Male Rheumatoid Arthritis Patients Research Articles

High Quantitative CRP And Low Albumin as Marker of Disease Activity in Patients with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by synovial tissue inflammation, leading to joint damage, pain, and systemic effects. Objective: To evaluate the utility of high quantitative C-reactive protein (CRP) and low serum albumin levels as markers of disease activity in RA patients. Methods: This cross-sectional study was conducted at the Department of Rheumatology, Khyber Teaching Hospital, Peshawar, from September 1, 2023, to February 29, 2024. Male and female RA patients aged 18 to 70 years were enrolled. Disease activity was assessed using the Disease Activity Score 28 (DAS 28). Serum CRP and albumin levels were measured and compared with DAS28 scores. Results: A total of 105 patients were included, with a majority being female (n=60, 57.1%). The mean age was 52.4 ± 9.8 years, with most participants aged between 40 and 50 years (n = 35, 33.3%). Elevated CRP levels were associated with increased disease activity, with an odds ratio of 1.82 (95% CI: 1.53 - 2.17, p < 0.001). Conversely, lower albumin levels were linked to higher disease activity, with an odds ratio of 3.47 (95% CI: 4.35 - 2.63, p < 0.001). Conclusion: Serum CRP and albumin levels serve as valuable indicators for assessing disease activity in RA patients, highlighting their potential role in clinical management.

Whole-hand and regional bone mineral density involvement in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by symmetric polyarthritis that can lead to joint deformity, disability, and osteoporosis. We aimed to evaluate whole hand and regional BMD in RA patients compared to controls. In addition, we evaluated the BMD of dominant versus non-dominant hands in healthy subjects. We included adult female and male RA patients and control subjects matched by age, sex, and BMI. BMD (g/cm2) was measured by DXA in lumbar spine (LS), whole hand, and three regions of interest: carpus, metacarpal bones, and phalanges. Results: 44 control subjects (49.5±11.8 y) and 60 with RA (52.7±12.7 y) were included. Significant lower BMD in RA patients was found in LS (−8.7%), dominant whole hand (−9.5%), carpus, metacarpal bones, and phalanges, and non-dominant whole hand (−8.7%), metacarpal bones, and phalanges compared to controls. A significant positive correlation was found between LS and whole-hand BMD (dominant r=.63, non-dominant r=.67). Finally, the whole hand, metacarpal bones, and carpus BMD measurements were significantly higher in the dominant hand compared to the non-dominant hand without differences in the phalangeal ROI. In conclusion, hand BMD was significantly lower in RA patients compared to control subjects and there was a significant correlation with LS BMD. We demonstrated that BMD measurements of the whole-hand, and different ROI (carpus, metacarpal bones, and phalanges) by DXA would be an easily reproducible technique to evaluate bone loss. In addition, the whole hand, metacarpal bones and carpus BMD measurements were significantly higher in the dominant hand compared to the non-dominant hand without differences in the phalanges.

Male rheumatoid arthritis patients at substantially higher risk for cardiovascular mortality in comparison to women

BackgroundPatients with rheumatoid arthritis (RA) are at an increased risk for developing cardiovascular diseases. While advice regarding cardiovascular risk screening and management in RA patients has been incorporated in several guidelines in recent years, its implementation and adherence is still poor. ObjectivesTo assess the cardiovascular disease risk in new diagnosed RA patients and evaluate whether advice to initiate preventive medical treatment of high risk patients was followed. MethodsAll patients with a recent diagnosis of RA, aged 40–70 years, were screened between May 2019 and December 2022 for cardiovascular diseases and risk factors within the first year after diagnosis at the outpatient rheumatology clinic, as part of standard care. Screening included a physical examination with blood pressure measurement, and laboratory tests with lipid profile tests. All patients and their general practitioner (GP) received an overview with their cardiovascular risk profile and a calculated 10-year cardiovascular mortality risk. Cardiovascular risk was defined as low (<1%), intermediate (1–5%), high (5–10%) and very high (>10%). The national pharmacy network was consulted to check whether or not patients started preventive medication after screening. ResultsA total of 125 RA patients was included in this study. The mean age was 56 years and 78% was female. Median RA disease duration at screening was 6 months. Six patients (5%) indicated to have been screened before, and used antihypertensive medication. During screening, hypertension was found in 57% of male patients and 43% of female patients and dyslipidemia was found in 36% in male and 32% in female patients. 46% of male patients and 21% of female patients currently smoked. A high or very high 10-year cardiovascular mortality risk was found in 50% of male patients, but in only 4% of female patients. Only 26% of (very) high risk patients started antihypertensive or statin medication after screening. ConclusionsAn increased cardiovascular disease risk is often present in newly diagnosed RA patients, especially male patients, with a large proportion having undiagnosed and untreated hypertension and hypercholesterolemia. Even with structural screening and informing of the patients and GPs, treatment of cardiovascular risk factors in high risk patients remains insufficient. CV risk screening needs to be part of standard care for RA patients, with clear agreement on the responsibilities between primary and secondary care. Awareness of the importance of CVD risk screening needs to improve among both RA patients themselves and the GPs to ultimately reduce the cardiovascular burden of our patients. Obviously, a better collaboration between GPs and rheumatologists is urgently needed to lower the cardiovascular burden of our patients.

Potential Cancer Risk in Patients with Rheumatoid Arthritis: A Longitudinal Korean Population-Based Analysis.

The potential link between rheumatoid arthritis (RA) and cancer incidence needs to be validated due to inconsistent results between Asian and Western countries. We explored the long-term association of RA with the overall and organ-specific cancer incidence using nationwide population data. This longitudinal follow-up study (2002–2015) included 3070 patients with RA and 12,280 controls (1:4 propensity score-matched for sex, age, residence, and income) from the Korean National Health Insurance Service-Health Screening Cohort database. A Cox proportional hazard model estimated the hazard ratio for malignancy following adjusting for covariates. Despite the similar overall cancer incidence between RA and control groups, differences in the incidence of organ-specific cancers were noted: the RA group had a 1.63-fold greater likelihood for lung cancer (95% confidence interval 1.11–2.40). In the sex-stratified subgroup analyses, the male RA patients exhibited higher odds of lung and thyroid cancer but a lower probability for colorectal cancer; no such associations were detected in either female patients with RA or age subgroups. In summary, the higher likelihood for lung cancer in Korean RA patients, especially thyroid and lung cancer in male RA patients, seems to be characteristic, which needs to be carefully monitored.

Tofacitinib monotherapy and erectile dysfunction in rheumatoid arthritis: a pilot observational study.

We aimed to explore the effect of tofacitinib on erectile dysfunction (ED), as well as disease activity and health related quality of life in male patients with rheumatoid arthritis (RA). Forty eight male RA patients with ED were included. Demographic and clinical data at baseline and 6 month of treatment were recorded from patients' medical records. Disease activity was evaluated with the disease activity score on 28 joints (DAS28), quality of life with Health Assessment Questionnaire-Disability Index (HAQ-DI) and ED with International Index of Erectile Function-5 (IIEF-5). The patients were aged 45.58 [Formula: see text] 2.14years with a disease duration of 79.33 [Formula: see text] 25.31months. According to the IIEF-5, 17 (35.4%) patients had severe ED, 10 (20.8%) patients moderate ED, 10 (20.8%) patients mild to moderate ED and 11 (22.9%) patients mild ED. For the entire patient group, baseline median IIEF-5 score was significantly increased from 9.35 (5.30-19.40) to 9.90 (5.20-24.90), baseline median DAS28 was significantly decreased from 5.65 (4.80-6.70) to 5.00 (2.40-6.40), HAQ-DI from 1.70 (1.10-2.40) to 1.15 (0.40-2.20) at 6th month of treatment (all p value < 0.001). Also, quantitative change in IIEF-5 was significantly correlated with changes in DAS28 (r:-0.735, p < 0.001) and HAQ-DI (r: -0.700, p < 0.001). Tofacitinib monotherapy may improve ED severity and as well as disease activity and health related quality of life in male patients with RA complaining of ED.

Composition of the body in male patients with rheumatoid arthritis with account of androgenic status

Aim. To evaluate alterations in body composition and bone mineral density (BMD) in male patients with rheumatoid arthritis (RA) taking into account their androgen status. Materials and methods. The single-stage study included 96 male RA patients. The mean age of patients was 59 [54; 64.75] years. The control group included 30 healthy men of comparable age. The androgen status assessment was based on sex hormone binding globulin (SHBG), total and free testosterone levels determination. Body composition and BMD measurements were performed using dual-energy X-ray absorptiometry (DXA) on the Stratos dR device (DMS, France) with the program “Whole Body”. Depending on the combination of BMD, lean- and fat-mass parameters, phenotypes of body composition were determined. The study was approved by Pirogov Russian National Research Medical University Local Ethics Committee. All patients signed informed consent.Results. Generally, lumbar spine, femoral neck and total hip BMD in RA patients was significantly less than in the control group (p&lt;0.05). In 69 (71.9%) patients with RA osteopenic syndrome was detected. It was represented by osteopenia and osteoporosis (OP) in 60.4% and 11.5% of cases respectively. The spine and femoral neck BMD correlated negatively with SHBG level, and positive correlation was detected between BMD and free testosterone level. The RA patients had significantly less lean mass than the control group. Low lean mass was found in 48.9% of patients in the main group and was not detected in the control group. Appendicular lean mass (ALM) correlated positively with total and free testosterone levels. According to DXA data, the adipose tissue content (%) corresponded to obesity in 63.3% of patients. Adipose tissue indicators correlated negatively with SHBG, total and free testosterone levels. The BMD of various skeleton parts correlated positively with trunk lean mass, and the femoral neck and total hip BMD had positive relationships with body mass index (BMI). Body composition alterations were revealed in 93.2% of RA patients. The most common phenotypes were osteosarcopenic obesity (25%), osteopenic obesity (21.6%) and osteopenic sarcopenia (14.8%). Conclusion. Our study shows that RA course in men is associated with the development of osteopenic syndrome in 71.9% of cases and ALM decrease to diagnostic values of sarcopenia in 48.9% of cases. This fact should be considered in the development of a gender approach to RA patients management and rehabilitation.

The impact of sex on susceptibility to systemic lupus erythematosus and rheumatoid arthritis; a bioinformatics point of view

The unknown etiology of systemic autoimmune diseases, such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA), with a remarkable predominance of female, have prompted many researchers for unveiling the precise molecular mechanisms involved in this gender bias. In fact, depending on hormones and transcribed genes from sex chromosomes, at least, the initial mechanisms involved in pathogenesis might differ largely. With the aim of elucidating the above mechanisms, we have tried to specify the differentially expressed genes (DEGs) extracted from microarray libraries from both female and male SLE and RA patients. Subsequently, the androgen and estrogen receptor elements (ARE and ERE) among differentially expressed transcription factors (TFs) and the DEGs located on X or Y chromosomes have been determined. Moreover, the pathways regarding the common DEGs in both sexes are enriched. Our data revealed several ARE and ERE-containing genes (LCN2, LTF, RPL31, RPL9, RPS17, RPS24, RPS27L, S100A8, ABCA1, HIST1H2BD, ISG15, MAFB, GNLY, EVL, and HDC) to be associated with the related autoimmune disease and sex. Also, two DEGs (KDM5D and RPS4Y1) in SLE patients were determined to be on Y chromosome with one had been proved to be associated with autoantigens in SLE. Altogether, our data showed a number of plausible pathways in both autoimmune conditions together with the relevance of several sex-related genes in the mentioned diseases pathogenesis.

Plasma expression of microRNA-425-5p and microRNA-451a as biomarkers of cardiovascular disease in rheumatoid arthritis patients

To validate in a cohort of 214 rheumatoid arthritis patients a panel of 10 plasmatic microRNAs, which we previously identified and that can facilitate earlier diagnosis of cardiovascular disease in rheumatoid arthritis patients. We identified 10 plasma miRs that were downregulated in male rheumatoid arthritis patients and in patients with acute myocardial infarction compared to controls suggesting that these microRNAs could be epigenetic biomarkers for cardiovascular disease in rheumatoid arthritis patients. Six of those microRNAs were validated in independent plasma samples from 214 rheumatoid arthritis patients and levels of expression were associated with surrogate markers of cardiovascular disease (carotid intima-media thickness, plaque formation, pulse wave velocity and distensibility) and with prior cardiovascular disease. Multivariate analyses adjusted for traditional confounders and treatments showed that decreased expression of microRNA-425-5p in men and decreased expression of microRNA-451 in women were significantly associated with increased (β = 0.072; p = 0.017) and decreased carotid intima-media thickness (β = −0.05; p = 0.013), respectively. MicroRNA-425-5p and microRNA-451 also increased the accuracy to discriminate patients with pathological carotid intima-media thickness by 1.8% (p = 0.036) in men and 3.5% (p = 0.027) in women, respectively. In addition, microRNA-425-5p increased the accuracy to discriminate male patients with prior cardiovascular disease by 3% (p = 0.008). Additionally, decreased expression of microRNA-451 was significantly associated with decreased pulse wave velocity (β = −0.72; p = 0.035) in overall rheumatoid arthritis population. Distensibility showed no significant association with expression levels of the microRNAs studied. We provide evidence of a possible role of microRNA-425-5p and microRNA-451 as useful epigenetic biomarkers to assess cardiovascular disease risk in patients with rheumatoid arthritis.

Decrease in handgrip strength in rheumatoid arthritis (RA): is there a sex-related difference?

Rheumatoid arthritis occurs two to three times more often in women than in men and it has been less studied in men. The results of gender influence on clinical course of the disease are contradictory. The aim of this study is to determine the difference in handgrip strength between female and male RA patients in comparison to healthy individuals. The study included 100 RA patients and 100 healthy individuals (50% were male in both groups). Handgrip strength was measured in both hands using a dynamometer. A two-way ANCOVA was used to analyse the data and age was included in the study as covariate. The results show that both male and female RA patients have lower handgrip strength compared to healthy individuals. The analysis of gender and disease interaction has shown that male RA patients have lower handgrip strength than female RA patients in comparison with the healthy group, age adjusted. This interaction is evident and statistically significant in both right hand (F 1, 195) = 14.62; p < 0.01) and left hand (F 1, 195) = 20.54; p < 0.01). The common-language effect size has shown that there is 92% (right hand) and 93% (left hand) chance that male individual will have stronger handgrip than his female counterpart. In RA patients, there is 77% chance for both hands that male will have stronger handgrip. Men and women with RA have significantly lower handgrip strength compared to healthy individuals and the difference is more pronounced in men which was not previously observed in the literature.

Evaluation Of The Relationship between Serum Uric Acid and Bone Mineral Density In Rheumatoid Arthritis Male Patients

Background: Hyperuricemia is a common risk factor for conditions associated with oxidative stress. Alternatively, there is increasing evidence that normal serum uric acid (UA) plays a protective role as an antioxidant. Osteoporosis was commonly attributed to oxidative stress and is a common complication of rheumatoid arthritis (RA). Objectives: To study the relationship between serum UA and bone mineral density in male patients with rheumatoid arthritis. Patients and methods: Fifty RA male patients were included in this study. Age, disease duration, and type of medication were recorded. Clinical examination for tender and swollen joints was done and disease activity score 28 was calculated. Body mass index, random blood glucose, erythrocyte sedimentation rate, C-reactive protein, serum UA, rheumatoid factor and anti-CCP were measured. Bone mineral density was measured using dual-energy X-ray absorptiometry at the lumbar spine, hip and radius. Results: A highly significant positive correlation between serum UA and T scores in the lumbar spine and hip. However, serum UA was negatively correlated with disease activity, ESR and CRP (P < 0.001). There was significant (P < 0.001) association between serum UA and different therapeutic agents (levels of serum UA were higher in patients taking combined biological and conventional disease modifying anti-rheumatic drugs (DMARDs) than those who were taking biological or conventional DMARDs alone. Conclusion: High normal serum UA level is protective against osteoporosis at both the lumbar spine and hip in male rheumatoid arthritis patients. Also, serum UA level is negatively correlated with RA disease activity and acute phase reactants in male patients with RA.

Association of P2X7 receptor genetic polymorphisms and expression with rheumatoid arthritis susceptibility in a sample of the Iranian population: a case-control study.

Rheumatoid arthritis (RA) is a complex inflammatory autoimmune disease with joint eruption, systemic manifestation, and numerous predisposing genetic factors. The P2X7 receptor is an essential ligand-gated channel that contributes to many physiological processes, especially inflammation. However, genetic variations can alter the P2X7 receptor function. Therefore, the present study aimed to explore the impact of P2X7 genetic polymorphisms and expression on susceptibility to RA in a sample of the Iranian population. We enrolled 160 (145 female, 15 male) RA patients and 160 (142 female, 18 male) healthy individuals in this study. Genotyping was performed using tetra amplification refractory mutation system-polymerase chain reaction (TARMS-PCR) for rs1718119, rs2230912, rs2393799, rs28360457, rs35933842, and allele-specific PCR for rs1653624 and rs3751143. Furthermore, 44 new cases of RA and 48 healthy controls were recruited to investigate whether P2X7 mRNA expression is associated with RA susceptibility. The results revealed that the rs2393799 significantly increased the risk of RA in all genetic models (p<0.05), while rs3751143 in codominant (CC vs. AA, OR=0.49, 95% CI=0.26-0.92), dominant (AC+CC, OR=0.59, 95% CI=0.37-0.94), C allele (OR=0.63, 95% CI=0.46-0.88), and rs2230912 in codominant (AG vs. AA, OR=0.56, 95% CI=0.34-0.94), dominant (AG+GG vs. AA, OR=0.59, 95% CI=0.35-0.99), and overdominant (AG vs. AA+GG, OR=0.57, 95% CI=0.33-0.98) significantly decreased the RA risk (p<0.05). Furthermore, the rs1718119 and rs1653624 were not associated with susceptibility of RA (p>0.05), and rs28360457 and rs35933842 were not polymorphic in our study. The mRNA expression level of P2X7 in both groups revealed that the P2X7 gene was significantly upregulated in RA (3.18±0.43) compared to healthy subjects (1.47±0.15, p<0.001). Our results suggest that rs2393799, rs3751143, and rs2230912 variants of the P2X7 gene are associated with RA's susceptibility in a sample of the Iranian population. Also, P2X7 mRNA expression was higher in our new RA patients. The P2X7 receptor has been considered as a potential pharmacologic target in RA. Key Points • P2X7 variants (rs2393799, rs2230912, rs3751143) were associated with RA susceptibility in a sample of the Iranian population. • rs2393799 increases the risk of RA, while rs2230912 and rs3751143 decrease the risk of RA. • P2X7 expression was significantly upregulated in new RA patients compared to controls.

Impact of Sex on Clinical Response in Rheumatoid Arthritis Patients Treated With Biologics at Approved Dosing Regimens.

The prevalence of rheumatoid arthritis (RA) is higher in females than in males. With the development of new treatment options and strategies such as biologics, we found it worthwhile to identify whether males and females warrant different treatment regimens to ensure the best clinical response. Our meta-analysis included 11 clinical trials of RA patients in support of the Food and Drug Administration's approval of 6 biological products. We evaluated the data of American College of Rheumatology 20 (ACR20) 24 or 26 weeks after treatment. Logistic regression models were applied to compute the odds ratio (OR) of treatment responses between sexes. The ORs of ACR20 response rates in males and females were similar across all studies and not significantly different in overall studies (OR, 1.05; 95% confidence interval, 0.96-1.16) analyzed with a fixed-effects model. Further analyses on the 7 ACR20 subcomponents showed high heterogeneity among studies (Q statistic P < .00007, I2 > 95%), with no observed clinically meaningful sex-related difference. Thus, our meta-analysis did not find significant difference in ACR20 response rates between male and female RA patients treated with biologics at approved dosing regimens. This result supports the current clinical practice of not requiring sex-dependent treatment regimens for RA patients.

Association of NCF2, NCF4, and CYBA Gene Polymorphisms with Rheumatoid Arthritis in a Chinese Population.

Objective Recent studies have focused on the special roles of NADPH-oxidase in multiple autoimmune diseases. Nevertheless, the association of genetic variation in NADPH-oxidase genes with rheumatoid arthritis (RA) was not extensively studied in a Chinese population. We performed this study to examine the association of NCF2, NCF4, and CYBA gene polymorphisms with RA susceptibility in a Chinese population. Methods Six single nucleotide polymorphisms (SNPs) (NCF2 rs10911363, NCF4 rs1883112, rs4821544, rs729749, CYBA rs3794624, and rs4673) were genotyped in a cohort composed of 593 RA patients and 596 normal controls. Improved multiple ligase detection reaction (iMLDR) was used for genotyping. Results We observed that NCF4 rs4821544 CT genotype and C allele frequencies in RA patients were significantly decreased when compared to controls (CT vs. TT: P = 0.043; C vs. T: P = 0.031), and rs4821544 polymorphism was significantly associated with an increased RA risk under the dominant model (TT vs. CT+CC: P = 0.031). Our results also indicated that rs729749 CT genotype frequency was significantly lower in RA patients than that in controls (CT vs. CC: P = 0.033). Moreover, the rs729749 CT genotype frequency was also significantly decreased in RA patients in males (CT vs. CC: P = 0.024). No significant association between NCF2 and CYBA gene polymorphisms and RA susceptibility was observed. There were significant associations between rs4821544 TT genotype and T allele frequencies and anti-CCP in male RA patients. Conclusions In summary, NCF4 rs4821544 and rs729749 polymorphisms might contribute to RA susceptibility, while NCF2 and CYBA gene polymorphisms were not associated with RA susceptibility.

Osteoporosis in patients with rheumatoid arthritis: trends in the German National Database 2007\u20132017

Osteoporosis is a frequent comorbidity in rheumatoid arthritis (RA). Due to the improved treatment options for RA, we expect a long-term decrease in osteoporosis as an accompanying disease. Data from the German National Database (NDB) were used to investigate whether the frequency of osteoporosis has changed in the last 10 years. From 2007 to 2017, approximately 4000 patients were documented annually with data on therapy and comorbidity. The cross-sectional data were summarised descriptively. Age, sex, disease duration, disease activity and glucocorticoids were considered as influencing factors. The Cochrane-Armitage test for trend was used to test whether the frequency of osteoporosis at the first visit changed from 2007 to 2017. Osteoporosis frequency in RA patients (mean age 63 years, 75% female) decreased from 20% in 2007 to 6% in 2017 (p < 0.001). The decrease affected women (22% to 17%) and men (14% to 8%) in all age groups and both short-term (≤ 2-year disease duration: 9% to 3%) and long-term RA patients (> 10-year disease duration: 28% to 20%). Patients with high disease activity and patients who took glucocorticoids (GC) were more often affected by osteoporosis than patients in remission or without GC. Drug prophylaxis in patients without osteoporosis increased (20% to 41% without GC, 48% to 55% with GC). Men with GC received less prophylactic treatment than women (48% vs. 57% in 2017). In this cohort, osteoporosis in patients with RA is less frequently observed compared to former years. RA-specific risk factors for osteoporosis such as disease activity and GC therapy have declined but long-term GC use is still present. Assessment of osteoporosis in RA patients should be investigated more consistently by bone density measurement. Male RA patients still need to be given greater consideration regarding osteoporosis drug prophylaxis, especially when GC therapy is needed.

Quantification of hand muscle volume and composition in patients with rheumatoid arthritis, psoriatic arthritis and psoriasis

BackgroundPsoriasis (Pso), psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are inflammatory diseases. PsA and RA are characterized by bone and muscle loss. In RA, bone loss has been extensively characterized, but muscle loss has, to the best of our knowledge, not been quantified to date.MethodsA random forest based segmentation method was used to analyze hand muscle volume in T1 weighted MRI images of 330 patients suffering from Pso, PsA or RA. In addition, fat volume was quantified using MRI Dixon sequences in a small subset (n = 32).ResultsMales had a higher relative muscle volume than females (14% for Pso, 11% for PsA, n.s. for RA). Between 40 and 80 years male Pso patients lost 13%, male PsA patients 16%, male RA patients 23% and female PsA patients 30% of their relative muscle volume. After adjustment for age, relative muscle volume in males RA patients was 16% and in female RA patients 9% lower than in Pso patients. In male RA patients relative muscle volume was 13% lower in than in male PsA patients. There was no difference in females. A significant negative correlation (R2 = 0.18) between relative intramuscular fat content relative hand muscle volume was observed.ConclusionThese preliminary data showed that relative hand muscle volume significantly decreased with age in male and female patients with Pso, PsA and RA patients. Independent of age, relative hand muscle volume was significantly smaller in patients with RA compared to the patients with Pso and the difference was twice as large in males compared to females. Also in male but not in female RA patients relative hand muscle volume was significantly smaller than in PsA patients.

Risk Factors and Changes of Peripheral NK and T Cells in Pulmonary Interstitial Fibrosis of Patients with Rheumatoid Arthritis.

Objective The absolute and relative changes of peripheral NK and T subsets are unclear in rheumatoid arthritis (RA) associated with pulmonary interstitial fibrosis (RA-ILD). To investigate the clinical risk factors, especially the changes of lymphocyte subsets, in RA-ILD in order to make early diagnosis and achieve prevention of the pulmonary interstitial lesions. Methods A total of 100 RA and 100 RA-ILD patients were enrolled. Rheumatoid factor, anti-cyclic citrulline peptide antibody, erythrocyte sedimentation rate, immunoglobulin, and C-reactive protein were examined. The percentage and absolute number of NK, T, B, Treg, Th1, Th2, and Th17 cells in peripheral blood were determined by flow cytometry. Results RA-ILD is more common in older and male RA patients and/or those with higher autoantibody titers. Flow cytometry showed that the absolute and relative numbers of CD56+ NK cells were significantly higher in RA-ILD (280.40 ± 180.51 cells/μl vs. 207.66 ± 148.57 cells/μl; 16.62 ± 8.56% vs. 12.11 ± 6.47%), whereas the proportion of T cells and CD4+ T cells was lower in peripheral blood of RA-ILD patients (69.82 ± 9.30%; 39.44 ± 9.87 cells/μl) than that in RA patients (74.45 ± 8.72%; 43.29 ± 9.10 cells/μl). Conclusions The occurrence of RA-ILD is closely related to the older male patients with high titer of various self-antibodies. Imbalance of CD3−CD56+ NK cells and T cells with other subsets were found in RA-ILD patients, which, together with older age, male, and high levels of autoantibodies should be considered as risk factors of pulmonary interstitial lesions.

The impact of gender on time to rheumatoid arthritis classification: a retrospective analysis of a population-based cohort.

The objective is to compare the time to fulfillment of 1987 and 2010 ACR/EULAR classification criteria between female and male patients with rheumatoid arthritis (RA) and to assess the potential impact of gender on the time to DMARD therapy. Time from first provider-documented joint swelling to fulfillment of 1987 and 2010 ACR/EULAR criteria was measured in a population-based cohort of adults with incident RA, who were stratified by male or female gender. Disease characteristics, time to start of DMARD therapy, and choice of initial DMARD were compared between groups. The study included 214 patients with RA (148 females and 66 males). Median times from first joint swelling to fulfillment of 1987 (6.5 vs 2.5days, p = 0.48) and 2010 (1 vs 0days, p = 0.34) classification criteria were not different between female and male patients overall. There was no difference in time to first DMARD therapy in female vs male patients (15.5 vs 16days, p = 0.90), and methotrexate was used most frequently as first DMARD in both genders (61% female vs 64% male, p = 0.76). Among the 49 female and 20 male RF/ACPA-negative patients, females experienced a higher median time from first joint swelling to fulfillment of the 1987 (65 vs 11days, p = 0.063) and 2010 (65 vs 0days, p = 0.035) classification criteria. Overall, there was no significant delay in meeting 1987 and 2010 ACR/EULAR classification criteria between female and male RA patients, though time to meeting both 1987 and 2010 criteria was slightly longer in males compared with females. Among seronegative patients, females experienced a significant delay to meeting 2010 criteria from first clinically detected synovitis.

Gender Impact on Rheumatoid Arthritis Disease Characteristics in A Cohort of Egyptian Patients

AbstractBackground: Rheumatoid Arthritis (RA) is a chronic inflammatory disease characterized by various extra-articular manifestations and progressive articular damage. It has been a common perception that RA is more severe in females, but the literature is not clear about gender difference regarding RA disease course and prognosis.Aim of Study: To compare between male and female patients with rheumatoid arthritis regarding demographic, clinical characteristics, laboratory features, treatment received as well as the functional disabilities.Patients and Methods: Two hundred and ten RA patients consecutively recruited from the Rheumatology Department outpatient Clinic, Cairo University Hospitals from December 2017 to May 2018. Patients were divided based on sex and were compared regarding clinical characteristics, laboratory features, medications received, disease activity score 28 (DAS28) and The Stanford Health Assessment Questionnaire (HAQ).Results: Out of our studied patients 176 (83.8%) were females and 34 (16.2%) males with male to female ratio 5:1. Female RA patients were statistically significant younger age (p=0.04) and statistically significant had lower hemoglobin level (p=0.00), also had higher number of Tender Joint Count (TJC) (p=0.4), higher DAS28 score (p=0.3), higher health assessment questionnaire score (p=0.5), and more frequently receiving methotrexate (p=0.3) than male RA patients although the differences did not reach statistical significance. On the other hand male RA patients were statistically significant more smoker (p=0.00), and statistically significant more frequently having subcutaneous nodule (p=0.004).Conclusion: Female RA patients demonstrated slightly worse levels of disease activity and functional disability, although the difference did not reach statistical significance.

β-cell Related Amyloidosis Localized to the Islets of Langerhans, Type II Diabetes Mellitus and Liponecrotic Pancreatitis in Rheumatoid Arthritis: A Postmortem Clinicopathologic Statistical Study of 234 Autopsy Patients

The aim of this study was to determine the prevalence of systemic AA amyloidosis (AAa), islet amyloidosis (IA) and liponecrotic pancreatitis (LnP) including acute liponecrotic (aLnP), acute relapsing liponecrotic (aRelLnP), and chronic liponecrotic pancreatitis (chrLnP) in rheumatoid arthritis (RA), and to analyse the possible relationship between them.Patients and methods: At the National Institute of Rheumatology 11558 patients died between 1969 and 1998; among them 234 with RA, and all of them were autopsied. RA was confirmed clinically according to the criteria of the American College of Rheumatology (ACR). The diagnosis of DM was based on clinical data. Tissue samples of pancreas were available for histologic evaluation in 164 of 234 patients. AAa, IA and LnP were diagnosed histologically. Demographics of different patient cohorts were compared with the Student (Welch) t probe. The relationships between AAa and IA, furthermore between IA and DM or LnP (including aLnP, aRelLnP, chrLnP) were analyzed by Pearson’s chi-squared (c2) test.Results: AAa complicated RA in 42 (25.61%) of 164 patients. IA localized to the islets of Langerhans was observed in 16 (9.76%) of 164 pancreases. Clinically diagnosed DM was associated with RA in 31 (18.90%) of 164 patients. Pancreatitis with multiple liponecrotic foci (LnP) was found in 19 (11.58%) of 164 patients; aLnP existed in 9 (47.37%), aRelLnP in 4 (21.05%), and liponecrotic foci in combination with chronic fibrotic pancreatitis (chrLnP) in 6 (31.58%) of these 19 patients.Discussion and conclusions: There was no significant difference between female and male RA patients associated with AAa, IA, DM and LnP. The age, sex and onset of disease did not influence basically the prevalence of AAa, IA, DM and LnP except male patients with IA, whose mean age at death was significantly higher than the general RA population. IA (fibrillar amyloid IAPP deposits -AIAPP) is related to the activity of b cells and may presumably be a faulty product of b-cells (normal islets of Langerhans do not contain IA deposits). The progressive deposition of IAPP prohormon fragments inhibits the function of b-cells because of their toxic effect and/or blocking mechanically the blood supply of b-cells and they “die in their own product”. The significant correlation between IA and DM refers to a close connection between them, but not necessarily a direct cause and effect relationship; it may be an indirect result of damaged (apoptotic) b-cells. The early stage of IA is characterized by minimal IAPP deposits involving only a few islets, which represents a clinically latent DM, and the advanced stage of IA is characterized by massive IAPP deposits involving most of the islets, which correspond to clinically manifest DM. Based on the positive and significant correlation between IA and clinically not diagnosed DM, IA may be a good indicator of potential DM in the latent stage of disease. Therefore we recommend that all biopsy material and surgical specimens of pancreas to be tested for IA or IAPP deposition.

Gender Differences in Cardiovascular Risk Profile in Rheumatoid Arthritis Patients with Low Disease Activity.

Objective Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular (CV) disease (CVD). The objective of the study was to compare CV risk profile in female and male RA patients with low disease activity. Materials and Methods The study group consisted of 70 RA patients with continuous low disease activity and no CVD (54 women, 16 men) and 33 healthy controls of comparable age. The groups were assessed for blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography, ejection fraction (EF), and diastolic dysfunction (DD). Results Significantly higher burden of atherosclerosis, as revealed by higher cIMT, was found in males [0.93 (0.2) mm] vs females [0.80 (0.2) mm]. The risk of 10-year CVD was significantly higher in men than in women with RA. High/very high risk of fatal CVD was found in 62.5% of male patients. Males were significantly more often current/ex-smokers and had lower HDL-cholesterol and higher atherogenic index. There were no significant differences in NT-proBNP, QTc duration, and parameters of EF and DD. Conclusions In RA patients with continued low disease activity, a higher burden of atherosclerosis was found in males than in females. The data suggest a significant impact of traditional CV risk factors.