Low Disease Activity Group Research Articles

Factors affecting patient activation among patients with systemic lupus erythematosus

There are limited published studies on patient activation among patients with systemic lupus erythematosus (SLE) in China. Disease activity can significantly influence a patient's perception of their condition, subsequently impacting patient activation. However, the mechanisms through which disease activity influences patient activation remain poorly understood. This study aimed to investigate patient activation among patients with SLE in China and explore the influencing factors. We conducted a cross-sectional study from June to December 2021 at a rheumatology and immunology department of a tertiary hospital in Chengdu, China. Data were collected by questionnaire, including general information, disease activity, quality of chronic illness care, health literacy, self-efficacy, motivation, social support, and patient activation. A patient activation model was constructed based on the conceptual framework derived from the individual and family self-management theory. To evaluate the moderating effect of disease activity on patient activation model, participants were divided into two subgroups (low disease activity group and high disease activity group). 426 SLE patients were included. The mean score of patient activation among SLE patients was 63.28 ± 11.82, indicating that most SLE patients lacked skills and confidence to stick with health-promoting behaviors. Health literacy, social support, and self-efficacy had the greatest effect on patient activation. In the multi-group analysis, social support and health literacy contributed more to patient activation in SLE patients with high and low disease activity, respectively. Patient activation among SLE patients in China was at the third level. Healthcare professionals should help them adhere to health-promoting behaviors. Health literacy, social support, and self-efficacy are vital factors for patient activation. These factors should be prioritized based on disease activity when developing individually tailored interventions for patient activation.

Ten-year radiographic and functional outcomes in rheumatoid arthritis patients in remission compared to patients in low disease activity

BackgroundTo compare the 10-year structural and functional prognosis between patients in sustained remission versus patients in sustained low disease activity (LDA) in early rheumatoid arthritis (RA).MethodsWe included 256 patients from the ESPOIR cohort who fulfilled the 2010 ACR/EULAR criteria for RA and who were in sustained remission using the Simple Disease Activity Index (SDAI) score (n = 48), in sustained LDA (n = 139) or in sustained moderate to high disease activity (MDA or HDA, n = 69) over 10 years. The mTSSs progression over 10 years and the 10-year HAQ-DI scores were compared between the 3 groups. A longitudinal latent process mixed model was used to assess the independent effect of SDAI status over time on 10-year mTSS progression and HAQ-DI at 10 years.ResultsPatients in sustained remission group were younger, had lower baseline HAQ-DI and mTSS scores and were less exposed to glucocorticoids, methotrexate or biologic disease-modifying anti-rheumatic drugs over 10 years. Patients in sustained remission had lower 10-year structural progression (variation of mTSS in the remission group: 4.06 (± 4.75) versus 14.59 (± 19.76) in the LDA group and 21.04 (± 24.08), p < 0.001 in the MDA or HDA groups) and lower 10-year HAQ-DI scores (10-year HAQ-DI in the remission group: 0.14 (± 0.33) versus 0.53 (± 0.49) in the LDA group and 1.20 (± 0.62) in the MDA or HDA groups, p < 0.001). The incidence of serious adverse events over 10 years was low, about 3.34/100 patient years, without any difference between the three groups.ConclusionRA patients in sustained SDAI remission have better long-term structural and functional outcomes in comparison to patients in sustained LDA.

Characteristics of pain and their relationship to disease activity in UK patients with Behçet's syndrome: a prospective cohort study.

Behçet's syndrome (BS) is a rare multi-systemic vasculitis of unknown aetiology. Fibromyalgia syndrome (FMS) is more prevalent in rheumatological conditions such-as BS, than the general population. However, there is limited research into the aetiology and characteristics of pain in BS. To describe the pain characteristics and incidence of FMS in people with BS and investigate their relationship with BS disease activity. A cohort study of BS patients attending the Liverpool Behçet's Centre between February 2017 and March 2019. BS was defined using the International Study Group Criteria. BS severity was assessed using the Behçet's Disease Current Activity Form. FMS was determined from consultant diagnosis. Assessments of pain included: Pain Visual Analogue Scale (PVAS), Pain Mannequin, Brief Pain Inventory, EQ-5D-3L and Short Form McGill. Pain and FMS prevalence were compared between high and low disease activity. 90% reported moderate-severe pain with a median PVAS score of 68/100 [38, 81]. 35.6% of participants had FMS and 46.5% experienced generalized pain. 76% of participants with high disease activity reported severe pain, compared to 39.1% with low disease activity (p = .003). Pain was more generalised in high disease activity (72%) compared to low disease activity (37.7%) (p = .003). FMS was more prevalent in the high disease activity group (52%) than the low disease activity group (29%) (p = .04). This is the first study to explore pain in participants with BS in the United Kingdom. The majority of BS patients experience moderate-severe widespread pain. Severe widespread pain is more prevalent in those with high disease activity. We have demonstrated a relationship between high disease activity, worse pain intensity, and FMS. This paper contributes to the understanding of two conditions which remain to be fully understood, FMS and BS, and generates new hypotheses to describe the interplay between.

Relationship Between Vitamin D and Neutrophil-Lymphocyte Ratio with Rheumatoid Arthritis Disease Activity

Introduction: Rheumatoid arthritis is a chronic inflammatory disease characterized by peripheral and symmetrical polyarthritis. Vitamin D deficiency has been linked to the course of several autoimmune diseases, and there is a link. In the process of autoimmune disease, the value of the neutrophil lymphocyte ratio is also known to be one of the parameters to assess the degree of activity. This study was conducted to assess the relationship between neutrophil lymphocyte ratio and rheumatoid arthritis disease activity. Method: This research is a cross-sectional study with a retrospective approach, conducted from January to March 2023. This research was conducted on rheumatoid arthritis sufferers at Haji Adam Malik Hospital, Medan. Subsequent research subjects underwent anamnesis and physical examination to assess the DAS28 score. Blood sampling for examination of the ratio of neutrophil lymphocytes and vitamin D was carried out at Haji Adam Malik Hospital. The data collected was then analyzed using SPSS version 26. Results: There were 67 research subjects with an age range of 43-47 years. The research subjects consisted of 20 men and 47 women. MTX treatment history in the remission group was 56.7%, in the low disease activity group was 80% and in the moderate disease activity group was 81%. Leflunomide treatment history in remission group 43.3%, low disease activity group 20% and moderate disease activity group 19%. Correlation test of vitamin D levels and rheumatoid arthritis disease activity showed a p-value of 0.380. Correlation test of neutrophil lymphocyte ratio and rheumatoid arthritis disease activity showed a p-value of 0.862. Correlation test of vitamin D levels and neutrophil lymphocyte ratio with DAS28 using the Spearman correlation showed­ p-values of 0.133. Conclusion: There was no significant relationship between vitamin D levels and neutrophil lymphocyte ratio with rheumatoid arthritis disease activity (p-value 0.133). Keywords: Vitamin D, Lymphocyte Neutrophil Ratio, DAS28, Rheumatoid Arthritis

Number of days required to measure sedentary time and physical activity using accelerometery in rheumatoid arthritis: a reliability study

This study aimed to determine the minimum number of days required to reliably estimate free-living sedentary time, light-intensity physical activity (LPA) and moderate-intensity physical activity (MPA) using accelerometer data in people with Rheumatoid Arthritis (RA), according to Disease Activity Score-28-C-reactive protein (DAS-28-CRP). Secondary analysis of two existing RA cohorts with controlled (cohort 1) and active (cohort 2) disease was undertaken. People with RA were classified as being in remission (DAS-28-CRP < 2.4, n = 9), or with low (DAS-28-CRP ≥ 2.4—≤ 3.2, n = 15), moderate (DAS-28-CRP > 3.2—≤ 5.1, n = 41) or high (DAS-28-CRP > 5.1, n = 16) disease activity. Participants wore an ActiGraph accelerometer on their right hip for 7 days during waking hours. Validated RA-specific cut-points were applied to accelerometer data to estimate free-living sedentary time, LPA and MPA (%/day). Single-day intraclass correlation coefficients (ICC) were calculated and used in the Spearman Brown prophecy formula to determine the number of monitoring days required to achieve measurement reliability (ICC ≥ 0.80) for each group. The remission group required ≥ 4 monitoring days to achieve an ICC ≥ 0.80 for sedentary time and LPA, with low, moderate and high disease activity groups requiring ≥ 3 monitoring days to reliably estimate these behaviours. The monitoring days required for MPA were more variable across disease activity groups (remission = ≥ 3 days; low = ≥ 2 days; moderate = ≥ 3 days; high = ≥ 5 days). We conclude at least 4 monitoring days will reliably estimate sedentary time and LPA in RA, across the whole spectrum of disease activity. However, to reliably estimate behaviours across the movement continuum (sedentary time, LPA, MPA), at least 5 monitoring days are required.

The feasibility of existing JADAS10 cut-off values in clinical practice: a study of data from The Finnish Rheumatology Quality Register

BackgroundThe ten-joint juvenile arthritis disease activity score (JADAS10) is designed to measure the level of disease activity in non-systemic juvenile idiopathic arthritis by providing a single numeric score. The clinical JADAS10 (cJADAS10) is a modification of the JADAS10 that excludes erythrocyte sedimentation rate (ESR). Three different sets of JADAS10/cJADAS10 cut-offs for disease activity states have been published, i.e., the Backström, Consolaro, and Trincianti cut-offs. The objective of this study was to investigate the performance of existing JADAS10 cut-offs in real-life settings using patient data from The Finnish Rheumatology Quality Register (FinRheuma).MethodsData were collected from the FinRheuma register. The proportion of patients with an active joint count (AJC) above zero when classified as being in clinically inactive disease (CID) or low disease activity (LDA) groups according to existing JADAS10/cJADAS10 cut-off levels were analyzed.ResultsA significantly larger proportion of the patients classified as being in CID had an AJC > 0 when using the JADAS10/cJADAS10 cut-offs by Trincianti et al. compared to those for the other cut-offs. In the LDA group, a significantly larger proportion of the polyarticular patients (35%/29%) had an AJC of two when Trincianti JADAS10/cJADAS10 cut-offs were used compared with when Backström (11%/10%) and Consolaro (7%/3%) JADAS10/cJADAS10 cut-offs were used.ConclusionsWe found the cut-offs proposed by Consolaro et al. to be the most feasible, since these cut-off levels for CID do not result in the misclassification of active disease as remission, and the proportion of patients with AJC > 1 in the LDA group is lowest using these cut-offs.

P533 Relation between TL1A expression in intestinal mucosa, and endoscopic severity and clinical course in ulcerative colitis

Abstract Background TL1A is a TNF super family member cytokine encoded by TNFSF15 and reported to be a disease susceptibility gene for IBD. The relationship between TL1A expression and IBD pathophysiology, clinical course, endoscopic findings was not sufficiently clear. The aim of this study was to clarify the correlation between TL1A expression in the intestinal mucosa of UC and endoscopic severity, clinical severity, and clinical course. Methods The subjects were patients with UC who were visiting our hospital. Mucosal samples were biopsied from rectum with lower gastrointestinal endoscopy, and TL1A gene expression was examined by RT-PCR. We analyzed the relationship between patients’ background, clinical symptoms, blood test findings, and mucosal activity and TL1A expression. Results A total of 77 specimens obtained with individual colonoscopy from 61 cases were included. Median age was 43, 36 cases were males, duration of disease was 2 years, the number of pancolitis was 54, median partial mayo score (pMayo) was 3, and the level of CRP was 1.5 mg/L. The number with Mayo endoscopic subscore (MES) of 0, 1, 2, and 3 were 14, 27, 24, and 12, respectively, and the mean TL1A expression was 1.76-, 1.09-, and 1.17-times higher in MES 1, 2, and 3 than in MES 0, respectively. TL1A expression was significantly higher in MES 1 than in MES 0 and MES 2. TL1A expression was significantly lower in the active group (pMayo 4 or higher) compared to the clinically low disease activity group (pMayo 3 or lower). TL1A expression was significantly lower with CRP ≥0.03 compared to CRP &amp;lt;0.03. TL1A expression was significantly higher in those with MES 1 at the initial onset than in those with MES 2 and 3. Eight cases were compared before and after induction therapy, and TL1A expression increased 1.9-fold after induction therapy. No correlation was found between the use of biologics and small molecular compounds and the expression of TL1A. Conclusion Relatively low activity in UC revealed higher mucosal expression of TL1A. TL1A is known to be secreted from various cell types such as macrophages and lymphocytes. It was suggested that the source of cell types and the amount of expression would alter according to the degree of inflammation.

Frequency of osteoporosis in Chinese patients with rheumatoid arthritis: a meta-analysis.

To evaluate the current frequency of osteoporosis (OP) in Chinese patients with rheumatoid arthritis (RA) through meta-analysis. The databases of PubMed, Web of Science, Cochrane Library, CNKI, Wan Fang, CBM, and VIP were searched for relevant literature regarding the occurrence of OP in Chinese patients with RA from January 1, 2000, to September 15, 2022. The literature was screened using inclusion and exclusion criteria, and qualifying articles were subjected to data extraction, quality evaluation, and meta-analysis using Stata 17.0 software. Altogether, 44 publications were included in this study, with a total sample size of 12,264 RA cases and 4532 patients with OP. Meta-analysis revealed that the frequency of OP in patients with RA was 37.67% [95% CI: 34.38%, 40.97%], while subgroup analysis showed that the frequency in South China was 49.43% [95% CI: 40.53%, 58.32%]. Also, the frequency in men was 29.29% [95% CI: 22.42%, 36.16%], which was significantly lower than in women (41.89% [95% CI: 36.87%, 46.90%]). The incidence rate in pre-menopausal women was only 15.19% [95% CI: 8.79%, 21.59%], much lower than the figure of 54.29% [95% CI: 45.28%, 63.30%] for post-menopausal women. Additionally, the frequency rates in the low, intermediate, and high disease activity groups were 24.52% [95% CI: 11.52%, 37.52%)], 27.67% [95% CI: 13.50%, 41.85%], and 57.96% [95% CI: 37.35%, 78.56%], respectively. The frequency of OP in the Chinese RA population is higher than the world average, and patients with RA should receive standardized anti-RA therapy at an early stage, with emphasis on bone health in postmenopausal women, patients with high disease activity or longer disease duration.

Relationship between plasma fibrinogen degradation products(FDP) and D-dimer levels and disease activity in rheumatoid arthritis: A STROBE compliant article.

In this study, we aimed to investigate whether fibrinogen degradation products(FDP)and D-dimer could be used as serological indicators of rheumatoid arthritis(RA) activity, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelets (PLT). A total of 112 consecutive patients with RA between July 2018 and July 2020 were divided into moderate and high disease activity groups (disease activity score 28(DAS28) > 3.2, n = 60) and low disease activity and remission groups (DAS28≤3.2, n = 52). A total of 50 healthy volunteers were included in the control group, and FDP and D-dimer levels were compared across the three groups. The correlations of FDP and D-dimer levels with ESR, CRP, PLT, and DAS28 were analyzed. Analyses of the receiver operating characteristic(ROC) curves and area under the ROC curve (AUC) of FDP, D-dimer, ESR, CRP, and PLT levels were performed. FDP and D-dimer levels were significantly higher in the high-activity compared to the low-activity and remission (P < .001), and the control (P < .001). No significant differences in FDP and D-dimer were observed between the low-activity and remission and the control (P > .05). FDP and D-dimer levels were positively correlated with ESR, CRP, PLT, and DAS28 (all P < .001). The ROC curves showed that the FDP and D-dimer levels could be used to evaluate the RA activity (all P < .001). The AUC of FDP was significantly larger than that of PLT (P = .047). FDP and D-dimer can be used as supplementary serological indicators to assess RA activity, in addition to ESR, CRP, and PLT.

The association between comorbidities and disease activity in patients with rheumatoid arthritis: a multicenter, cross-sectional cohort study in Japan with the highest proportion of elderly individuals

BackgroundThis study aimed to assess the association of disease activity with the presence of comorbidities in patients with rheumatoid arthritis, using the Akita Orthopedic Group on Rheumatoid Arthritis (AORA) registry, a multicenter, cross-sectional registry in Japan with the highest proportion of elderly people. We included 1838 patients (mean age: 66.4 years old) who visited our affiliated institutions between April 2018 and March 2019. The patients were divided into two groups based on the disease activity in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) into the remission or low disease activity group (L group) and the moderate or high disease activity group (H group). Patient demographics and comorbidities in the two groups were compared.ResultsThe most common comorbidity was hypertension (33.7%), followed by renal disease (25.2%), respiratory disease (12.2%), diabetes mellitus (8.1%), cardiovascular disease (8.0%), malignancies (5.7%), and cerebrovascular disease (4.7%). The H group was older (p<0.0001); had a higher prevalence of hypertension (p<0.0001), diabetes (p=0.0011), respiratory disease (p<0.0001), cerebrovascular disease (p<0.0001), and cardiovascular disease (p=0.0030); and was less likely to use anti-rheumatic drugs. The prevalence of comorbidities other than renal disease and malignant tumor was higher in the H group. Multivariate logistic regression analysis showed that female sex (p=0.0054), advanced Steinbrocker class (p<0.0001), high anti-citrullinated protein antibody levels (p=0.0211), high prednisolone dose (p<0.0001), and absence of biologics’ or JAK inhibitors’ use (p<0.0001) were risk factors for high disease activity, and shorter treatment period was a low-risk factor for high disease activity (p=0.0041). Among comorbidities, the presence of cerebrovascular disease (p=0.0334) was the only independent risk factor for high disease activity.ConclusionsIn our registry study with a high proportion of elderly RA patients, cerebrovascular disease was associated with high disease activity in patients with RA. Therefore, when treating elderly patients with RA, we need to pay careful attention to cerebrovascular disease, and treatment should be aimed at achieving adequate control of RA.

Association between ultrasound images and patient-reported outcomes in the treatment of rheumatoid arthritis: a retrospective study

BackgroundImprovements in the treatment of rheumatoid arthritis (RA) have made it possible to achieve treatment goals. It has been reported that both residual synovitis caused by RA and the patients’ subjective symptoms remain even after achieving the treatment goals; however, there are limited reports showing a relationship between them. Furthermore, no studies have evaluated the relationship between patient-reported outcomes (PROs) and subclinical synovitis measured by musculoskeletal ultrasonography (MSUS) in the treatment of RA. This study aimed to investigate residual symptoms and residual synovitis due to remission (REM) or low disease activity (LDA).MethodsWe performed MSUS on 300 patients with RA who attended our hospital for routine care, and we analysed them cross-sectionally by disease activity. Grayscale (GS) and power Doppler (PD) synovitis was evaluated in 22 bilateral hand joints using MSUS. We first performed univariate and multivariate analysis by dividing the data by disease activity. Next, we analysed each PRO in the obtained MSUS results.ResultsA multivariate analysis of high disease activity (HDA)/moderate disease activity (MDA) vs. LDA/ REM group identified tender joint count (TJC), pain visual analog scale (VAS) score, and presence or absence of GS score ≥ 2. The one-way analysis of the relationship between the presence or absence of GS score ≥ 2 and each PRO showed a significant difference. In contrast, a multivariate analysis of LDA vs. REM group identified TJC and fatigue VAS score. In REM, PROs alone were relevant, and there was no correlation with MSUS.ConclusionWe found that the residual inflammation in the ultrasound images was associated with PROs in the LDA group, but not in the REM group.Trial registration Retrospectively registered.

Evaluation of vitamin D profile in juvenile idiopathic arthritis.

To observe the association between serum vitamin D level and disease activity in juvenile idiopathic arthritis (JIA). The observational study was conducted at a tertiary care hospital during 2017-2019. Patients suffered from JIA were recruited through purposive sampling which was stratified by the disease activity based on the Juvenile Arthritis Disease Activity Score 27 (JADAS27) criteria. Serum vitamin D was estimated alongside other laboratory parameters. The numerical and categorical variables were analysed with appropriate statistical tests. 40 subjects were studied where inactive disease was observed in nine subjects (22.5%), five subjects (12.5%) were found to be in low disease activity and moderate disease activity groups each, and twenty-one subjects (52.5%) had high disease activity. Considering the total sample size of the study, the mean (SD) JADAS27 score and serum vitamin D level were observed to be 12.02 (11.31) and 23.10 (5.93) respectively. A negative correlation was found between the JADAS27 score and serum vitamin D (r= -0.67). The corrected Chi-square test had revealed significant association between the status of serum vitamin-D and disease activity groups (=16.28; p < .001). In JIA, higher grade of disease activity was found to be significantly associated with lower serum vitamin D.

Validity of systemic lupus erythematosus disease activity score (SLE-DAS) for definition of lupus low disease activity state (LLDAS).

SLE disease activity score (SLE-DAS) is a novel, rapid, continuous and comprehensive score that overcomes the drawbacks of SLEDAI-2K. Low lupus disease activity state (LLDAS) has been targeted as an endpoint in many clinical trials and as a favourable outcome in clinical practice. Therefore, our objective in the current study is to evaluate the validity of SLE-DAS for defining LLDAS as an objective in the treat-to-target strategy. A cross-sectional study was carried out on 117 SLE patients who were diagnosed according to Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. Patients were evaluated for disease activity by both SLEDAI-2K and SLE-DAS. Additionally, patients were divided according to the SLEDAI-2K-derived LLDAS definition into two groups: low disease activity (LDA) group and high disease activity (HDA) group. The validity of SLE-DAS for the definition of LLDAS was evaluated in comparison to SLEDAI-2K. SLE-DAS shows highly significant positive correlation (r = 0.743, p < 0.001) with SLEDAI-2K. The ROC curve revealed that SLE-DAS is valid for the assessment of activity with the best detection of LLDAS was at 6.62 with 95.5% sensitivity, 79.3% specificity and 89.6% accuracy. Moreover, it had a good agreement with the SLEDAI-2K-derived definition of LLDAS (k = 0.765, p < 0.001). SLE-DAS is a valid score for the definition of LLDAS which can be used in the clinical practice as a simple and precise standalone criterion. Key Points • Correlation between SLEDAI-2K and SLE-DAS revealed a high significance. • Identify SLE-DAS cut-off 6.62 for the definition of LLDAS. • There is a good agreement between SLEDAI-2K-derived definition of LLDAS and SLE-DAS definition.

The role of body muscle mass as an indicator of activity in inflammatory bowel disease patients

Malnutrition is an objective disease activity parameter for patients with inflammatory bowel disease (IBD), particularly Crohn's Disease (CD), and is an indicator of lesion expansion or inflammatory activity. Active disease is correlated with the systemic response of the body's immune system, activating a hypermetabolic state and protein degradation (Argiles JM, 2015). These conditions lead to malnutrition, which significantly increases the risk of impaired clinical outcomes, such as delayed recovery or increased mortality (Landi F, 2019). Our aim was to identify malnutrition parameters associated with more pronounced metabolic status changes in IBD patients (i.e., classified as by low and high clinical activity) as an indicator of disease activity. This prospective pilot study included hospitalised patients aged ≥18 years, with an established diagnosis of IBD, with no medical history of surgical interventions. IBD patients were divided into those with low clinical activity indexes (CD activity index [CDAI] <150 for CD and Mayo <4 for ulcerative colitis [UC]) and those with high clinical activity indexes (CDAI >150 for CD and Mayo >4 for UC). Patients were assessed twice using the Nutritional Risk Score (NRS2002) and Malnutrition Universal Screening Tool (MUST) and 48 body bioelectrical impedance analysis (BIA) measurements were taken. A control group consisting of heathy age- and sex-matched individuals was used for comparison. Fifty hospitalised patients (median age, 36.5 IQR: 28.5-51.5 years) were enrolled, of which 44% (n=21) were female and 56% (n=27) were male. Of these, 48% (n=23) patients were diagnosed with CD and 52% (n=25) with UC. The median CDAI was 128 (IQR=6.0-207.0) and Mayo score was >4 (IQR=1.0-8.0). The study group comprised 48% (n=23) patients with low IBD activity and 52% (n=25) of patients with high IBD activity. According to the NRS2002, 31% (n=15) patients were nutritionally at risk and in need of nutritional support and an additional 24% (n=12) had low-risk requiring observation, without necessity for additional nutritional care. According to the MUST score, 40% (n=19) of patients had a high-risk of malnutrition requiring a nutritional care plan and 19% (n=9) were of low-risk. Overall, 31% (n=17) of patients received enteral oral feeding and 10% (n=4) required additional parenteral feeding. The group with low IBD activity showed a considerably lower score on both screening tools (NRS2002 p=0.007; MUST p<0.001). Comparing BIA results between IBD patients and the control group, the median BMI was lower for the CD (21.10 [IQR=19.2-23.3]) than for the control group (23.4 [IQR=21.5-25.8]) (p=0.014). In addition, visceral fat mass was lower in CD (-4,00 [IQR=-12.1 to 5.6]) than in the control group (7.85 [IQR=-0.9-18.2]) (p=0.003). In terms of deviation from standard weight, 39% (n=9) of CD patients showed reduced %body fat, while this was observed in only 19% (n=5) of UC patients. Reduced muscle mass was observed in 48% (n=11) of CD patients and in 19% (n=4) of UC patients, while only 13% (n=6) of all IBD patients had reduced BMI. IBD patients with high disease activity indices had a noticeably increased risk for malnutrition (according to NRS2002 scores), taking into consideration not only IBD activity, but also increased weight loss and loss of appetite. Most CD patients in both the low and high disease activity groups had reduction in muscle mass, which was not evaluated in UC patients. Identification of the reduction in soft lean muscle mass in CD patients can be used as an anticipatory indicator of disease activity.

Short-term transcutaneous non-invasive vagus nerve stimulation may reduce disease activity and pro-inflammatory cytokines in rheumatoid arthritis: results of a pilot study

Objective: Rheumatoid arthritis (RA) is a chronic, autoimmune, inflammatory disease. Studies suggest that pro-inflammatory cytokines may be attenuated by the vagus nerve through the cholinergic anti-inflammatory pathway. We aimed to evaluate the anti-inflammatory effects of short-term transcutaneous non-invasive vagus nerve stimulation (n-VNS) applied to the cervical vagus nerve in patients with RA. Method: We conducted a single-centre, open-label, preliminary proof-of-concept study of n-VNS in two cohorts of participants with RA: one with high disease activity (n = 16) and one with low disease activity (n = 20). Disease Activity Score based on 28-joint count–C-reactive protein (DAS28-CRP), cardiac vagal tone, and pro-inflammatory cytokines were measured at baseline and after 1 and 4 days of n-VNS. Results: In the high disease activity group, n-VNS resulted in reductions in DAS28-CRP (4.1 to 3.8, p = 0.02), CRP (8.2 to 6 mg/mL, p = 0.01), and interferon-γ (29.8 to 22.5 pg/mL, p = 0.02). In the low disease activity group, there was no effect on DAS28-CRP, and n-VNS was associated with a decrease in cardiac vagal tone (p = 0.03) and a reduction in interleukin-10 (0.8 to 0.6 pg/mL, p = 0.02). Participants with high disease activity had lower baseline cardiac vagal tone than those with low disease activity (3.6 ± 2 vs 4.9 ± 3 linear vagal scale, p = 0.03). Cardiac vagal tone was negatively associated with DAS28-CRP (r = −0.37, p = 0.03). Overall, n-VNS was well tolerated. Conclusion: This study provides preliminary support for an anti-inflammatory effect of n-VNS in patients with RA. These findings warrant further investigation in larger placebo-controlled trials.

Increased Serum Interleukin-2 Levels Are Associated with Abnormal Peripheral Blood Natural Killer Cell Levels in Patients with Active Rheumatoid Arthritis.

Objective To investigate the relationship between serum interleukin-2 (IL-2) levels and disease activity, absolute numbers of peripheral lymphocyte subsets, autoantibodies, and associated cytokines in patients with rheumatoid arthritis (RA). Methods This study included 106 patients with RA, evaluated their disease activity (DAS28 score), and divided them into disease remission (DAS28 ≤ 2.6), low disease activity (DAS28 ≤ 3.2), and moderate-high disease activity (DAS28 > 3.2) groups. Flow cytometry was used to detect the absolute numbers of peripheral lymphocyte subpopulations and CD4+ T cell subsets in each group, and serum cytokine levels were measured using cytometric bead array. Results Serum IL-2 levels in RA patients were positively correlated with disease activity and rheumatoid factor titers (p < 0.001 and p = 0.045, respectively), and multiple regression analysis revealed that serum IL-2 levels were an independent factor affecting disease activity. Serum IL-2 levels were positively correlated with Th17/Treg ratios (p = 0.013). Compared with the remission group, peripheral lymphocyte and CD4+ T lymphocyte subsets in patients with active RA decreased to varying degrees; however, the numbers of peripheral natural killer (NK) cells were significantly higher in the moderate-high disease activity group than in the remission (p = 0.046) and low disease activity (p = 0.020) groups; the percentages of NK cells had the same trend. In addition, the number and percentage of NK cells were positively correlated with serum IL-2 levels (p = 0.018 and p = 0.006, respectively). Conclusions In RA patients, serum IL-2 levels were not only correlated with patients' disease activity and autoantibody levels but were also involved in their Th17/Treg immune imbalance. In addition, in patients with active RA, NK cell levels were abnormally elevated, possibly due to high serum levels of IL-2.

Correlation of Sympathovagal Imbalance with Disease Activity and Inflammatory Markers in South Indian Patients with Rheumatoid Arthritis

Background and Aim: Rheumatoid arthritis (RA) patients have higher risk of cardiovascular disease and mortality and that is not linked to traditional cardiovascular risk factors. Altered sympathovagal balance is associated with cardiovascular disease. In RA sympathovagal balance and inflammatory markers were reported to be increased, but there is inadequacy of data on its assessment and association with disease activity. This study was conducted to find the correlation of sympathovagal balance with disease activity and inflammatory markers in South Indian patients with RA. Methods: RA patients (diagnosis of RA made as per 2010 ACR/EULAR classification criteria) were enrolled from Department of Clinical Immunology, JIPMER. Participants were sub grouped as low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (HDA) using disease activity score 28 with ESR. Frequency and time domain parameters of heart rate variability and inflammatory markers like Interleukin-1α (IL-1α), Interleukin-6 (IL-6), tumor necrosis factor-α (TNFα) and cortisol were measured for all the participants. Results: A total of 143 RA patients (23 in LDA group, 69 in MDA group and 51 in HDA group) were assessed during the study. LF-HF ratio (ratio of low frequency power to high frequency power) a marker of sympathovagal balance showed significant increase in MDA and HDA group compared to LDA group. LF-HF ratio correlated positively with DAS28 (r=0.473, p<0.001), cortisol (r=0.363, p<0.001), IL -1α (r=0.379, p<0.05). Conclusion: Sympathovagal imbalance was significantly increased in the MDA and HDA group compared to LDA group and positively correlated with disease activity, IL-1α and cortisol in the patients of RA. Assessment of sympathovagal balance may help to find the autonomic dysfunction and cardiovascular risk in RA.

Time-averaged disease activity of rheumatoid arthritis associated with long-term bone mineral density changes.

Background:Rheumatoid arthritis (RA) is associated with poor bone mineral density (BMD). We designed the current study owing to the lack of long-term prospective studies regarding whether a high disease activity leads to increased bone loss.Methods:We have continually enrolled patients with RA. According to the average disease activity score in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) during follow-up, the patients were classified into remission, low disease activity, and moderate or high disease activity groups. Patients were examined with dual-energy X-ray absorptiometry at baseline and after 3 years of follow-up. BMD changes were compared among the groups.Results:We have studied 477 patients. Overall BMD was significantly reduced from baseline to the 3-year follow-up (p < 0.05). After stratifying according to the time-averaged DAS28-ESR levels and use of anti-osteoporosis treatment (AOT), the BMD values of the femur and spine significantly increased in patients in the remission group with AOT. The BMD changes of different DAS28-ESR patients were further compared using the generalized estimation equation model. For the patients on AOT, the negative change in femoral BMD values of the moderate or high activity group was significant when compared with the remission group with positive BMD changes (regression coefficient, –0.038; 95% confidence interval, –0.055 to –0.021).Conclusion:For RA patients, if remission is achieved, AOT can better improve BMD, especially in the femur. In addition, moderate or high disease activity will lead to significant bone loss; therefore, disease activity must be actively controlled.

Pooled analysis of TNF inhibitor biosimilar studies comparing radiographic progression by disease activity states in rheumatoid arthritis

ObjectiveTo evaluate the relationship between disease activity and radiographic progression in rheumatoid arthritis, three phase III studies of SB4, SB2 and SB5 (biosimilars of etanercept, infliximab and adalimumab) were pooled...

Relation of Disease Severity with Neutrophil Lymphocyte Ratio and Mean Platelet Volume in Rheumatoid Arthritis

Objective: Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by symmetrical erosive synovitis. The neutrophil to lymphocyte ratio (NLR) and mean platelet volume (MPV) have been widely used to determine the severity of inflammation. Objectives: We aimed to investigate NLR and MPV values in RA population further assessing the relation between these indices, inflammatory markers and disease activity scores. Material and Methods: The present study was performed between March 2012 and March 2013, and designed retrospectively. Total 156 patients of RA were included. Results: The NLR was higher in active disease group but there was not significant difference between the remission group and active disease group (p: 0.616). Also NLR of low disease activity group, moderate disease activity group and high disease activity group were 1.98±0.71, 2.26±1.04, and 3.11±2.16 respectively. There is significant difference between groups (p: 0.030). The MPV of remission group and active disease group were 8.54±0.78 fl and 8.89±0.99 fl, respectively and there is no significant difference between both groups (p: 0.126). Also the MPV of remission group, low disease activity group, moderate disease activity group and high disease activity group were 9.31±1.09 fl, 8.91±0.98 fl, 8.71±0.97 fl, respectively. Although MPV is reduced in patients with higher disease activity, it was found that there was no significant difference between the groups (p: 0.206). Conclusions: NLR can be a useful marker to assess disease activity in RA patients. Increased NLR values ​​may indicate increased disease activity. Whereas, there is a need for comprehensive studies to claim that average platelet volume as an indicator of disease severity in RA patients.