Rheumatoid Arthritis Patients Research Articles

Prevalence of caries disease in patients with Rheumatoid arthritis: Results of a comparative study

Objectives: This study aims to determine the prevalence of dental caries in rheumatoid arthritis (RA) patients and compare it with controls. Materials and Methods: We conducted a cross-sectional study between two departments of the Ibn Sina University Hospital in Rabat: the Conservative Dentistry Department at the Center for Consultation and Dental Treatment and the Rheumatology B Department at El Ayachi Hospital in Salé.We collected socio-demographic, disease, and oral health data for each patient, assessing caries prevalence using the DMFT index (Decayed, Missing, and Filled teeth ) along with gingival and plaque indices (Löe and Silness) Results: We recruited 61 patients, including 31 patients with rheumatoid arthritis (RA) and 30 control patients. The average age was 47.6 ± 13.1 years, mostly female, with 59.3% postmenopausal. RA patients had a higher number of missing teeth (8.3±7 [0; 19]), moderate to severe gingival inflammation in 64.6% of patients, and significant plaque buildup in 67.7% of cases. Only 38.7% of patients used proper brushing techniques, and 45.2% viewed their condition as a barrier to oral hygiene.The DMFT index in the RA group was 15.5, with an average of 2 [0; 4] filled teeth, compared to 0 [0; 2] in the control group (p=0.05). 67.7% of RA patients had visible plaque deposits, and 64.6% showed moderate to severe gingival inflammation Conclusion: Patients with rheumatoid arthritis exhibited poorer oral health compared to the control group, highlighting the importance of multidisciplinary care, including regular dental consultations and treatment

Efficacy of N-Acetylcysteine as an Adjuvant Therapy for Rheumatoid Arthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Aims/Background Rheumatoid arthritis (RA) is an inflammatory autoimmune disease and N-acetylcysteine (NAC) is considered a potential therapeutic agent for RA due to strong antioxidant and anti-inflammatory properties. Therefore, this systematic review and meta-analysis aimed to evaluate the efficacy of NAC as an adjuvant therapy for RA. Methods A systematic search was conducted across five databases from inception to 1 August 2024, including CINAHL, Cochrane Library, EMBASE, PubMed, and Web of Science. The Cochrane risk-of-bias tool for randomized trials was used to assess the quality of the included studies. Sensitivity analysis was performed when significant heterogeneity was identified. Results Four studies involving 204 patients were included in our meta-analysis. The results indicated that NAC alleviated disease activity in RA patients (Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR): mean difference (MD) = 0.54). Additionally, NAC reduced inflammatory markers (erythrocyte sedimentation rate (ESR): MD = 3.00). However, the beneficial effects of NAC on oxidative stress in RA patients were not observed. Conclusion This meta-analysis demonstrated the efficacy of NAC in reducing inflammatory markers, improving joint tenderness, and swelling in patients with RA.

Mitophagy drives maldifferentiation of tissue-resident memory T cells in patients with rheumatoid arthritis

Objective To investigate the function of mitophagy in instructing T-cell differentiation of patients with rheumatoid arthritis (RA). Method The mRNA and protein levels of optic atrophy protein-1 were detected in T cells from 94 RA patients and 37 age- and sex-matched healthy individuals by quantitative polymerase chain reaction and Western blotting. The impact of mitophagy on the differentiation of T cells was determined by flow cytometry. The therapeutic effect of targeting mitophagy was explored in humanized RA chimeras. Results Our study showed that T cells exerted high levels of mitophagy in RA patients. Since multiple T-cell subtypes play crucial roles in RA, we determined that mitophagy had a significant impact on the differentiation of tissue-resident memory T (Trm) cells, but not Th1 or Th17 cells. Importantly, we demonstrated that inhibiting mitophagy significantly reduced the number of Trm cells and downregulated inflammatory responses, as evidenced by diminished levels of T cell receptor β, interferon-γ, and interleukin-17A, in the humanized RA chimeras. Conclusions Mitophagy is elevated in RA T cells, leading to maldifferentiation of Trm cells in RA patients. Since these findings were obtained from clinical patients, mitophagy may be a potential therapeutic target for RA treatment.

Incidence of and risk of mortality after hip fractures in Rheumatoid Arthritis relative to the general population.

Osteoporosis, a known complication of rheumatoid arthritis (RA), increases the risk of hip fracture, which is associated with high morbidity and mortality. Fracture risk estimates in RA patients treated with contemporary treatment strategies are lacking. The objectives were 1) to estimate age- and sex-specific incidence rates and compare the risk of hip fractures in RA relative to age and sex-matched general population controls, and 2) to compare the risk of all-cause mortality in RA and general population controls after hip fracture. A longitudinal study of a population-based incident cohort of RA patients diagnosed between 1997 and 2009, followed until 2014, with age- and sex-matched controls from the general population of British Columbia, using administrative health data. Hip fracture outcomes (ICD9-CM codes 820.0 or 820.2; ICD10-CA code S72.0 to S72.2) and mortality at pre-defined intervals after fracture (in-hospital, 90 days, 1-year, 5-year) were identified. Hip fracture incidence rates for RA and controls, and incidence rate ratios (IRR) were calculated. Cox proportional hazards models compared hip fracture and mortality risk in RA vs. controls; logistic regression compared in-hospital mortality risk. Overall, 1314 hip fractures over 360,521 person-years were identified in 37,616 RA individuals and 2083 over 732,249 person-years in 75,213 controls, yielding a 28% greater fracture risk in RA (IRR 1.28 [95%CI, 1.20;1.37]). Mean age at time of fracture was slightly younger for RA than controls (79.6 + 10.8 vs. 81.6 + 9.3 yrs). Post-fracture mortality risk at 1- and 5-years did not differ between RA and general population controls. Results were similar in a sensitivity analysis including only RA individuals who received disease-modifying antirheumatic drugs (DMARDs). People with RA had a greater risk of hip fractures, but no greater risk of mortality post fracture, than the general population. The relative risk of hip fractures observed was not as high as previously reported, likely reflecting better treatment of inflammation and management of osteoporosis and its risk factors.

Risks of malignancies related to disease-modifying antirheumatic drugs in rheumatoid arthritis: a pharmacovigilance analysis using the FAERS database

ObjectivesOver the years when disease-modifying antirheumatic drugs (DMARDs) have been used in rheumatoid arthritis patients, reports of malignancies have emerged. This study aims to investigate the association between malignancies and DMARDs by using data extracted from the Food and Drug Administration Adverse Event Reporting System (FAERS).MethodsFAERS data (January 2019 to December 2023) were reviewed. For each drug-event pair, the disproportionality analysis was conducted to evaluate the risk of malignancy. Multivariate logistic regression was implemented to mitigate potential biases. Moreover, the time to onset of malignancy was also evaluated.ResultsWe conducted a detailed search for rheumatoid arthritis indications and identified a total of 17,412 adverse event reports associated with malignancies, with selective DMARDs designated as the role code “primary suspect”. At the preferred term level, there were 198 positive signals, among which the lower limit of the 95% confidence interval for the information component is 3.55 for squamous cell carcinoma of the skin, 2.39 for breast cancer, and 2.27 for lymphoproliferative disorder. In comparison to other DMARDs, targeted synthetic DMARDs were associated with a broader range of malignancies at both preferred term and Standardized MedDRA Queries levels. The number of adverse events reported in female patients is approximately 2–3 times higher than men, and the median age across the population was approximately 62 years. In terms of onset time, the conventional synthetic DMRADs exhibited a relatively longer median time, ranging from 3.58 to 7.08 years, while the targeted synthetic DMARDs demonstrated a shorter median time of 0.83–1.67 years.ConclusionOur study uncovers varying degrees of malignancy risks related to DMARDs, with a significantly higher risk observed in targeted synthetic DMARDs. Additionally, novel malignancy signals, not documented in product labels, have been detected. In the future, further research will be necessary to validate our findings.

Dietary habit and risk of rheumatoid arthritis: a mendelian randomization study identifying protective and risk factors.

Dietary habit significantly contributes to the initiation and progression of rheumatoid arthritis (RA). Dietary choices intersect with a range of clinical and societal factors. The utilization of cross-sectional methodologies in numerous studies poses a challenge in establishing definitive causality for the noted associations. Moreover, within identical food categories, specific items may elicit diverse effects on the pathogenesis of RA, and the correlation between several prevalent food items or beverages and RA remains inadequately explored. We performed a two-sample Mendelian Randomization (MR) study to evaluate the causal impact of 27 distinct dietary habits and RA susceptibility. These dietary-related phenotypes encompass both the relative intake of the four macronutrients (fat, protein, carbohydrates, and sugar) and 23 specific single food intake. Several filtering steps were employed to select eligible genetic instruments strongly associated with each of the traits. The random-effects inverse-variance weighted, weighted median, and MR-Egger methods were employed for MR estimations. Sensitivity analyses and power calculations were executed to ensure the robustness of our study. After rigorous single-nucleotide polymorphism (SNP) filtering procedures, 611 SNPs were included in our ongoing investigations. The consumption of dried fruit, bread, and alcohol emerged as protective factors, while beef, processed meat, and coffee intake were identified as risk factors. The robustness of our study was confirmed through the outcomes of sensitivity analysis and power calculation. The ongoing investigations furnish evidence that accentuates the influence of diet on RA disease activity, underscoring the importance of delineating the optimal nutritional lifestyle for RA patients.

Therapeutic Dose of Zinc Aspartate and Zinc Citrate Attenuates Disease Activity Indices in Rheumatoid Arthritis.

Zinc aspartate and zinc citrate have been used as zinc supplements in different health conditions. Taking into consideration their anti-inflammatory, immunomodulatory, anti-oxidant and antimicrobial properties, the present study has been designed to analyse the effect of zinc aspartate and zinc citrate treatment at therapeutic dose level on disease severity index, haematological, serological, antimicrobial and radiological markers of rheumatoid arthritis in Wistar rats. Bactericidal potential of the two organic zinc compounds was analysed in vitro in clinically isolated Escherichia coli. Arthritis was induced in male Wistar rats by intradermal injection of an emulsion containing collagen type II and Complete Freund's Adjuvant (CFA) containing 1mgmL-1 Mycobacterium tuberculosis H37Ra. Zinc aspartate and zinc citrate were orally administered after the onset of the disease for 4weeks. Ameliorative effect of zinc aspartate and zinc citrate was evaluated by analysing indices of severity and disease activity markers of rheumatoid arthritis. The liver and kidney function tests were performed to evaluate any possible adverse effect of compounds. Antimicrobial activity of the zinc compounds was assessed in clinically isolated E. coli by MTT assay. Zinc aspartate and zinc citrate equivalent to a therapeutic dose of 50mg/day of elemental zinc attenuated the clinical characteristic of rheumatoid arthritis in the animal model of arthritis, collagen-induced arthritis (CIA). Both zinc salts also exhibited antimicrobial effects against E. coli. The selected dose of zinc aspartate and zinc citrate showed no adverse effects in treated rats. This study highlights the potentiality of zinc compounds as antiarthritic agents and also point to its preventive effects on microbial growth that has been observed in rheumatoid arthritis patients due to their increased sensitivity for bacterial infection.

Rheumatoid arthritis and COVID-19 outcomes: a systematic review and Meta-analysis.

This study aimed to conduct a comprehensive systematic literature review and meta-analysis to assess the risk and outcomes of coronavirus disease 2019 (COVID-19) in patients with rheumatoid arthritis. A systematic search was performed across four electronic databases. The quality of the studies was assessed using the Newcastle‒Ottawa quality assessment scale and the Joanna Briggs Institute critical appraisal checklist. Statistical analyses were conducted using STATA 14 software. A total of 62 studies were included in the analysis. First, the meta-analysis revealed the following prevalence rates among rheumatoid arthritis patients: COVID-19, 11%; severe COVID-19, 18%; COVID-19-related hospitalization, 29%; admission to the intensive care unit (ICU) due to COVID-19, 10%; and death from COVID-19, 8%. Second, rheumatoid arthritis was associated with an increased risk of COVID-19 infection (OR 1.045(0.969-1.122), p = 0.006), COVID-19-related hospitalization (OR 1.319(1.055-1.584), p = 0.006), admission to the ICU due to COVID-19 (OR 1.498(1.145-1.850), p = 0.002), and death from COVID-19 (OR 1.377(1.168-1.587), p = 0.001). Third, no statistically significant association was found between rheumatoid arthritis and severe COVID-19 (OR 1.354(1.002-1.706), p = 0.135). Rheumatoid arthritis patients have a significantly greater risk of COVID-19 infection, hospitalization, ICU admission, and death than individuals without rheumatoid arthritis. However, rheumatoid arthritis did not show a significant association with the risk of severe COVID-19. These findings underscore the need for tailored management strategies and vigilant monitoring of COVID-19 outcomes in rheumatoid arthritis patients. The study has been registered on PROSPERO [ https://www.crd.york.ac.uk/PROSPERO/ ], and the registration number is CRD42024528119.

Preferable effect of CTLA4-Ig on both bone erosion and bone microarchitecture in rheumatoid arthritis revealed by HR-pQCT.

This exploratory study aimed to examine the impact of abatacept treatment on bone structure in patients with rheumatoid arthritis (RA) using high-resolution peripheral quantitative computed tomography (HR-pQCT). RA patients initiating either abatacept or newly introduced csDMARDs were enrolled in this prospective, non-randomized, two-group study. Bone structure in the 2nd and 3rd metacarpal heads was assessed using HR-pQCT at 0, 6, and 12months after enrollment. Synovitis was evaluated using musculoskeletal ultrasound and MRI. The adjusted mean between-group differences (abatacept-csDMARDs group) were estimated using a mixed-effect model. Thirty-five patients (abatacept group: n = 15; csDMARDs group: n = 20) were analyzed. Changes in erosion volume, depth and width were numerically smaller in the abatacept group compared to the csDMARDs group (adjusted mean between-group differences: - 1.86 mm3, - 0.02mm, and - 0.09mm, respectively). Over a 12-month period, 5 erosions emerged in the csDMARDs group, while only 1 erosion appeared in the abatacept group. Compared to csDMARDs, abatacept better preserved bone microarchitecture; several components of bone microarchitecture were significantly worsened at 6months in the csDMARDs group, but were not deteriorated at 6months in the abatacept group. Changes in synovitis scores were similar between the two treatment groups. Our results indicate that abatacept prevented the progression of bone erosion including new occurrence, and also prevented worsening of bone strength independently with synovitis compared to csDMARDs including MTX. Thus, abatacept treatment may provide benefits not only in inhibiting the progress of bone erosion but also in preventing bone microarchitectural deterioration.

A comparison of comorbidities and their risk factors prevalence across rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis with focus on cardiovascular diseases: data from a single center real-world cohort.

Management of comorbidities is essential to a patient-centered approach to the treatment of chronic inflammatory arthritis. The aim of this study was to compare the prevalence of comorbidities and their risk factors in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) in a single center outpatient cohort. This cross-sectional study included adult patients diagnosed with RA, PsA, and axSpA from a single rheumatology outpatient center. Comorbidities were documented by physicians, and patients were categorized into two age groups, younger (< 45years) and older (≥ 45years), with age- and gender-basedcomparisons. Disease activity, comorbidities, and cardiovascular(CV) risk factors were analyzed using chi-squared tests for categorical variables and independent samples t-tests for continuous variables, with p values < 0.05 considered statistically significant. Comorbidities were registered by physicians using GoTreatIt® Rheuma software. Among 508 RA, 267 PsA, and 285 axSpA patients, the four most common comorbidities were hypertension (36.4%, 25.1%, and19.7%, respectively), dyslipidemia (19.5%, 15.4%, 14.7% respectively), obesity (16.9%, 22.5%, 14% respectively) and thyroid disease (21.5%, 13.9%, 11.2% respectively). Other comorbidities differedamong thediseases and included osteoporosis, osteoarthritis, diabetes mellitus, arrhythmia, and asthma in RA, diabetes mellitus, depression and asthma in PsA, osteoporosis and serious infection in axSpA. RA patients, compared to axSpA had a higher prevalence of coronary artery disease (4.1% vs. 0.7%,p = 0.006), arrhythmia (6.9% vs. 2.5%,p = 0.008) and major adverse cardiac events (2.6% vs. 0.4%,p = 0.024) compared to axSpA. Osteoporosis was more frequent in RA (19.1%) and axSpA (8.4%) than in PsA (2.3%;p < 0.001) and was frequently diagnosed in patientsaged < 45. Depression prevalence was surprisingly low (1.6%,5.2%, and 1.8%, respectively). RA patients had the highest multimorbidity rate, with 26.6% reporting three or more comorbidities, compared to 16.8% in PsA and 10.6% in axSpA (p < 0.001). Health status was poorest in RA and worse in women compared to men for all diseases. RA, PsA, and axSpA share the same four most common comorbidities: hypertension, dyslipidemia, obesity, and thyroid disease but have different prevalence of other disorders and CV risk factors, indicating the need for an individual screening and prevention approach. The possible unrecognition of depression should be evaluated.

Effect of traditional Chinese Yijinjing exercise on hand dysfunction in rheumatoid arthritis patients: a randomized controlled trial

IntroductionRheumatoid arthritis (RA) patients often experience significant hand dysfunction. Yijinjing, a traditional Chinese exercise, has been recognized for its benefits to mind–body health. This study aimed to evaluate the efficacy and safety of Yijinjing in improving hand dysfunction among individuals with RA.MethodsThis research was conducted as a single-center, outcome-blinded, randomized controlled trial. A total of 66 eligible RA participants were randomly assigned in a 1:1 ratio to either the Yijinjing exercise group (YJJG) with sessions conducted three times per week over a 12-week period or the control group (CG), which maintained ordinary activities. Various outcomes were assessed, including the Michigan Hand Outcomes Questionnaire (MHQ), handgrip strength, active range of motion (AROM), RA disease activity, the Health Assessment Questionnaire Disability Index (HAQ-DI), levels of anxiety and depression, and wrist ultrasound, all of which were collected at baseline and the week 12.ResultsAt the end of the 12 weeks, the YJJG demonstrated significant improvements in MHQ scores compared to the CG (p &amp;lt; 0.05), alongside enhancements in handgrip strength and AROM, specifically in wrist extension, radial deviation, and metacarpophalangeal flexion (p &amp;lt; 0.05). Wrist ultrasound scores did not exhibit a significant increase in the YJJG, meaning no inflammation aggravation (p &amp;gt; 0.05). Additionally, morning stiffness duration, Disease Activity Score 28-ESR (DAS28-ESR), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels showed significant improvement in the YJJG (p &amp;lt; 0.05). Both groups reported enhancements in quality of life, as well as reductions in anxiety and depression scores, with the YJJG displaying greater improvements overall (p &amp;lt; 0.05). Importantly, no adverse events or significant abnormalities in vital signs were observed in either group.ConclusionYijinjing exercise may effectively enhance hand function, handgrip strength, and flexibility in RA patients with low disease activity. Furthermore, it appears to improve quality of life and reduce anxiety and depression without exacerbating joint inflammation.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05527158, Identifier NCT05527158.

Superb Microvascular Imaging Is Better Than Power Doppler Ultrasound in Diagnosing Subclinical Synovitis in Patients With Inflammatory Arthritis in Remission.

The aim of this study was to investigate the value and reliability of superb microvascular imaging (SMI) in detecting subclinical synovial inflammation in patients with inflammatory arthritis. All patients with inflammatory arthritis who had achieved clinical remission were retrospectively analyzed and evaluated with SMI and power Doppler ultrasound (PDUS). Subclinical synovitis was graded by a semiquantitative score (0-3) for each imaging method. Imaging findings and synovitis scores were compared between the rheumatoid arthritis (RA) group and non-RA group. Eighty RA patients with 270 joints and 38 non-RA patients with 112 joints were recruited. In all patients, the remission rates of SMI and PDUS were 73.7% and 79.7%, respectively. The remission rates by SMI were found lower and the sensitivity of SMI was higher than PDUS in both RA and non-RA groups. Compared with PDUS, the number of joint count with synovial vascular flow signals was found to be significantly higher in SMI in each group (p < 0.001). Moreover, semiquantitative ultrasound scores were found significantly higher with SMI in each joint (p < 0.001). SMI appears to be better than PDUS in detecting synovial signals in terms of joint number and vascularity scoring in monitoring disease activity in patients with inflammatory arthritis in clinical remission. Future research should focus on SMI and new ultrasound-based activity scores to identify and achieve true remission.

Pristimerin inhibits the progression of antibody-induced autoimmune arthritis

Objectives Rheumatoid arthritis (RA) is an autoimmune disease of the synovial joints. Pro-inflammatory cytokines produced by various immune cells drive the chronic inflammatory processes that lead to joint damage. Many drugs are available for the treatment of RA, but a significant proportion of patients do not respond adequately to them and/or have severe adverse effects. Accordingly, there is an urgent need for new therapeutics for RA. Therefore, we tested pristimerin, a natural triterpenoid, for its anti-arthritic activity in experimental RA. Method Collagen antibody-induced arthritis (CAIA) was induced in DBA/1 mice. After the onset of arthritis, mice were injected daily intraperitoneally with pristimerin or vehicle for 9 days. The severity of clinical arthritis was graded and further validated by micro-computed tomography and histological examination of the hind paws. Defined mediators of arthritogenic processes were quantified by gene expression in the spleen and further validated by immunohistochemistry of paws. Results We observed that pristimerin can effectively control arthritis progression in CAIA mice. A preliminary exploration of the mechanisms showed that pristimerin targeted key pro-inflammatory cytokines and chemokines, along with specific mediators of angiogenesis, bone remodelling, and cellular signalling, including the Notch signalling pathway. Conclusions This is the first report on pristimerin for its use in the treatment of antibody-induced arthritis and for the targeting of Notch pathway in arthritis by this triterpenoid. As pristimerin can control the effector phase of arthritis, our results are promising for the translation of this experimental therapy to RA patients.

Serum Anti-Aminoacyl-Transfer Ribonucleic Acid Synthetase Antibody Levels Are Involved in Rheumatoid Arthritis Complicated with Interstitial Lung Disease

Objectives: A common complication in patients with rheumatoid arthritis (RA) is interstitial lung disease (ILD). Antibodies (Abs) to anti-aminoacyl-transfer ribonucleic acid synthetase (ARS) are linked to ILD in patients with idiopathic inflammatory myopathies (IIM). There have been limited studies of anti-ARS Abs in RA. In this study, we examined anti-ARS Abs in ILD in patients with RA. Methods: Anti-ARS Abs in serum from patients with RA were measured. Results: There were higher anti-ARS Ab levels in RA patients with ILD (mean ± SDM, 16.3 ± 32.3 vs. 7.4 ± 7.0 (Index), p = 5.58 × 10−12), usual interstitial pneumonia (14.4 ± 24.4 vs. 7.4 ± 7.0 [Index], p = 3.14 × 10−12), and nonspecific interstitial pneumonia (17.9 ± 37.7 vs. 7.4 ± 7.0 (Index), p = 5.07 × 10−5) compared with patients without chronic lung disease. The area under the curve (AUC) of the receiver operating characteristic curve for anti-ARS Ab was too low to allow for discrimination among RA patients with/without chronic lung disease (0.608, 95% confidence interval (CI) 0.560–0.655, p = 8.69 × 10−6). Multiple logistic regression analyses of age, smoking status, anti-ARS Abs, as well as Steinbrocker stage generated an ARS-index with a high AUC value (0.707, 95%CI 0.662–0.752, p = 2.20 × 10−19). Conclusions: Anti-ARS Abs are related to ILD pathogenesis in RA and may be a biomarker for ILD.

Analysis of periodontal status in Polish patients with rheumatoid arthritis treated with biological therapies

IntroductionPeriodontitis, characterized by inflammation affecting the tooth-supporting tissues, may increase the risk of rheumatoid arthritis (RA) or cardiovascular diseases. The aim of the study was to evaluate the periodontal status in RA patients and its impact on the inflammatory markers and red cell parameters obtained from complete blood laboratory tests to study the risk of cardiovascular disease development.Material and methodsThe cross-sectional study included 50 patients with RA treated with biologi­cal therapies: tumor necrosis factor inhibitors, interleukin-6 blockers. Rheumatoid arthritis disease activity was assessed with Disease Activity Score with 28-joint count (DAS28). The periodontal indices modified Approximal Periodontal Index, modified Papillary Bleeding Index, and Periodontal Screening Index (PSI) were used to assess patients’ periodontal status. Serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used as inflammatory markers and a potential cardiovascular risk factor.ResultsNo statistically significant correlation was found between the periodontal status and RA activity. However, a statistically significant correlation was found between the CRP results and the PSI scores (&lt;i&gt;R&lt;/i&gt; = –0.264510, &lt;i&gt;p&lt;/i&gt; = 0.048837). Evaluation of the red cell parameters showed statistically significant differences in the markers of inflammation ESR (&lt;i&gt;R&lt;/i&gt; = 0.369398, &lt;i&gt;p&lt;/i&gt; = 0.008289) and CRP (&lt;i&gt;R&lt;/i&gt; = 0.367405, &lt;i&gt;p&lt;/i&gt; = 0.008672). Red cell distribution width values were also correlated with RA activity (&lt;i&gt;R&lt;/i&gt; = 0.286387, &lt;i&gt;p&lt;/i&gt; = 0.043769) and duration of the disease (&lt;i&gt;R&lt;/i&gt; = 0.339425, &lt;i&gt;p&lt;/i&gt; = 0.015889).ConclusionsA satisfactory periodontal status was found in most of the study group. Increased CRP levels in patients with periodontitis may indicate the negative impact of periodontal status on the general clinical condition of the patient.

Prediction model for bone erosion in rheumatoid arthritis based on musculoskeletal ultrasound and clinical risk factors.

Progressive bone erosion (BE) is a prominent manifestation of structural damage in rheumatoid arthritis (RA). This study aimed to construct and validate a BE prediction model (BEPM) for RA based on musculoskeletal ultrasound and clinical risk factors. A total of 312 RA patients without BE were consecutively collected and followed up for 2years, who were divided into BE group and non-bone erosion group, as confirmed by two radiology experts based on at least two imaging techniques. Relevant clinical information, such as anti-cyclic citrullinated peptide (ACCP) antibody and disease duration, was collected. Musculoskeletal ultrasound examinations were performed on all patients upon admission. Univariate and binary logistic regression analyses were conducted to identify risk factors for BE and to establish the prediction model. The calibration, diagnostic efficacy, and clinical effectiveness of BEPM were evaluated by calibration curve plots, receiver-operating characteristic curve, and decision curve analysis (DCA). Binary logistic regression analysis screened four variables, including synovial hyperplasia, synovial blood flow, ACCP + , and disease duration, into the prediction model. BEPM exhibited good diagnostic performance in both the training and validation groups, with area under the curve values of 0.949 (95% CI 0.924-0.973) and 0.965 (95% CI 0.935-0.996), respectively. Using 0.376 as the optical cutoff value for BE, the sensitivity, specificity, and Youden index of the model in the training group were 86.0%, 90.4%, and 76.4%, respectively. In the DCA curves, BEPM indicated overall good population benefit. BEPM demonstrates high diagnostic performance and clinical utility, and may be a useful clinical model for predicting BE in patients with RA. Key Points • Synovial hyperplasia, synovial blood flow, ACCP+ , and disease duration are independent risk factors for bone erosion in RA patients. • BEPM exhibits good diagnostic performance in both the training and validation groups. • Combining musculoskeletal ultrasound parameters with key clinical risk factors to construct a bone erosion model is feasible.

Comparison of treatment of severe rheumatoid arthritis patients with biological agents and JAK-STAT inhibitors. An extension study

IntroductionThis study compared treatment with biologic agents and Janus kinase inhibitors (JAKi) in combination with methotrexate (MTX) for rheumatoid arthritis (RA) in a real-world setting at a large center in Poland. There is a persistent shortage of such studies, and illustrating the switching of medications in search of a suitable way of treatment for a given patient is a crucial step towards future personalized therapy.Aim of the studyThis study is an extension of the initial work published in 2022 in &lt;i&gt;Reumatologia&lt;/i&gt;, with the addition of an analysis of patients treated with upadacitinib. The study compared the effectiveness and side effects after treatment of biological disease modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) in combination with MTX.Materials and methodsA total of 130 patients with active severe RA (Disease Activity Score for 28 joints based on the erythrocyte sedimentation rate [DAS28-ESR] value &gt; 5.1) were treated at the Rheumatologic Outpatients Department of the Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland between January 2010 and September 2021. All patients were treated with MTX 25 mg per week. They were divided into two groups: group I (80 patients) treated with biologic agents, and group II (50 patients) treated with JAKi. Assessment of DAS28-ESR and Simplified Disease Activity Index (SDAI) and analy­sis of Boolean criteria for remission were performed. Remission or low disease activity, switching between drugs and adverse events were assessed and compared between studied groups.ResultsPatients treated with tsDMARDs had previously used a higher number of conventional synthetic DMARDs (csDMARDs) and bDMARDs compared to those treated with bDMARDs. However, they achieved lower SDAI and assessment of disease activity using Visual Analogue Scale (VAS) values, and a higher proportion of patients achieved Boolean criteria for remission after treatment.ConclusionsThe results of treatment with JAKi were successful, but the potential side effects indicate that this treatment may not be equally suitable for all RA patients.

Menopause Matters: Results of a National Survey of Rheumatoid Arthritis Patients in the UK.

The effects of the menopause have received a lot of attention in the press recently. Anecdotally, patients report changes in their arthritis around the menopause, either onset or aggravation of symptoms. Clearly, there are hormonal influences on arthritis with the female predominance, onset of RA around times of hormonal change and improvement during pregnancy. We were interested in exploring the patient perspective to inform future research and educational needs. A national survey was organised through the National Rheumatoid Arthritis Society (NRAS), using their database of people with RA and online community who self-selected as peri menopausal, menopausal or post-menopausal. A questionnaire was developed by the steering group seeking responses on the effects of the menopause, changes in the arthritis at the time, use of hormone replacement therapy (HRT) and any discussions they had had with their healthcare providers. Free text comments were analysed qualitatively. A total of 779 people responded during September/October 2023. Respondents were 95% Caucasian mainly in their 50s with onset of menopausal symptoms in their 40s. 80% responded that their arthritis was worse during the menopause with 10% being much worse. 47% had taken HRT. Of these, 80% experienced an improvement in their menopausal symptoms and 30% had a moderate or large improvement in their arthritis symptoms. A standout statistic was that 93% of respondents had had no medical discussion about the menopause. For those who did, this was most frequently with the GP in relation to HRT and osteoporosis. 84% of participants felt that the rheumatology team should receive more education and training about the menopause in relation to RA. The qualitative analysis revealed several themes: Discussion about the menopause only occurred if the patient raised it. There was conflicting advice about HRT. There is overlap and confusion of symptoms between RA and the menopause. Participants expressed a perceived link between menopause and onset or deterioration of their arthritis. This study was long overdue. Patients perceive a strong association between the menopause and onset or deterioration of their arthritis, with confusion over what is due to arthritis and what is being caused by the menopause. Patients would like much more discussion about the menopause, but this is not currently happening. They are getting conflicting advice on HRT. Further research is necessary to clarify the impact of the menopause on people with arthritis.

Shared lung and joint T cell repertoire in early rheumatoid arthritis driven by cigarette smoking

ObjectivesSmoking has been associated with an increased risk of developing rheumatoid arthritis (RA) in individuals carrying shared epitope (SE) HLA-DRB1 alleles. Yet, little is known about the regional and systemic...

Utilising Hyperspectral Autofluorescence Imaging in the Objective Assessment of Disease State and Pain in Patients with Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a chronic inflammatory disease resulting in joint swelling and pain. Treatment options can be reliant on disease activity scores (DAS) incorporating patient global assessments, which are quantified via visual analogue scales (VAS). VAS can be subjective and not necessarily align with clinical symptoms, such as inflammation, resulting in a disconnect between the patient’s and practitioners’ experience. The development of more objective assessments of pain would enable a more targeted and personalised management of pain within individuals with RA and have the potential to improve the reliability of assessments in research. Using emerging light-based hyperspectral autofluorescence imaging (HAI) technology, we aimed to objectively differentiate disease and pain states based on the analysis of synovial tissue (ST) samples from RA patients. In total, 22 individuals with RA were dichotomised using the DAS in 28-joint counts (DAS-28) into an inactive (IA) or active disease (active-RA) group and then three sub-levels of pain (low, mid, high) based on VAS. HAI was performed on ST sections to identify and quantify the most prominent fluorophores. HAI fluorophore analysis revealed a distinct separation between the IA-RA and active-RA mid-VAS cohort, successfully determining disease state. Additionally, the separation between active-RA Mid-VAS and active RA High-VAS cohort suggests that HAI could be used to objectively separate individuals based on pain severity.