Rheumatoid Factor Titer Research Articles

Vitamin D deficiency and pulmonary affection in rheumatoid arthritis

Background Vitamin D appears to play a key role both in the innate and in the adaptive immune system, and the presence of its receptors in different cell types seems to play a role in the pathogenesis of rheumatoid arthritis (RA). Vitamin D deficiency is common and seems to be correlated with the course of RA and outcome of pulmonary disease, which is a major contributor to morbidity and mortality in RA patients. Aim This study aimed to evaluate the prevalence of vitamin D deficiency and its relationship with pulmonary affection in a cohort of Egyptian RA patients. Patients and methods A total of 100 RA patients were enrolled in this study, who underwent a clinical examination, with a focus on articular and extra-articular manifestations including pulmonary manifestations. Assessment of RA disease activity was performed using the disease activity score (DAS)-28 score and serum vitamin D level was measured. Spirometry and diffusion lung capacity for carbon monoxide were performed. Radiographic evaluation, Plain x-ray on hands, chest x-ray and high-resolution computed tomography (HRCT) chest were done. Results Our study included 100 RA patients (40 patients with pulmonary affection and 60 patients without pulmonary affection). DAS-28 and rheumatoid factor titer were increased in RA patients with pulmonary affection. Moreover, vitamin D serum levels were decreased in RA patients with pulmonary affection. Multiple regression analysis showed that older age, disease activity parameters, and decreased vitamin D levels had an independent effect on increasing the HRCT chest total score. Logistic regression analysis showed that the increase in the DAS-28 score and the rheumatoid factor titer and the decrease in the vitamin D levels had an independent effect on increasing the probability of pulmonary affection occurrence. Conclusion Patients with RA-associated interstitial lung disease ‘proved by HRCT and/or diffusion lung capacity for carbon monoxide’ tend to have a high prevalence of vitamin D deficiency and high disease activity; also, lower levels of vitamin D play a significant role in the pathogenesis of RA-interstitial lung disease.

A Study of Correlation of Disease Severity with Antibody Titers in Rheumatoid Arthritis

Introduction: Rheumatoid Arthritis (RA) is one of the most frequent autoimmune diseases in the world which affects about 1% of people. Anti-Cyclic Citrullinated Peptides (Anti-CCP) is shown to be more specific than rheumatoid factor in the diagnosis of RA. This test becomes positive in early stage of disease and it has a high predictive value. Aim: To correlate the relationship between anti-CCP antibody and rheumatoid factor titers and disease activity scores. Materials and Methods: A cross-sectional study was performed in 50 patients with RA for evaluating the relation between anti-CCP antibody titer and Disease Activity Score 28 (DAS28), Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI). A detailed examination of each patient including their demographic characteristics, duration of disease, number of tender and swollen joints, ESR and C-reactive protein, patient’s and physician’s global assessment by VAS (0-10) and titers of rheumatoid factor and nti-CCP antibody. Patients who fulfilled the ACR-EULAR 2010 criteria were included. The statistical analysis was done using Pearson’s correlation coefficient. A p-value of less than 0.05 was considered significant. Results: Of the 50 patients which were included (mean age, 44.82 range, 18-70), 38 were females and 12 were males. Mean ESR was 54±27 mm/hr and Mean CRP was 17.277±23.41 mg/dL. Mean DAS 28 was 5.955±0.962; mean SDAI was 46.9±27.1 and CDAI 28.9±10.8. There was positive correlation (p<0.001) between DAS28 and SDAI (r=0.550) and CDAI (r=0.808). Anti-CCP level was associated with SDAI (r=0.317) and CDAI (r=0.282) (p<0.05). Conclusion: There was significant correlation in the titers of anti-CCP and disease activity indices-SDAI and CDAI. Patients with higher levels of anti-CCP antibody had greater activity.

Relationship between bone mineral density and anti-citrullinated protein antibody and rheumatoid factor in patients with rheumatoid arthritis.

ObjectiveRheumatoid arthritis (RA) is one of the causes of osteoporosis, and it leads to systemic bone loss. The anti-citrullinated protein antibody (ACPA) and rheumatoid factor (RF) are associated with local and systemic low bone mineral density and osteoclast-mediated bone resorption independently of inflammation in patients with RA. In this article, we aimed to evaluate the relationship between the ACPA, RF, and systemic bone mineral density in patients with RA.MethodsNinety-three patients (6 male, 87 female) with RA were included in the study. The disease activity score 28-erythrocyte sedimentation rate and titers of RF, ACPA, and bone mineral density of the total hip, femoral neck, and lumbar areas were evaluated. The independent samples t-test, Mann-Whitney U-test, Spearman’s correlation, and multivariable regression analysis were used for the statistical analysis.ResultsThe RF and ACPA were positive in 40.9% and 48.4% of patients with RA, respectively. Disease activity was negatively correlated with the T- and Z-scores. The T- and Z-scores were lower in the seropositive group than in the seronegative group. The ACPA was negatively correlated with the T- and Z-scores of the femoral neck. There was a significant difference for the Z-score of the femoral neck in patients with ACPA and RF-positive patients compared to seronegative patients with RA.ConclusionA low bone mineral density, especially in the femoral neck, is associated with the presence of ACPA and RF. It would be a more appropriate approach to carefully monitor osteoporosis in seropositive RA patients.

Predictive value of rheumatoid factor titre in cryoglobulinemia in Hepatitis C positive patients

Background/objective: HCV viremia has been known to provoke a plethora of autoimmune syndromes as well as nonspecific rheumatologic manifestations. HCV is the most frequent cause of mixed cryoglobulinemia, which is characterized by endothelial deposition of rheumatoid factor containing immune complexes and endorgan vasculitis. Rheumatoid factor positivity is found to be more prevalent among patients with HCV infection compared to the general population. The aim of the study was to ascertain the relationship of rheumatoid factor titer with cryoglobuliemia in hepatitis C virus positive patients and to assess its relation with different disease characteristics. Methods: A cross sectional study was carried out through one year. Fifty patients known to suffer from HCV were subjects of the study. Patients were interviewed and demographic, clinical and serologic data were recorded. All patients were tested for cryoglobulins by crude method and rheumatoid factor titer was determined in all patients. Child-Pugh classification was used for assessment of liver cell failure. Data were analyzed by the Statistical Package for the Social Sciences (SPSS, version 17). Data analysis is done by using Chi-Squared test (χ2) test and Fisher’s exact test as appropriate. Associations between interval, ordinal and dichotomous variables were tested by Pearson`s Product Moment Correlation Coefficients (r). Results: Cryoglobulinemia was detected in 36 (72%) patients out of the 50 HCV patients. Rheumatoid Factor (RF) was positive in 38% patients (76%). All HCV patients who were positive for cryoglobulin had a positive RF. Presence of RF found to be positively significantly correlated with the presence of cryogloulins in HCV patients. Conclusions: HCV infection is a major contributing factor of mixed cryoglobulinemia with elevation in RF titre. Positive anti-HCV antibodies together with highly positive RF titre in the presence of musculoskeletal, neurological and cutaneous manifestations strongly suggest the diagnosis of mixed cryoglobulinemia.

Rheumatoid Factor Positivity is Associated with Lower Bone Mass in Korean Male Health Examinees without Clinically Apparent Arthritis

Objective. This cross-sectional study aimed to investigate the association between rheumatoid factor (RF) positivity and bone mineral density (BMD) in male Korean subjects without any history of joint disease. Methods. Of 84,344 males who had undergone a comprehensive health checkup program in 2012, 1,390 male health examinees were recruited, whose BMD and RF results were available. A RF titer ≥20 IU/mL was considered positive. BMD was measured at lumbar spine (L1∼L4) or hip (femoral neck and total hip) by dual-energy X-ray absorptiometry. Results. The association between RF positivity and BMD was assessed by multiple linear regression analysis. The mean age was 52.7±10.9 years (range 19∼88 years), and RF was detected in 64 subjects (4.6%). Demographics and laboratory data were not different between RF-positive and -negative subjects except hepatitis B surface antigen (HBsAg), which was more frequently seen in RF-positive subjects (15.6% vs. 4.3%, p=0.001). RF-positive subjects had significantly lower BMD compared to RF-negative subjects in lumbar spine but not in total hip regardless of the existence of HBsAg (1.17±0.16 g/㎠ vs. 1.10±0.18 g/㎠, p=0.002 in total subjects; 1.17±0.16 g/㎠ vs. 1.10±0.18 g/㎠, p=0.004 in HBsAg-negative subjects). After adjusting for multiple confounders, RF positivity was negatively associated with lumbar spine BMD (B=-0.088 and standard error=0.035, p=0.011). Conclusion. Our results show that the presence of RF could have an unfavorable impact on bone density in apparently normal males. Additional studies to elucidate the osteoimmunological mechanism of rheumatoid factor are warranted. (J Rheum Dis 2019;26:31-40)

Comparison of rheumatoid factor of IgM, IgG and IgA isotypes with disease activity score 28 in patients of rheumatoid arthritis

Introduction/background: Rheumatoid factor (RF) is a widely used serological marker for the diagnosis of rheumatoid arthriris (RA). RF can be detected in up to 70 to 80% of RA patients and it is associated with disease activity, bone erosion, and disease outcome. RF is an autoantibody targeting the 'fraction crystallizable' (Fc) region of IgG antibodies and exists as IgA, IgG and IgM isotypes. The objective of this study was to compare the RF isotypes IgM, IgG and IgA with disease activity score 28 in rheumatoid arthritis patients. Materials and Methods: This was a descriptive study, which included 83 RA patients. Blood samples of the patients were collected from the Department of Rheumatology, Sheikh Zayed Hospital Lahore. The levels of different isotypes of RF i.e. IgM, IgG and IgA were determined by ELISA technique. Data was analysed by SPSS 20.0. Results: RF, IgM, IgG, and IgA isotype, was detected in 83%, 10%, and 40% of RA patients respectively. RF istoypes were compared with DAS28. There was no significant association between DAS 28 and RF IgM [Odd ratio (CI)] [0.5(0.07-3.18)], RF IgG [3.0(0.27-32.20)] and RF IgA [0.4(0.43-0.13)]. Disease duration was also compared with RF isotypes but no significant association found. There was no significant association between disease duration and RF IgM [Odd ratio (CI)] [1.4(0.46-4.86)], RF IgG [1.6(0.50-5.0)] and RF IgA [1.1(0.53-2.7)]. Conclusion: All the isotypes of RF were detected in RA patients. As a screening method for rheumatoid arthritis the IgM-RF is superior to other RF isotypes. RF titer may be valueable in estimation of disease activity and other inflammatory parameters in RA patients.

Effects of Tocilizumab Therapy on Serum Interleukin-33 and Interleukin-6 Levels in Patients With Rheumatoid Arthritis.

This study aims to examine the effects of tocilizumab therapy on serum levels of interleukin (IL)-33 and IL-6 in rheumatoid arthritis (RA) patients. Interleukin-33 and IL-6 levels in serum samples from 83 RA patients (10 males, 73 females; mean age 51.9 years; range, 26 to 77 years) and 12 healthy controls (2 males, 10 females; mean age 52.2 years; range, 39 to 62 years) were compared by cross-sectional, case control analysis. Of the RA patients, 40 received 24 weeks of tocilizumab therapy and were assigned to the prospective cohort. These 40 patients were then divided into two subgroups as responders and non-responders according to the American College of Rheumatology (ACR) 20. The remaining 43 RA patients did not receive tocilizumab therapy. Serum cytokine levels were analyzed at baseline and after 24 weeks of tocilizumab therapy in these patients. Interleukin-33 and IL-6 concentrations were significantly higher in RA patients than in healthy controls (p<0.001 for both). Serum IL-33 levels in RA patients showed a significant correlation with rheumatoid factor titer (r=0.660, p<0.001), and IL-6 levels showed a significant correlation with high-sensitivity C-reactive protein levels (Spearman's rank correlation coefficient=0.482, p<0.001). Serum IL-33 levels decreased significantly after 24 weeks of tocilizumab therapy (p<0.001); this was particularly marked in ACR20 responders (p<0.001). However, the decrease in non-responders was not significant (p=0.066). Changes in serum IL-6 levels after 24 weeks of tocilizumab therapy were not significant in either ACR20 responders or non-responders. Serum IL-33 levels in RA patients receiving tocilizumab therapy decreased significantly, particularly in ACR20 responders. Thus, IL-33 may be a useful marker for monitoring responses to tocilizumab therapy.

A Pain in the Colon: Rheumatoid Arthritis as an Unusual Cause of Colonic Ischemia

Colonic ischemia is the most common form of intestinal ischemia and is defined by the reduction of blood flow to a level insufficient to maintain cellular metabolic function. Rheumatoid vasculitis (RV) can occur in up to 5% of rheumatoid arthritis (RA) patients with intestinal involvement in 10-38% of patients. We report a rare case of RA as the cause of isolated right sided colonic ischemia. A 61-year-old African American woman with a history of RA, pulmonary sarcoidosis, and hypertension presented with abdominal pain and non-bloody diarrhea for two weeks. She reported four to five loose watery bowel movements a day. The abdominal pain was intermittent, cramping, and not associated with food. She also endorsed joint stiffness in her hands. Her medication list included daily aspirin 81mg, hydroxychloroquine 400mg, prednisone 5mg, hydrochlorothiazide 25mg, and twice daily leflunomide 20mg. She was previously on etanercept and stopped 6 months prior.Significant physical exam findings revealed a normotensive patient with mild diffuse abdominal tenderness, metacarpophalangeal joint swelling, and swan neck deformity of her fingers. Other than high titers of rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody, and elevated c-reactive protein (1.7mg/dL), laboratory workup was unremarkable with a negative infectious workup. Colonoscopy revealed multiple superficial linear ulcerations with erythematous borders from the cecum to the hepatic flexure. Pathology from the biopsies showed no granulomas but noted areas of hemorrhage, ischemia, and nuclear dust suggestive of neutrophilic vasculitis surrounding thrombosed small vessels consistent with RV. A CT angiography showed diffuse mucosal enhancement of the ascending colon with associated fat stranding and patent abdominal arterial vasculature. Her symptoms resolved after supportive treatment, titration of prednisone, and restarting etanercept. Clinicians should be aware of RA as a rare cause of colonic ischemia. Although there are no formal diagnostic criteria, the diagnosis should be suspected in patients with colonic ischemia who have RA, high titers of RF with characteristic histopathology showing neutrophilic vasculitis on colonoscopy biopsies after more common causes are ruled out. The pathogenesis is thought to arise from immune complex formation from RF in small vessels. Treatment involves supportive care and immunosuppression of the RA.1556_A Figure 1. Colonoscopy showing superficial ulcerations in the right colon.1556_B Figure 2. Abdominal CT showing mucosal enhancement of the ascending colon.1556_C Figure 3. Histopathology showing nuclear dust suggestive of neutorphilic vasculitis surrounding a thrombotic small vessel.

Clinical and diagnostic significance of serum immunoglobulin A rheumatoid factor in primary Sjogren's syndrome.

The aim of this study was to investigate the diagnostic accuracy of rheumatoid factor (RF) isotype for the detection of primary Sjogren's syndrome (pSS) and evaluate the clinical and serological associations of immunoglobulin (Ig) A RF in patients with pSS. RF levels were measured in 77 and 37 patients with pSS and idiopathic sicca symptoms, respectively, using ELISA and analysed with respect to clinical and laboratory disease characteristics. Receiver operating characteristic curves were used to determine and compare the diagnostic accuracy of IgA RF with other diagnostic tests. Serum levels of IgA RF were significantly higher in patients with pSS than in those with idiopathic sicca symptoms. IgA RF showed sensitivity, specificity, positive, and negative predictive values of 83.1, 78.4, 88.9, and 69.0%, respectively, for pSS diagnosis. IgA RF was associated with xerostomia, severe sialoscintigraphic grade, low unstimulated salivary flow rate (USFR), antinuclear antibody, high IgG and IgM/G RF levels, and low C3 levels in patients with pSS. IgA RF titres had positive correlations with sialoscintigraphic grade and IgG and IgG/M RF levels and had negative correlations with USFR and C3 levels. Our findings confirmed the potential of IgA RF to distinguish pSS from idiopathic sicca symptoms. The presence of IgA RF in patients with pSS was associated with significantly worse exocrine function and active serologic profile. No association between IgA RF and extra-glandular manifestations was noted. IgA RF should be the predictive and diagnostic marker in patients with pSS.

Neuromuscular Ultrasound Versus Electrophysiological Studies in Assessment of Posterior Tibial Nerve Neuropathy in Rheumatoid Arthritis Patient

Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming polyarthritis. Extra-articular manifestations occur in 10–20% of patients, especially those with high titers of rheumatoid factor. Neuromuscular ultrasound is useful for the work up of posterior tibial nerve neuropathy. Diagnosis of posterior tibial neuropathy is based on a combination of characteristic symptoms and electrophysiological abnormalities. Recently, neuromuscular ultrasound has become an attractive complement to electrodiagnostic (EDX) studies in the evaluation of peripheral nerves. Aim of the Work: To evaluate neuromuscular ultrasound versus electrophysiological studies in assessment of posterior tibial nerve neuropathy in rheumatoid arthritis patients. Patients and Methods: The subjects included in our study functionally were divided into two groups. Group (A): Thirty Egyptian patients with Rheumatoid Arthritis (RA), all fulfilled the American College of Rheumatology (ACR) 2010 criteria for diagnosis of RA and ACR criteria for classification of rheumatoid arthritis (1987). All were over the age of sixteen at time of diagnosis. They were recruited from Physical Medicine, Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from November 2017 to April 2018. They were complaining of burning pain or paresthesia on the plantar aspect of the foot and toes. Group (B): Thirty healthy individuals, age and sex matched, were used as a control group after an informed consent from all subjects. Results: Neuromuscular ultrasound had a complementary role in the diagnosis of posterior tibial nerve neuropathy. The combined use of electrophysiology with neuromuscular ultrasonography further confirmed the diagnosis of posterior tibial nerve neuropathy. Conclusion: Neuromuscular ultrasound became an attractive complement to electrodiagnostic (EDX) studies in the evaluation of posterior tibial nerve neuropathy.

Neuromuscular Ultrasound Versus Electrophysiological Studies in Assessment of Posterior Tibial Nerve Neuropathy in Rheumatoid Arthritis Patient

Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming polyarthritis. Extra-articular manifestations occur in 10–20% of patients, especially those with high titers of rheumatoid factor. Neuromuscular ultrasound is useful for the work up of posterior tibial nerve neuropathy. Diagnosis of posterior tibial neuropathy is based on a combination of characteristic symptoms and electrophysiological abnormalities. Recently, neuromuscular ultrasound has become an attractive complement to electrodiagnostic (EDX) studies in the evaluation of peripheral nerves. Aim of the Work: To evaluate neuromuscular ultrasound versus electrophysiological studies in assessment of posterior tibial nerve neuropathy in rheumatoid arthritis patients. Patients and Methods: The subjects included in our study functionally were divided into two groups. Group (A): Thirty Egyptian patients with Rheumatoid Arthritis (RA), all fulfilled the American College of Rheumatology (ACR) 2010 criteria for diagnosis of RA and ACR criteria for classification of rheumatoid arthritis (1987). All were over the age of sixteen at time of diagnosis. They were recruited from Physical Medicine, Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from November 2017 to April 2018. They were complaining of burning pain or paresthesia on the plantar aspect of the foot and toes. Group (B): Thirty healthy individuals, age and sex matched, were used as a control group after an informed consent from all subjects. Results: Neuromuscular ultrasound had a complementary role in the diagnosis of posterior tibial nerve neuropathy. The combined use of electrophysiology with neuromuscular ultrasonography further confirmed the diagnosis of posterior tibial nerve neuropathy. Conclusion: Neuromuscular ultrasound became an attractive complement to electrodiagnostic (EDX) studies in the evaluation of posterior tibial nerve neuropathy.

Image analysis of fibrosis in labial salivary glands of patients with systemic autoimmune diseases. Close correlation of lobular fibrosis to seropositive rheumatoid arthritis and increased anti-CCP and RF titres in the serum

Lobular fibrosis in labial salivary glands of patients with systemic autoimmune disease is a rarely examined and rather neglected histological change. Its significance and disease association is poorly understood. Our aim was to explore the clinical correlations of fibrosis in labial salivary gland samples using objective methods and laboratory parameters. Labial salivary gland samples from more than 300 patients over a 3-year period were selected from the archives of the pathology department, histologically examined, digitised, image analysed and statistically evaluated to identify the presence and intensity of lobular fibrosis, its relation to age, clinical diagnoses of systemic autoimmune disease and the presence of rheumatoid factor (RF), anti-cyclic citrullinated peptide (CCP), antinuclear antibodies (ANAs), and anti-dsDNA serum markers. Significant correlationwas found between lobular fibrosis and the presence of autoimmune disease (p= 0.023), mainly seropositive rheumatoid arthritis (p < 0.001). Also significant association was found between the fibrosis and the presence of serum anti-CCP (p < 0.001) and IgA/IgG/IgM-RF (p < 0.001, p < 0.001 and p= 0.008, respectively). Significant association was explored between the anti-dsDNA positivity and the negative histology groups (p= 0.033) and between the ANA positivity and the inflammation only group (p= 0.021). The results suggest that lobular fibrosis tends to associate to certain systemic autoimmune diseases, mainly seropositive rheumatoid arthritis, and seems to be rare in labial salivary gland biopsiesof autoimmune diseases characterised by presence of anti-dsDNA. The close correlation of ANA positivity and the inflammation only histology was not surprising, since the majority of patients (62%) have Sjögren's syndrome, known for its inflammatory infiltrate. These findings emphasise that evaluation of lobular fibrosis and inflammation in histological samples of labial salivary gland biopsiesare equally important.

Vapour, gas, dust and fume occupational exposures in male patients with rheumatoid arthritis resident in Cornwall (UK) and their association with rheumatoid factor and anti-cyclic protein antibodies: a retrospective clinical study

ObjectivesTo quantify exposure to vapour, gas, dust and fumes (VGDF) and smoking in male rheumatoid arthritis (RA) and investigate impact on rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) levels.DesignA...

HLA-DRB1 Analysis Identified a Genetically Unique Subset within Rheumatoid Arthritis and Distinct Genetic Background of Rheumatoid Factor Levels from Anticyclic Citrullinated Peptide Antibodies.

HLA-DRB1 is the most important locus associated with rheumatoid arthritis (RA) and anticitrullinated protein antibodies (ACPA). However, fluctuations of rheumatoid factor (RF) over the disease course have made it difficult to define fine subgroups according to consistent RF positivity for the analyses of genetic background and the levels of RF. A total of 2873 patients with RA and 2008 healthy controls were recruited. We genotyped HLA-DRB1 alleles for the participants and collected consecutive data of RF in the case subjects. In addition to RF+ and RF- subsets, we classified the RF+ subjects into group 1 (constant RF+) and group 2 (seroconversion). We compared HLA-DRB1 alleles between the RA subsets and controls and performed linear regression analysis to identify HLA-DRB1 alleles associated with maximal RF levels. Omnibus tests were conducted to assess important amino acid positions. RF positivity was 88%, and 1372 and 970 RF+ subjects were classified into groups 1 and 2, respectively. RF+ and RF- showed similar genetic associations to ACPA+ and ACPA- RA, respectively. We found that shared epitope (SE) was more enriched in group 2 than 1, p = 2.0 × 10-5, and that amino acid position 11 showed a significant association between 1 and 2, p = 2.7 × 10-5. These associations were independent of ACPA positivity. SE showed a tendency to be negatively correlated with RF titer (p = 0.012). HLA-DRB1*09:01, which reduces ACPA titer, was not associated with RF levels (p = 0.70). The seroconversion group was shown to have distinct genetic characteristics. The genetic architecture of RF levels is different from that of ACPA.

Biochemical and genetic characteristics of the largest worldwide Fabry cohort reported to present

To systematically analyze literature with the aim of examining whether rheumatoid factor (RF) is a predictor of response to tumor necrosis factor (TNF) antagonists in rheumatoid arthritis (RA).A systematic review and meta-analysis of observational studies were conducted. All studies on the association of baseline RF (titer and/or status) and response to any TNF antagonists, or with enough information to estimate this association were included. Qualitative analysis and meta-analysis using random-effects approach by type of outcome response and RF test was performed. Risk of publication bias was also evaluated.The systematic review included 18 studies of 4163 identified articles, involving 5703 patients with homogeneous baseline characteristics. The most common outcome to assess response was European League Against Rheumatism (EULAR) response criteria, normally merging good and moderate categories as response. The weighted mean difference (WMD) of baseline IgM RF titer in meta-analysis was higher in the non-responders group [−101.58 (95% CI −156.58,−46.59) I2 = 0.0]. Combined odds ratios (ORs) of positive IgM RF, positive IgA RF, and positive IgG RF to achieve good/moderate response were 1.08 (0.80, 1.47), I2 = 40.9%; 0.83 (0.39, 1.73), I2 = 39.8%, and 1.30 (0.48, 3.51), I2 = 62.9%, respectively. We did not find an association between a positive IgM RF and EULAR good response or remission.This meta-analysis does not support baseline IgM RF titer as a predictor of response to TNF antagonists in RA. However, this conclusion is hampered by high heterogeneity in the studies included in this meta-analysis.

Males With Rheumatoid Arthritis Often Evidence Carotid Atheromas on Panoramic Imaging: A Risk Indicator of Future Cardiovascular Events

Males with rheumatoid arthritis (RA) are at an exceedingly high risk of adverse intraoperative ischemic events, given the role of systemic inflammation in the atherogenic process. We hypothesized that their panoramic images would demonstrate calcified carotid artery atheromas (CCAPs) significantly more often than those from a general population of similarly aged men. We implemented a retrospective observational study. The sample was composed of male patients older than 55years of age who had undergone panoramic imaging studies. The predictor variable was the diagnosis of RA confirmed by a positive rheumatoid factor (RF) titer, and the outcome variable was the prevalence rate of CCAPs. The other major study variable was the level of RF among the patients evidencing CCAPs. The prevalence of CCAPs among the patients with RA was then compared with that of a historical general population of similarly aged men. Descriptive and bivariate statistics were computed, and the P value was set at .05. Of the 100 men (mean age 69.89±8.927years) with RA, 29 (29%; mean age 72.10±7.68years) had atheromas (CCAP+). Of these 29 men, 25 (86%; mean age 71.88±7.43years) had a RF titer of ≥41 IU/mL, twice that of normal. A statistically significant (P<.05) association was found between a diagnosis of RA and the presence of an atheroma on the panoramic image compared with the 3% rate found in the historical cohort. The results of the present study suggest that CCAP, a risk indicator of future adverse cardiovascular events, is frequently seen on panoramic images of male patients with RA and that these individuals routinely manifest high titer levels of RF, a biologic marker of inflammation. Oral and maxillofacial surgeons planning surgery for male patients with RA must be uniquely vigilant for the presence of these lesions.

Achieving Sustained Viral Remission in Patients with Chronic HCV Infection and Cryoglobulinemic Vasculitis Does Not Always Correlate with Normalization of the Serologic Markers.

Objective:We aim to describe the persistence of symptoms associated with HCV-associated cryoglobulinemic vasculitis following achievement of (SVR) with IFN- free direct acting antiviral (DAA) therapy. In particular, we describe the persistence of C4 hypocomplementemia and positive Rheumatoid Factor (RF).Methods:We analyzed a case series of four patients enrolled from the Cleveland VA and known to have chronic HCV infection complicated by mixed cryoglobulinemia. The study included patients treated with interferon (IFN) based treatment and IFN free direct acting antiviral (DAA) therapy.Results:Of the four patients, patients 1 and 2 experienced decline of RF without resolution following DAA therapy. Patient 1 continues to have evidence of disease following treatment. Patient 3 did not have resolution of RF during IFN-based treatment and experienced stabilization of kidney function while on treatment. Patient 4, previously a non-responder to IFN based treatment, experienced significant decline in RF titers along with resolution of cryoglobulin-associated rash with DAA therapy. C4 remained low following treatment in patients 1 and 3. Of the four patients, only patient 1 had prolonged persistence of cryoglobulinemia, measured at 3%, 17 months following achievement of SVR.Conclusions:We highlight the complexity of the viral-mediated immunologic mechanism that causes cryoglobulinemic vasculitis. Our cases also emphasize the need to consider cryoglobulinemic vasculitis as part of the differential diagnosis even with treated HCV infection. Recognizing these findings are important in our understanding of the pathophysiology of the disease and management in the era of IFN-free DAA therapy.

Frequency of rheumatoid arthritis in patients with autoimmune thyroid disease: a case–control study

Introduction Hashimoto’s thyroiditis and Graves’ disease both constitute autoimmune thyroid diseases (AITD) that frequently coexist with other autoimmune disorders (AID). This study was conducted to evaluate the frequency of rheumatoid arthritis (RA) in patients diagnosed with AITD in relation to the general population. Patients and methods This was a cross-sectional case–control study, conducted on 103 patients with AITD of either Hashimoto’s thyroiditis or Graves’ disease with positive antithyroid peroxidase (TPOAb). A group 100 volunteers, matched for age and sex, with normal thyroid function and negative history of AID, were investigated for the prevalence of RA in the general population (control group). Participants in the study were tested for thyroid profile, rheumatoid factor (RF), erythrocyte sedimentation rate, and C-reactive protein. When appropriate, anticitrullinated peptide antibody was checked. Results Patients with AITD had a higher frequency of RA than the control (P=0.031). Thyroid profile showed no significant difference between patients with and without RA within the group of AITD. In that group, a positive correlation between titers of both RF and TPOAb was observed (r=0.474, P Conclusion RA is more prevalent in patients with AITD than the general population, and the underlying autoimmunity is likely to be the link. Our data highlight the importance of screening thyroid patients for RA especially if present with type 2 diabetes mellitus, another AID, or having a family history of RA.

Elevated expression of PD‑1 on T cells correlates with disease activity in rheumatoid arthritis

It is well known that lymphocytes are important in rheumatoid arthritis (RA). Programmed cell death-1 (PD‑1) is one of the immunosuppressive costimulatory molecules, which mediates an inhibitory effect. However, its role in RA remains to be fully elucidated. In the present study, the expression levels of PD‑1 on T cells in the peripheral blood(PB) and synovial fluid (SF) were determined using flow cytometry. In addition, the expression levels of PD‑1 on T cells in the PB and SF of patients with RA were further analyzed to determine correlation with markers of the autoimmune response, inflammation and disease activity in RA. Compared with healthy controls, the expression of PD‑1 on T cells in the PB was significantly elevated in patients with RA (P<0.0001). The expression of PD‑1 on Tcells in the SF of patients with RA was significantly increased, compared with that in the autologous PB (P<0.0001). It was also found that the expression of PD‑1 on T cells in the PB of patients with RA was increased significantly in subjects with a high rheumatoid factor titer, high levels of inflammatory markers and a high disease activity score28(DAS28). The expression of PD‑1 on T cells in the SF of patients with RA was increased significantly in subjects with a high DAS28. These data showed that the expression of PD‑1 on T cells was elevated in patients with RA and was correlated with the disease activity.

Rheumatoid factor is correlated with disease activity and inflammatory markers in antineutrophil cytoplasmic antibody-associated vasculitis

BackgroundSome patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) also have positivity of rheumatoid factor (RF). However, the clinical significance of this occurrence remains unknown in AAV patients. The aim of this study was to clarify an association between the presence of RF and clinical features in patients with AAV.ResultsForty-seven patients diagnosed with AAV who were not complicated with RA were enrolled in this study. We compared clinical manifestations of AAV between an RF-positive subset (n = 29) and an RF-negative subset (n = 18). The Birmingham Vasculitis Activity Score (BVAS) was higher (P = 0.026) in the RF-positive subset than in the RF-negative subset. The levels of CRP and ESR were higher in the RF-positive patients (P = 0.020 and P = 0.007, respectively) compared to the RF-negative subset. IgM-RF titers were significantly correlated with the BVAS (r = 0.50, P = 0.0004). In addition, the IgM-RF titers had significant correlations with the levels of CRP (r = 0.41, P = 0.004), ESR (r = 0.39, P = 0.016), IgM (r = 0.36, P = 0.016) and IgG (r = 0.37, P = 0.015). The frequency of commencement of dialysis therapy, usage of mechanical ventilation and mortality were higher in the RF-positive subset than in the RF-negative subset.ConclusionsIn patients with AAV, RF titers were significantly correlated with disease activity and the levels of inflammatory markers. The presence of RF could be a poor prognostic factor in patients with AAV.