, anti-cyclic citrullinated peptide antibodies in patients with rheumatoid arthritis in comparison with other rheumatic diseases; a nephrology point of view

Introduction: Rheumatoid arthritis (RA) is one of the most common autoimmune rheumatic disease with a chronic and progressive inflammatory disorder manifestations leading to articular cartilage damage, and disability, and also renal involvement. It seems that recruitment of tests based on high specific and sensitive serological immunobiomarkers removes these mentioned gaps. Additionally, the results of laboratory tests, assist to reach an accurate prognosis and real estimation of the patient’s clinical statue especially hospitalized individuals in intensive care units. Objectives: The aim of this study is assessment and titration of some autoantibodies as anti-mutated citrullinated vimentin (anti-MCV), anti-cyclic citrullinated peptides (anti- CCP), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in RA patients in comparison to patients with other forms of rheumatologic diseases. Patients and Methods: This descriptive study was conducted from January to June 2012 in Zanjan province on 100 patients with RA and 100 patients with other rheumatic disease that were randomly selected. All necessary data of clinical history for the patients was extracted from their medical records. After delivering antecubital venous blood (7 mL) to hematology ward of laboratory, quantative ELISA test was performed for autoantibodies. Results: Anti-MCV tests showed 72% positivity in RA group compared to 10% positivity in other group of rheumatic diseases. There was a significant correlation between positivity of anti-MCV and RA disease. Mean anti-MCV titer is 236.23 ± 2.319 U/mL in RA group and 28.75 ± 0.432 U/mL in other disease group. In this study anti-MCV antibodies had diagnostic sensitivity of 81.7% (versus anti-CCP), diagnostic specificity of 72.22%, positive and negative predictive value 93.05% and 46.42%, respectively. Conclusion: According to results of this study, not only anti-MCV measurement but also anti-CCP assist to early diagnosis of RA. Results of the recent study could not show definite correlation between anti-MCV and disease activity. The result of this study may be helpful for renal involvement in RA patients, whereas evaluation on this aspect of RA patients seems essential.