Number Of Painful Joints Research Articles

Efficacy and safety of levilimab in the treatment of patients with rheumatoid arthritis

Evaluation in real clinical practice of the effectiveness and safety of levilimab therapy in patients with highly and moderately active rheumatoid arthritis (RA). A prospective observational study (6 months) involving 35 patients with RA (29 women and 6 men, mean age 53.17±13.2 years) who were treated at the Ochapovsky Regional Clinic Hospital of Krasnodar Region. All patients included in the study were prescribed the drug levilimab (Ilsira). After 1 month of observation, there was a decrease in the clinical and laboratory activity of the process in the form of a decrease in the number of painful joints - 17.0 (14.0; 20.0) vs 8.0 (6.0; 10.0); p=0.000001, number of swollen joints - 3.0 (2.0; 4.0) vs 0.0 (0.0; 0.0); p=0.000002, reduction in pain intensity according to visual analog scale - 60.0 (60.0; 70.0) mm vs 30.0 (20.0; 40.0) mm (p=0.000001). Also, by the end of the first month of therapy, there was a decrease in clinical activity indices DAS28-ESR by 43%, SDAI by 60%, CDAI by 55%. Positive dynamics of laboratory parameters were noted - a decrease in erythrocyte sedimentation rate by 76%, a decrease in C-reactive protein level by 98%. By the 6th month of therapy, a decrease in RF by 36% and ACCP by 11% was recorded, but the dynamics of these indicators did not reach statistical significance. By the end of 4 weeks of treatment, 24 (68.6%) patients showed an increase in the level of total blood cholesterol - 5.1 (3.91; 6.0) mmol/L vs 6.1 (4.99; 7.07) mmol/L (p=0.000006), while 11 (45.8%) patients from this group had initially elevated cholesterol levels (6.4±0.6 mmol/L). In 5 (14.3%) patients, an increase in alanine aminotransferase (ALT) was recorded in the 4th week - 17.0 (11.0; 25.0) U/L vs 32.0 (22.0; 43.0) U/L (p=0.000062) and aspartate aminotransferase (AST) - 19.0 (14.0; 24.0) U/L vs 25.0 (18.0; 36.0) U/L (p=0.000171), in 1 (2.85%) of the patient, an increase in ALT and AST above normal was noted (ALT 144 U/L, AST 52 U/L), which required discontinuation of levilimab. In 2 (5.7%) patients, by the end of the 4th week a decrease in the absolute number of neutrophils was registered - 3.2 (2.6; 4.0)×10E9/L vs 2.3 (2.0; 2.5)×10E9/L (p=0.002), which did not require discontinuation of treatment, since the number of cells remained more than 1×10E9/L. During treatment with levilimab 162 mg subcutaneously once a week, the proportion of patients taking prednisolone decreased from 46% at the start of therapy to 11% at the end of 6 months of therapy. Levilimab is a highly effective drug for the treatment of patients with highly and moderately active RA and has a favorable tolerability and safety profile.

Multimodal nature of pain syndrome in patients with rheumatoid arthritis in relation to the course of the disease and clinical characteristics

Purpose of the study. To evaluate the character of pain syndrome in patients with rheumatoid arthritis in correlation with the course of the disease and comorbid pathology.Material and methods. Sixty-six patients with a verified diagnosis of RA were examined. Of them 84.9% were women (n=56) and 15.1% men (n=10). The median age was 59 [52; 63] years. Disease activity was assessed by DAS28-CRP, with a median of 5.2 [4.54; 6.0]. Patients with moderate (31.8%) and high activity (57.5%) predominated. Disease duration averaged Me 156 [93; 246] months. Seropositive RA was suffered by 89.3% of patients. The distribution by radiological stage was as follows: 2 radiological stage – 36.3% (n=24), 3 radiological stage – 30.3% (n=20), 4 radiological stage – 33.4% (n=22). Baseline anti-inflammatory therapy was taken by 84.8% of patients (n=56), genetically engineered biological drugs were received by 28.7% (n=16). To assess the multicomponent nature of pain syndrome, the following were used: Pain Detect questionnaire — to verify neuropathic pain (NP), CSI questionnaire — to verify central sensitisation (CS). The EQ-5D-3L questionnaire was used to assess quality of life, and the Charlson index was used to assess comorbid pathology. Structural changes were assessed by modified Sharpe method on hand and foot radiographs, synovium vascularisation was assessed by joint ultrasound.Results. 84.8% of patients had pain syndrome of mixed nature. NP correlated with pain intensity by VAS (rSp=0.458, p<0.001), DAS28-CRP (rSp=0.509, p<0.001), number of peripheral arthritis (rSp=0, 414, p<0.001), number of comorbidities (rSp=0.337, p=0.006), Charlson index (rSp=0.323, p=0.009), EQ-5D-3L (rSp= –0.268, p=0.031). CS–with VAS pain intensity (rSp=0.250, p=0.045), DAS28-CRP (rSp=0.251, p=0.044), number of painful joints (rSp=0.353, p=0.004), number of comorbidities (rSp=0.368, p=0.003), BMI (rSp=0.266, p=0.032), systolic blood pressure level (rSp=0.403, p<0.001), number of erosions on hand and foot radiographs (rSp= –0.299, p=0.016), EQ-5D-3L (rCp= –0.408, p<0.001). Patients with the presence of synovial vascularization by ultrasound had three-component pain in more than half of cases, and the combination of inflammatory pain and CS did not occur in them.Conclusions. 84.8% of patients had multicomponent pain, with pain associated only with clinical parameters of disease activity. Associated pathology and local chronic inflammation in the joint potentiate the development of other types of pain and have a mutual negative influence.

Assessment of Neuropathic Pain in Erosive Hand Osteoarthritis.

Background/Objectives: Erosive hand osteoarthritis (EHOA) is an aggressive form of hand osteoarthritis (OA) and a severely disabling condition. Patients affected by OA frequently lament symptoms suggestive of neuropathic pain (NP). The aim of our study was to ascertain the presence and severity of NP in patients with EHOA and correlate its presence with EHOA clinical characteristics. Methods: In this retrospective study, we included all consecutive EHOA patients with NP symptoms who underwent upper limb electroneurography (ENoG) and nerve ultrasound. The presence of NP was screened using the ID pain neuropathic pain-screening questionnaire (ID-Pain). In addition, the following NP questionnaires were also used: Douleur Neuropathique en 4 Questions (DN4), PainDETECT, and Neuropathic Pain Symptom Inventory (NPSI). Moreover, patients completed the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Dreiser's algofunctional finger index questionnaires assessing EHOA disease activity. The following clinical and laboratory data were collected: age, sex, BMI, disease duration, intensity of pain (VAS 0-10), painful and swollen joints, and inflammatory indices, as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Results: Of the 34 patients studied, 24 (70.6%) presented NP to the ID-Pain questionnaire. According to DN4, 14 (41.2%) patients had NP, while using the PainDETECT questionnaire, 67.6% had NP. Patients with NP were statistically younger and had a higher VAS pain score compared to subjects without NP. The ENoG and median nerve ultrasound were normal in 81% of patients, while four patients had carpal tunnel syndrome. The ID-Pain questionnaire correlated with the number of painful joints (r = 0.48, p = 0.03) and with the AUSCAN questionnaire (r = 0.37, p = 0.05). The DN4 questionnaire correlated with PainDETECT (r = 0.58, p < 0.01). The PainDETECT questionnaire correlated with VAS pain (r = 0.49, p = 0.02), the DN4 questionnaire (r = 0.58, p < 0.01), and AUSCAN (r = 0.51, p = 0.02). The NPSI questionnaire correlated negatively with BMI (r = -0.53, p = 0.01) and positively with the PainDETECT questionnaire (r = 0.49, p = 0.02). Conclusions: Our study revealed that 32% to 70% of EHOA patients exhibited symptoms consistent with NP, with observed variability depending on the questionnaire utilized. Despite patients frequently exhibiting symptoms compatible with NP, only 19% of patients presented alterations on ENoG and ultrasound examinations confirming CTS. This suggests a probable nociplastic component for pain in patients with EHOA, which warrants tailored treatment. In the present study, NP correlated with clinical and functional indices of EHOA.

Significance of High-Frequency Sonography for the Subclinical Progression of Rheumatoid Arthritis.

This study aims to investigate the use of high-frequency sonography as a tool for detecting inflammatory and destructive changes in the hand and foot joints of patients with early and long-term RA. This study employs a prospective cohort design involving 162 patients diagnosed with Rheumatoid arthritis (RA) who meet the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria. Patients were divided into two groups based on disease duration: Group 1 (n = 74) included patients with a disease duration of up to 2 years, or early РА (ERA;), Group 2 (n = 88) consisted of patients with a disease duration exceeding 2 years, or long-term persistent РА (LtRA). All patients underwent a clinical assessment of their joints, as well as radiography and arthrosonography, at the beginning of the study and again at 6 and 12 months later. In the general group of patients, ultrasound examination revealed signs of synovitis in the joints of the hands more frequently (66%) compared with clinical examination (56% by a number of swollen joints [NSJ] and 55% by a number of painful joints [NPJ], P < .01). After 6 months of treatment, 12% of the patients achieved full US remission and 24% achieved partial US remission. Within the scope of comprehensive RA diagnostics, arthrosonography of the joints of the hands and feet, utilizing a combination of greyscale and power Doppler, may surpass radiography in detecting early RA. This method allows for a more accurate assessment of disease activity and progression rates.

Echocardiography Coupled with Strain Method in the Screening for Cardiac Involvement in Rheumatoid Arthritis.

In this study, the usefulness of transthoracic echocardiography (TTE) in systematic screening was assessed for various cardiac abnormalities in patients with rheumatoid arthritis (RA). We performed a comparative cross-sectional study from July 2020 to February 2021. Each patient underwent a TTE coupled with the strain technique. Seventy-two RA patients and 72 controls were included. Abnormalities detected by TTE were more frequent in RA patients (80.6% vs. 36.1%; p < 0.01), and they were asymptomatic in 65.5% of cases. Valvular involvement was found in 45.8% of RA patients, with a significant difference (p < 0.01). Left ventricular diastolic dysfunction was also more frequent in the RA group (36.1% vs. 13.9%; p < 0.01). Left ventricular systolic dysfunction was absent in our study, but subclinical left ventricular myocardial damage assessed by Global Longitudinal Strain (GLS) method was found in 37.5% of RA patients and 16.6% of controls (p < 0.01). The mean GLS in RA patients was -17.8 ± 2.9 (-22 to -10.7) vs. -19.4 ± 1.9 (-24.7 to -15.7) in controls. Left ventricular hypertrophy was detected in 22.2% of RA patients and in 6.9% of controls (p < 0.01). Pericardial effusion and pulmonary arterial hypertension were present only in the RA group (2.8% of cases). We found a significant relationship between echocardiographic damage and disease activity (p < 0.01), number of painful joints (p < 0.01), functional impact (HAQ) (p = 0.01), CRP level (p < 0.01) and the use and dose of Corticosteroids (p = 0.02; p = 0.01). Echocardiographic damage in RA is frequent and often asymptomatic, hence there has been an increased interest in systematic screening in order to improve the quality of life and vital prognosis of patients. Early management of RA can reduce the risk of occurrence of cardiac involvement.

Factors associated with achieving an acceptable health-related quality of life in the treatment of patients with psoriatic arthritis

Objective: to analyze factors associated with the achievement of acceptable health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA) 7 years after the start of observation.Material and methods. The study included 53 patients (28 women, 25 men) with PsA who met the 2006 CASPAR criteria. The mean age of patients was 45.7±12.0 years, the median duration of PsA was 90 [72; 99] months, and the observation period was 81 [61; 91] months. The study included patients in early stage of PsA (duration up to 2 years), who were treated according to the “treat-to-target” strategy (T2T) for 24 months. Subsequently, all patients continued therapy according to the standards of medical care under the supervision of the treating physician. Over time, a standard rheumatological examination was performed. Activity of PsA was assessed by DAPSA, psoriasis by BSA, HRQoL by Psoriatic Arthritis Impact of Disease (PsAID-12); body mass index (BMI, kg/m2 ) and functional status by HAQ were also assessed. PsAID-12 ≤4 corresponded to achieving a Patient Acceptable State Status (PASS). The results were analyzed in two groups of patients: PsAID-12 ≤4 and PsAID-12 &gt;4. The number of patients (%) who achieved minimal disease activity (MDA) after 1–2 years of active treatment and after 7 years was assessed. X-rays of the hands and feet (n=42) were performed using standard methods, changes were assessed using the Sharp/van der Heijde method modified for PsA (m-Sharp/van der Heijde).Results and discussion. After 7 years, 38 (71.7%) of 53 patients were found to have PASS. Patients who achieved PASS had significantly lower PsA and psoriasis activity, lower CRP levels, lower m-Sharp/van der Heijde scores, better functional status and HRQoL, and lower BMI at baseline. Factors associated with achieving PASS were identified: absence of nail psoriasis, BSA ≤3%, CRP ≤5 mg/l, number of swollen joints ≤3, number of painful joints ≤5, HAQ ≤0.5 at baseline and after 24 months, and achievement of MDA during the first 12 months of treatment.Conclusion. The majority of PsA patients treated at an early stage according to T2T principles had PASS, which is associated with low disease activity, fewer joint erosions, better functional status and achievement of MDA during the first 12 months of therapy. These factors should be considered when predicting disease progression.

Association of serum chemerin levels with complications and comorbidity in rheumatoid arthritis

Introduction. Rheumatoid arthritis (RA) is a systemic autoimmune disease as well as a typical inflammatory process. Chemerin is a fat tissue cytokine, which specific receptors were discovered on the surface of the innate immune cells. It is of interest to study the association of chemerin with the complications and comorbidity in RA.Aim. To study the association between serum chemerin levels with complications and comorbidity in rheumatoid arthritis.Materials and methods. 88 women with RA were enrolled in our study. ll patients undergone standard clinical and laboratory examination. Serum chemerin, high-sensitive C-reactive protein (hsCRP), anti-citrullinated protein antibodies, insulin and C-peptide levels were determined using ELISA. X-ray absorptiometry was performed. Statistical analysis was performed using conventional methods with a software package Statistica 10.0.Results. Median chemerin concentration was 463.5 [366–576.5] ng/ml. Chemerin concentration correlated with the age (ρ = 0.232; р = 0.030), weight (ρ = 0.254; р = 0.017) and body mass index (BMI) (ρ = 0.212; р = 0.047), but wasn’t associated with the RA classification criteria. Positive correlation between chemerin concentration and number of painful joints (NPJ) (ρ = 0.213; р = 0.046) and hsCRP (ρ = 0.273; р = 0.010) was observed. Patients with type 2 diabetes mellitus (DM2) had higher chemerin concentration (598.0 ng/ml vs 479.5 ng/ml, Z = -2.68; p = 0.007) and patients with cholecystectomy in anamesis had lower (359.0 ng/ml vs 479.0 ng/ml, Z = 2.02; p = 0.043). Chemerin concentration correlated with systolic and diastolic blood pressure (BP) (ρ = -0.41; р &lt; 0.001 and ρ = -0.27; р = 0.028, respectively).Conclusions. Chemerin concentration in women with RA correlates with age, weight, BMI, NPJ and hsCRP. Chemerin concentration in patients with comorbid DM2 was higher and in patients comorbid with cholecystectomy in anamnesis was lower. Chemerin concentration correlates negatively with a systolic and diastolic BP.

Quality of life of patients with rheumatoid arthritis and comorbid fibromyalgia

Objective: to evaluate the impact of comorbid fibromyalgia (FM) on the quality of life (QoL) of patients with rheumatoid arthritis (RA). Material and methods. The study involved 90 patients with confirmed RA who complained of chronic pain. All patients underwent general clinical and laboratory examination. FM was diagnosed according to the 2016 ACR criteria. The questionnaires assessed the presence and severity of fatigue (FSS), anxiety and depression (HADS), sleep disorders (PSQI), cognitive impairment (DSST), symptoms of central sensitization (CSI) and the neuropathic component of pain (DN4, PD). The severity of pain syndrome (PS) was assessed by 10-cm VAS at rest. QoL was assessed using the EQ-5D questionnaire. Results. In the main (FM+) and control (FM-) groups, the average severity of PS according to VAS at rest was 7 and 4 cm (p&lt;0.001), the average score on the CSI questionnaire was 50 and 38.5 (p&lt;0.001), and according to the PD questionnaire – 17 and 11 (p&lt;0.001), respectively. Analysis of the severity of comorbid disorders revealed significant differences between the groups in terms of such parameters as fatigue (p=0.003), anxiety (p=0.001), sleep quality (p&lt;0.001) and cognitive impairment (p=0.021). The QoL of patients (according to EQ-5D) in the main group was significantly lower (0.52 vs. 0.59; p=0.003). Significant correlations were found between the QoL index according to EQ-5D and VAS, FSS and PD values in both groups, CSI, DN4, HADS-T parameters and the number of painful joints – only in the main group. Conclusion. Concomitant FM significantly reduces the QoL of patients with RA. The main factors affecting QoL in patients with RA and comorbid FM were the intensity and neuropathic phenotype of PS, increased fatigue and anxiety. Patients with FM are also significantly more likely to have sleep and cognitive impairments.

The painful joint after COVID-19 treatment: A study on joint osteonecrosis following COVID-19-related corticosteroid use.

This study aims to evaluate the incidence of osteonecrosis (ONC), with a special focus on ONC of the femoral head (ONFH), in novel coronavirus disease 2019 (COVID-19) patients two years after the pandemic. This prospective study included COVID-19 patients who were admitted to our center between March 2020 and June 2020. A total of 472 patients (289 males, 183 females; mean age: 42.3±12.0 years; range, 18 to 60 years) were arranged in a list according to their date and time of admission and, then, divided into two groups: those not receiving corticosteroid (CS) treatment (Group 1, n=236) and those receiving CS treatment (Group 2, n=236). The patients were evaluated for joint pain based on X-rays and magnetic resonance imaging scans, and the patients were routinely followed. For each patient in Group 2, additional data regarding CS use were recorded. The possible relationship between ONC and risk factors was analyzed. Both groups were similar in terms of age and sex. Group 2 had a significantly longer hospitalization period. A significant increase in the number of painful joints was observed in Group 2. At two years, 5.1% of the patients in Group 1 complained of at least one painful joint compared to 11.9% of patients in Group 2. Eight patients from Group 2 developed ONC. The incidence of ONC after CS therapy in COVID-19 patients is on the rise. At two years, 5% of patients receiving various doses of CSs may develop ONC. Residual joint pain is common even after recovering from the virus. No relationship is evident between the duration of treatment, cumulative dosage of medication, maximum one-day dosage received, and the presence of ONC.

Curcuma longa and Boswellia serrata extract combination for hand osteoarthritis: an open-label pre-post trial

Context Osteoarthritis (OA) of the hand is a common painful musculoskeletal disorder with no cure. There is a need for an efficient and safe treatment to relieve OA pain. Objective To investigate the effects of a Curcuma longa and Boswellia serrata food supplement in addition to standard care on hand pain. Materials and methods This open-label, non-controlled, post-observational study was based on 232 patients suffering from hand pain with or without joint deformity. Patients received a medical prescription for a three-month treatment with a food supplement containing 89 mg of C. longa dry extract, 120 mg of B. serrata resin, and 1.8 µg vitamin D. Pain was evaluated on a 10-point visual analog scale (VAS). The number of painful hand joints, patient satisfaction, nonsteroidal anti-inflammatory drugs intake, and side effects were also recorded. Results Baseline pain intensity (regression coefficient ± SE: −0.19 ± 0.01, p < 0.0001) and the number of painful joints (regression coefficient ± SE: −0.022 ± 0.0029, p < 0.0001) decreased significantly throughout the 3 months treatment period. NSAIDs intake and topical drug application were significantly decreased by 64% (p < 0.0001) and 79% (p < 0.0001) after 12 weeks, respectively. Only 3/239 (1.3%) patients reported side effects probably related to the product. 80.3% were satisfied with the treatment and 75.5% wished to continue treatment. Conclusion This is the first clinical trial showing that C. longa and B. serrata resin can relieve symptoms in patients with hand osteoarthritis. The study provides useful information for the design of a clinical trial including a broader population.

Subclinical left ventricular dysfunction and N-terminal pro-brain natriuretic peptide in patients with rheumatoid arthritis

Aim – to determine the frequency of myocardial dysfunction using echocardiography with speckle tracking (STE) method, the relationship between a low global longitudinal strain (GLS) with the level of NT-proBNP, clinical and laboratory manifestations of rheumatoid arthritis. Material and methods. The study included 43 patients with RA (ACR/EULAR criteria, 2010): 79% women, age – 53.0 [38.0; 63.0] years, disease duration – 60.0 [36; 180] months; DAS28 – 5.9 [5.2; 6.4], positive for ACCP (74%), RF IgM (81%), without prior biological therapy and CVD. Methotrexate was received by 44%, leflunomide – 35%, sulfasalazine – 9.3%, hydroxychloroquine – 7%, glucocorticoids – 67.4%, non-steroidal anti-inflammatory drugs – 74% of patients with RA. All RA patients underwent echocardiography – tissue Doppler and STE. The level of NT-proBNP was determined in the blood serum The normal range for NT-proBNP was less than 125 pg/ml.Results. Low GLS was observed in 26 (61%) patients with RA. RA patients had a decrease GLS, E LV, E’ LV, E/A LV compared with the control group. Left ventricular diastolic dysfunction (LVDD) was higher in RA patients (13 (31%) vs 0%). Patients with RA had significantly higher levels of NT-proBNP (114.8 [45.1; 277.5] and 52 [40.5; 69.1] pg/ml) compared with the control group. There were correlations between a low GLS and DAS28 (r=0.9), the number of painful joints (r=0.6), radiological stage (r=0.6) and the presence of systemic manifestations (r=0.5), age (r=–0.9), E LV velocity (r=–0.5) (p&lt;0.05 in all cases). There were correlations between the level of NT-proBNP and the E/A LV ratio (r=–0.4), A LV velocity (r=0.5) (p&gt;&lt;0.05 in all cases).&gt;&lt; 0.05 in all cases). There were correlations between the level of NT-proBNP and the E/A LV ratio (r=–0.4), A LV velocity (r=0.5) (p&lt; 0.05 in all cases).Conclusions. In RA patients with a high frequency the low GLS LV was detected, which is associated with a high activity of the inflammatory process. STE helps to detect myocardial dysfunction in patients with RA at earlier stages than tissue Doppler. The use of STE, the determination of the level of NT-proBNP make it possible to diagnosing preclinical disorders of systolic and diastolic functions of the LV, which can contribute to the early initiation of therapy and improve the prognosis in this category of patients.

Combination of Methotrexate and Leflunomide Is Efficient and Safe for 60 Patients with Rheumatoid Arthritis.

The present work is aimed at exploring the clinical efficacy and safety of methotrexate (MTX) and leflunomide (LEF) combination therapy for rheumatoid arthritis. From June 2019 to June 2021, a total of 120 individuals with rheumatoid arthritis received a diagnosis. Sixty patients each were randomly assigned to the control and observation groups. The observation group received MTX and LEF combo medication while the control group only received MTX treatment. Clinical efficacy, complication incidence, and the alleviation of inflammatory markers, joint pain, and clinical symptoms were compared between the 2 groups. Posttreatment, the observation group had overall response rate of 96.66%, while the control group had 86.67%, with significant differences. Compared with pretreatment, both control and observation group patients showed decreasing trends of IL-1 levels and increasing trends of IL-10 levels posttreatment, with significant differences (P < 0.05). Compared with the control group, patients in the observation group had lower IL-1 and TNF-α levels with significant differences (P < 0.05) and higher levels of IL-10 with significant difference (P < 0.05). In both groups, the pain score and the number of painful joints were much lower than they were prior to treatment. Following treatment, the observation group displayed significantly lower levels of erythrocyte sedimentation rate, rheumatoid factor, and C-reactive protein than the control group (P < 0.05). Clinical measures in the observation group were all lower than those in the control group with statistically significant differences (P < 0.05). Moreover, the incidence rate of adverse reactions showed no significant difference between these 2 groups (P > 0.05). In conclusion, the combination therapy of MTX and LEF is efficacious for rheumatic arthritis.

Depressive symptoms and multi-joint pain partially mediate the relationship between obesity and opioid use in people with knee osteoarthritis

To assess the relation of obesity to opioid use in people with or at risk of knee osteoarthritis (OA), and the extent to which this association is mediated by number of painful joints or depressive symptoms. We used data from the Multicenter Osteoarthritis Study, a longitudinal cohort of older adults with or at risk of knee OA. Opioid use was identified by prescription medications and self-report. Obesity was defined as BMI≥30kg/m2. Multi-joint pain was assessed using a standardized body homunculus, and depressive symptoms using the Center for Epidemiological Studies Depression scale. We quantified the direct and indirect effect of obesity on opioid use through the number of painful joints or depressive symptoms using causal mediation analysis by natural-effects models. We studied 2,335 participants (mean age: 68; mean BMI 31kg/m2; 60% women). Persons with obesity had ∼50% higher odds of opioid use than those without. Estimates of indirect (mediated) effect by the number of painful joints and depressive symptoms suggested an increased odds of opioid use by 34% (odds ratio [OR]=1.34, 95% CI: 1.04, 1.70) and 35% (OR 1.35, 95% CI: 1.05, 1.71), respectively, in obese vs non-obese individuals. The total effect of obesity on opioid use was higher in women than in men. Multi-joint pain and depressive symptoms partially explained greater opioid use among obese persons with knee OA, demonstrating that the negative impact of obesity on knee OA extends beyond its influence on knee pain and structural progression.

Comparison of Experimental Pain and Functional Impact in Individuals with Single- and Multi-site Osteoarthritis

Osteoarthritis (OA) is a painful and disabling disease that can involve a single joint or progress to multiple joints. We have limited understanding whether individuals with multi-site OA exhibit altered pain processing and psychosocial function compared to those with single-site OA. Here, we perform a secondary data analysis to test the hypothesis that individuals with multi-site OA have significantly higher experimental pain and functional impact than individuals with single-site OA or no OA. Individuals between 45 and 85 years of age underwent quantitative sensory testing (QST) and answered clinical questionnaires. Four cohorts were formed: individuals with only CMC pain (n=X), individuals with only knee pain (n=X), individuals with CMC + knee pain (n=X), and pain-free individuals (n=X). ANCOVAS were performed to identify significant differences in experimental pain and psychological variables across cohorts. The CMC + knee pain cohort had significantly higher heat induced pain during temporal summation (forearm at 44°C, p=0.01) in comparison to all other cohorts. This trend was observed across temperatures. The CMC + knee pain cohort also had significantly lower pressure pain thresholds (p≤0.01) compared to the CMC pain cohort but were not different from the knee pain cohort. Lastly, the CMC + knee pain cohort had the highest self-reported pain (p<0.01), disability (p<0.01), and emotional distress (p≤0.03) compared to individuals with only CMC or only knee pain. These results suggest knee OA compounded with CMC OA considerably increases disease impact and poor quality of life in comparison to single-joint OA. The results also support a relationship between the number of painful joints and enhanced widespread sensitivity. This study highlights the importance of measuring pain at sites other than the primary OA location. Enhancing our knowledge of symptoms and function across multiple joints could contribute to more targeted treatment and prevention of OA progression. Grant support from R01AG059809, R01AG067757, and R37AG033906.

Efectividad de un modelo de tratamiento integral de la osteoartrosis

Introduction. Osteoarthrosis (OA) is the most frequent degenerative joint disease causing a significant social burden and being a frequent cause of disability. It also affects the mental health of patients and increases health care costs, including costs of hospitalization or admission to emergency services. The most deteriorated joints are the knees, hands, hips, and spine; above all among female patients. Obesity is the main risk factor. Despite the international recommendations, comprehensive patient management is rare and most therapeutic interventions are isolated and focused on the administration of non-steroidal anti-inflammatory drugs (NSAID), viscosupplementation, or intra-articular administration of corticosteroids. Objective. The objective of this non-comparative retrospective study was to test the effectiveness of a comprehensive medical treatment (CMT) model for OA that has been implenting in Mexico since 2006. Material and Methods. To determine the OA improvement in the patient receiving a CMT scheme that includes phytopharmaceuticals, rehabilitation, nutritional intervention, patient education, and a telephone attention program, the consumption of traditional medicines (NSAID) was compared before and after the intervention and clinimetrically measuring the visual analog evaluation, number of painful joints, number of swollen joints, evaluation global assessment of the disease by the patient, global assessment of the disease by the treating physician, muscle strength, Health Assessment Questionnaire, and adherence to treatment. Results. Approximately 18% (17.92%) of the patients in the sample were taking two or more medications at the beginning of the study; at the end, only 2.79% took them. The proportion of patients with no drug, monotherapy and combination of drugs and/or supplements is significant between the initial visit and the final visit. In the clinimetric domain, a statistically significant decrease (p&gt; 0.01) was found between the value of the initial visit and the final visit. The number of painful joints and swollen joints from the initial visit to the final visit decreased statistically significantly. The global assessment of the disease by the patient from the initial visit to the final visit decreased statistically significantly. Discussion. CMT with periodic monitoring, phytopharmaceutical patient education, nutritional intervention, rehabilitation, and a telephone service program is effective for the control of osteoarthritis.

Correlations between body postures and musculoskeletal pain in guitar players.

BackgroundThe guitar-playing community is the largest group at risk of developing playing related musculoskeletal disorders. A thorough investigation of the relationships between the various risk factors and players’ report on musculoskeletal pain using objective and accurate means of assessment has yet to be reported.Purpose(a) to explore the correlations between demographic characteristics, anthropometric measurements, playing habits, and personal habits of guitar player and their complaints of musculoskeletal pain, (b) explore the correlations between the upper body kinematics of guitar players during playing the guitar and their complaints of musculoskeletal pain, and (c) compare the upper body kinematics of guitar players during playing the guitar while sitting versus standing.MethodsTwenty-five guitar players (27.5±4.6 years old) filled out questionnaires regarding their guitar-playing habits, and the Standardized Nordic Questionnaires for the analysis of musculoskeletal symptoms. Kinematics of their torso and upper limbs were tracked while they played a tune twice, once while sitting and once while standing.ResultsWe found moderate correlations between the number of painful joints in the last year and factors, such as physical comfort while playing, years of playing, and position during playing. During standing, lower back pain severity correlated with the rotation range of the torso, while during sitting, it moderately correlated with the average radial-ulnar deviation of the right wrist. During sitting, we found higher anterior and right tilt of the torso, combined with greater abduction of the right shoulder, higher flexion in the left shoulder and higher radial deviation in the left wrist.ConclusionOur results point to several risk factors, related both to playing habits but also to playing posture, which should be considered by the guitar players in order to prevent playing-related musculoskeletal disorders.

Предикторы достижения ремиссии при терапии генно-инженерными биологическими препаратами (тоцилизумабом и канакинумабом) детей с системным ювенильным идиопатическим артритом: когортное исследование

Therapy with biologicals at the onset of systemic juvenile idiopathic arthritis (sJIA) ensures faster achievement of inactive disease or remission in more patients compared to standard treatment. Identification of predictors of early response to biologicals is necessary to increase treatment efficacy in children with sJIA. Objective. To develop a model for predicting treatment outcomes with different biologicals in sJIA patients. Materials and methods. We analyzed medical records of sJIA patients who received tocilizumab or canakinumab and were admitted to the Department of Rheumatology between July 2009 and February 2021. Predicted outcomes included inactive disease after 12 months of therapy with biologicals (according to C. Wallace criteria and JADAS71) and drug-free remission (without biologicals) for at least 6 months. Potential predictors comprised patient demographic and clinical characteristics, such as sJIA activity, CHAQ index, concomitant therapy, treatment outcomes after 1 and 3 months of therapy, etc. (115 parameters in total). Independent predictors were chosen using multivariate binary logistic regression. Results. This study included 250 patients receiving tocilizumab and 73 patients receiving canakinumab. After 12 months of tocilizumab therapy, 179 patients (76%) achieved inactive disease according to C. Wallace criteria and 170 patients (72%) achieved remission according to JADAS71 index. Drug-free remission (for at least 6 months without biologicals) was registered in 51 patients (20%) from the tocilizumab group. In the canakinumab group, inactive disease according to C. Wallace criteria, remission according to JADAS71, and drug-free remission were achieved in 58 (79%), 58 (79%), and 10 (14%) patients, respectively. Duration of morning stiffness at sJIA onset, dynamics of the duration of morning stiffness after 1 and 3 months of treatment, disease activity evaluated by a physician using the 100-mm visual analog scale (VAS) after one month of therapy, and patientreported overall well-being evaluated using VAS after 3 months of therapy were found to be the predictors of achieving remission according to C. Wallace criteria in the tocilizumab group. The following factors were significantly associated with remission according to JADAS71 index: duration of morning stiffness at sJIA onset and upon treatment initiation, VAS score evaluated by a physician after 1 and 3 months, and number of painful joints after 3 months. We also found several predictors of achieving drug-free remission, including lymphocyte count at disease onset, therapy with glucocorticoids (GCs) and its duration by the time of biological initiation, ESR upon treatment initiation, 50% improvement according to ACR pediatric criteria after 1 month, administration of systemic GCs after 1 month, ESR dynamics by 3 months, and number of joints with limited motion after 3 months. In the canakinumab group, the following factors were associated with remission according to C.Wallace criteria and JADAS71: duration of morning stiffness at treatment initiation, number of biologicals received in the past, 30% improvement according to pediatric ACR criteria after 1 month, and presence of joints with limited motion after 3 months; the predictors of drug-free remission included previous treatment with tocilizumab, number of active joints, and patient-reported overall well-being evaluated using VAS at treatment initiation, dynamics of the number of joints with active arthritis after 1 and 3 months, dynamics of JADAS71 after 1 month, lymphadenopathy after 1 month, and dynamics of patient-reported overall well-being after 3 months. Conclusion. Treatment in the past, characteristics of joint syndrome before and 1–3 months following treatment initiation, dynamics of laboratory parameters and VAS scores of disease activity (both patient-reported and physician-rated) were independent predictors of remission in sJIA patients during therapy with tocilizumab and canakinumab. Key words: systemic juvenile idiopathic arthritis, remission, predictors, biologicals, interleukin-1b inhibitor, interleukin-6 receptor inhibitor, tocilizumab, canakinumab

Relationship Between Pain and Sedentary Behavior in Rheumatoid Arthritis Patients: A Cross-Sectional Study.

Despite the known benefits of physical activity, high numbers of individuals with rheumatoid arthritis (RA) remain physically inactive and sedentary. Little is known about the determinants of sedentary behavior (SB) in RA. This cross-sectional study was undertaken to examine a range of pain characteristics and RA-related symptoms and their relationship with objectively measured SB. In total, 76 adults with RA wore an activPAL4 accelerometer (PAL Technologies) over a 7-day period. Pain characteristics (pain intensity, painful joint count, nonarticular pain), fatigue, sleep, depression, anxiety, and disease activity were assessed. Analyses were first conducted to evaluate correlations with sedentary time. The independent contribution of pain characteristics to variation in SB was analyzed with multivariable linear regression (adjusted for demographic data and disease activity). Participants with valid accelerometer data (n = 72) spent a mean ± SD of 533.7 ± 100.1 minutes/day in SB. Positive associations with daily SB were found for pain intensity (r = 0.31, P < 0.01) and number of painful joints (r = 0.24, P < 0.05) but not nonarticular pain. In multivariable analyses, pain characteristics were not independently associated with SB. Analyses indicated that disease activity had an indirect association with SB mediated by pain intensity. Other correlates of daily SB included anxiety and depression but not fatigue or sleep. Results suggest that while pain and other RA-related factors do play a role in SB, they do not appear to have a significant influence after accounting for other variables. Future research should investigate SB and the role of factors unrelated to the symptoms of RA.

Comparative efficacy of tofacitinib and adalimumab in patients with psoriatic arthritis in real clinical practice. Data from the Russian nationwide register of patients with psoriatic arthritis

Objective: to compare the clinical efficacy in real clinical practice of the targeted synthetic disease-modifying antirheumatic drug (sDMARD) tofacitinib (TOFA) and the biologic DMARD (bDMARD), an inhibitor of tumor necrosis factor alpha (TNFα), adalimumab (ADA) in patients with psoriatic arthritis (PsA), included in the Russian nationwide register of patients with PsA.Patients and methods. The study included 77 patients with PsA (43 men and 34 women) who met the CASPAR criteria and were observed in the Russian nationwide register. Patients were divided into two groups depending on the treatment. Group 1, in which oral TOFA was prescribed, 5 mg 2 times a day, included 41 patients: 24 (58.5%) men and 17 (41.5%) women, the median age was 41 [34; 50] years, the median duration of PsA was 72 [35; 120] months. Group 2, in which subcutaneous ADA was used, 40 mg every 2 weeks, included 36 patients: 19 (52.8%) men and 17 (47.2%) women, the median age was 44 [34; 51] years, the median duration of PsA was 59 [22; 102] months. Combination therapy, including methotrexate (MT), received 80.5% of patients in the TOFA group and 52.8% of patients in the ADA group. At the beginning of the study and every 6 months further, the activity and efficacy of PsA therapy were assessed in all patients according to DAPSA and criteria for minimal disease activity – MDA (number of painful joints ≤1, number of swollen joints ≤1, PASI ≤1 or BSA ≤3 , pain score ≤15, patient's general assessment of disease activity ≤20 mm on a visual analogue scale, HAQ ≤0.5, enthesitis ≤1), dynamics of BASDAI and BSA were also assessed. The number of patients who achieved remission (DAPSA ≤4) or MDA (5 criteria out of 7) during therapy with TOFA and ADA was determined.Results and discussion. Before the start of the therapy in the 1st group, the median DAPSA was 44.2 [37.8; 55.3]: moderate PsA activity was in 5 (12.2%) patients, high in 36 (87.8%) patients. In group 2, the median DAPSA was 35.8 [21.1; 52]: low activity was detected in 3 (8.6%), moderate – in 11 (31.4%), high – in 21 (60%) patients (data from 35 patients was available). 6 months after the start of treatment in patients of the 1st and the 2nd group, there was a significant decrease in all indicators of PsA activity compared to the baseline. The median DAPSA was 11 [4.3; 17.3] and 9.1 [6; 19.6]; remissions according to DAPSA reached 11 (26.8%) and 6 (20.8%) patients, respectively, low activity – 15 (36.6%) and 13 (44.8%), MDA – 16 (40%) and 9 (30%). The number of patients with dactylitis in the 1st and in the 2nd group significantly decreased: from 22 (53.7%) to 5 (13.2%) and from 13 (36.1%) to 6 (20%), respectively. Median HAQ decreased from 1 [0.625; 1.5] to 0.5 [0; 0.875] and from 0.875 [0.5; 1.38] to 0.5 [0; 0.875]; median BASDAI – from 6 [4.2; 7] to 1.4 [0.6; 3.2] and from 4.4 [1.9; 5.8] to 3 [0.8; 4.5], respectively. In group 1, the number of patients with BSA&gt; 3% decreased from 16 (39%) to 8 (26.7%; p&lt;0.225), and in group 2, due to insufficient data (5 patients), we failed to evaluate BSA dynamics.Conclusion. In real clinical practice TOFA and ADA both had comparable efficacy on all clinical manifestations of PsA: after 6 months of therapy, most patients with PsA achieved MDA, low disease activity and remission according to DAPSA and BASDAI.

POS0191 THE VALUE OF MIR-20B, MIR-22, MIR-26A, MIR-125B AND MIR-221 IN RHEUMATOID ARTHRITIS

Background:Micro-RNAs (miRNAs) are an endogenous small, single-stranded, non-coding RNAs with a 18-25 nucleotide long and have been reported as a potential extracellular biomarkers of various diseases. They mainly decrease the gene expression by inhibiting the translation or cause mRNA destabilization.Objectives:The aim of the study was to identify miRNAs whose plasma expression level is associated with RA prevalence and/or activity.Methods:A total of 74 unrelated individuals, 50 with RA and 24 in a control group were enrolled to the study. Real-time PCR was used to evaluate the plasma expression levels of 5 miRNAs: miR-20b, miR-22 miR-26a, miR-125b, miR-221.Results:We found the differences in four out of five evaluated miRs between RA and HC group – miR-26a, p&lt;0.0001; miR-125b, p &lt;0.0001; miR-20b p&lt;0.0001; miR-22, p=0.005. Graphical presentation of the results is shown in Figure 1. The logistic regression results showed that miR-22 (p=0.0003) and miR-26a (p=0.049) are the most important molecules distinguishing RA patients and healthy controls in the study. MiR-22 was positively correlated with ESR (rs=0.41), CRP (rs=0.49) and DAS28 (rs=0.33) and miR-26a was positively correlated with ESR (rs=0.49), CRP (rs=0.41), number of swelling joints (rs=0.43), number of painful joints (rs=0.74) and DAS28 (rs=0.63). Moreover, miR-22 expression was different between rheumatoid factor (RF) positive and RF negative patients (p=0.04).Conclusion:The results showed that miR-22 (p=0.0003) and miR-26a (p=0.049) may be the most useful in evaluated panel of miRs distinguishing RA patients and HCs. In this study we demonstrated for the first time that plasma concentration of miR-22 may be considered as a potential molecular marker of RA exacerbation.