Rheumatology Research Articles

Application of video education combined with Teach-back in patients with rheumatoid arthritis

Objective To explore the effect of video education combined with Teach-back on the compliance of patients with rheumatoid arthritis (RA) to exercise at home and the condition of disease activity. Methods By convenience sampling, 80 patients with RA who were hospitalized in the Rheumatology and Immunology Department of Sichuan Provincial People's Hospital from March to November 2018 were included in the study. By random number table, the patients were divided into the intervention group and control group, the control group was given routine discharge instruction and the patients were taught about the functional exercise orally; on the basis of that, the intervention group was given the video education combined with Teach-back and assisted to download videos, Family Exercise Compliance Scale and Disease Activity Score in 28 Joints (DAS28) were used to evaluate the patients' compliance in functional exercise at home and disease activity condition before intervention, 1 month and 3 months after intervention. Results Finally, 73 cases (37 cases in the control group, 36 cases in the intervention group) in two groups completed the research plan. One and 3 months after intervention, the compliance with family functional exercise of the intervention group was better than the control group from the same period with statistical significance (P 0.05) . Conclusions Video education combined with Teach-back can effectively improve the compliance of RA patients with home functional exercise, help to cultivate healthy behavior, and hence reduce the number of tender joint, swelling joints, reduce the degree of pain, improve the prognosis of patients. Key words: Rheumatoid arthritis; Family functional exercise; Compliance; Disease activity

The clinical expression and significance of inhibitory receptor TIGIT gene on peripheral NK cells in rheumatoid arthritis

Objective To investigate the expression of inhibitory receptor TIGIT gene in peripheral NK cells of patients with rheumatoid arthritis (RA) and its clinical significance. Methods A case control study was conducted of 58 RA patients(30 patients with active RA disease, 28 patients with remission of RA) and 22 healthy controls (HC) in the department of rheumatology and immunology from Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine during December 2018 to June 2019, the related clinical data were collected. Flow cytometry was used to compare the expression of TIGIT gene on peripheral NK cells. The IFN-γ secretion level of cytokines in peripheral blood was detected by ELISA, and analyzed the correlations between TIGIT gene and disease activity and IFN-γ level. T-test or non-parametric test was used for comparison between the two groups, and Pearson correlation analysis was used for correlation between the two variables. Results Compared with HC group, the number of NK cells in RA disease group was reduced, which was (13.88±4.56) ×107 cells/L in RA disease group and (25.69± 2.48) ×107 cells/L in HC group (t=-2.036, P=0.041). The percentage of TIGIT gene expression in peripheral blood NK cells was not statistically different between RA disease group (39.73±9.37)% and HC group (45.64±9.91)% (t=-1.241, P=0.218). However, the average fluorescence intensity (MFI) of TIGIT gene expression was decreased, which was (7.21±2.03) in RA group and (9.01±3.29) in HC group (t=-2.947, P=0.004).MFI of TIGIT gene in NK cells of the disease active subgroup was (6.72±2.01), lower than that of the disease remission subgroup (8.75±2.64), (t=-3.316, P=0.002), and MFI of TIGIT gene in NK cells of the disease active subgroup was negatively correlated with DAS28 score (r2=0.649 6, P<0.000 1).The secretion level of IFN-γ cytokine in the RA disease group was (67.13±14.84) pg/ml, higher than that in the HC group (57.21±14.23) pg/ml (t=2.757, P=0.017), and the secretion level of IFN-γ cytokine in the disease active subgroup was negatively correlated with the MFI of TIGIT gene on NK cells (r2=0.662 2, P<0.000 1). Experimental results of peripheral blood mononuclear cell stimulation in the RA disease activity subgroup showed that the secretion level of cytokines IFN-γ was reduced after stimulation compared with that before stimulation (t=11.38, P<0.000 1). Conclusion The abnormal expression of TIGIT gene on peripheral NK cells are observed in patients with RA, which correlate with disease activity and IFN-γ secretion level. Key words: Arthritis, rheumatoid; Receptors, immunologic; Killer cells, natural; Interferon-gamma

Effect of Tripterygium Glycosides Tablets on immune-induced liver and kidney function in patients with rheumatoid arthritis based on data mining

This paper aims to investigate the effect of oral administration of Tripterygium Glycosides Tablets combined with traditional Chinese medicine on immune inflammatory index in patients with rheumatoid arthritis,in order to explore the compatibility mode of traditional Chinese medicine in the treatment of rheumatoid arthritis. Medical records of hospitalized patients with rheumatology at the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from June 2012 to December 2017 were collected. The combined administration of Tripterygium Glycosides Tablets and traditional Chinese medicine was adopted for the experimental group,while the simply administration of Tripterygium Glycosides Tablets were adopted for the control group. SPSS 21. 0 was used to analyze the changes of general conditions and immune inflammatory metabolic indexes in the two groups of RA patients. The association rules were analyzed by SPSS Clementine 14. 2 software Apriori module,and the random walk model was evaluated by ORACLE 10 g tool. The results showed that a total of 1 220 patients with rheumatoid arthritis met the requirements of this study,including 322 in the experimental group and 898 in the control group. Before treatment,there was no significant difference in age and duration between the two groups. The difference value of Ig A,Ig G,RF,CCP-AB,hs-CRP and ESR in the two groups of RA patients decreased before and after treatment,and the experimental group was superior to the control group in reduction of Ig A,Ig G,RF,CCP-AB,hs-CRP and ESR.The control group was superior to the experimental group in reduction of Ig M( P<0. 01 or P<0. 05). Compared with before treatment,ALT,AST,ALP,GGT,CREA,BUN,b-MG,MA,TRU and Ig U all increased,with statistically significant differences( P<0. 01).The UA of the two groups of RA patients decreased after treatment,with statistically significant differences( P<0. 01). The experimental group was superior to the control group in reduction of UA,with statistically significant differences( P < 0. 05 or P < 0. 01). The herbs adopted in the prescriptions of 1 220 patients were mainly classified into four categories,namely spleen-sweating herbs,blood-activating and stasis-relieving herbs,phlegm and phlegm-relieving herbs,and heat-clearing and antidote herbs. The results of association rule analysis indicated a significant correlation between the single-flavored Tripterygium Glycosides Tablets,oral Chinese medicine and immune inflammation,and improvement of liver and kidney function indexes. The results of the random walk model analysis indicated that the experimental group's Ig M and hs-CRP were superior to those of the control group in terms of random fluctuation maximum,walking positive growth rate,comprehensive evaluation index increasing rate,comprehensive improvement rate,comprehensive evaluation index recording times,and expected improvement value. The results of this study showed that the single administration of Tripterygium Glycosides Tablets can effectively improve the immune inflammatory metabolic index of patients with rheumatoid arthritis,and the combined administration of Tripterygium Glycosides Tablets and traditional Chinese medicine could alleviate the immune inflammatory index of RA patients and reduce liver and kidney dysfunction compared with simple oral administration. The comprehensive evaluation Ig M and hs-CRP in the group of combined administration of Tripterygium Glycosides Tablets and traditional Chinese medicine were better than those in the group of the Tripterygium Glycosides Tablets. There was a long-term correlation between the comprehensive evaluation index and the intervention measures of the two groups of patients.

Virtual clinics in the present - a predictor for the future?

There is great interest in non-face-to-face (F2F), internet or app based outpatient interaction at the moment. As these become established, we look at the non-F2F appointments already happening in telephone and virtual clinics in a busy urban rheumatology department. Here we look at the type of diagnoses dealt with in a non-F2F environment and potential outcomes from …

On the terms «rheumatology» and «rheumatic diseases» (regarding Sh. Erdes's article «Definition of the term «rheumatology»: do we need this and how do the EULAR and the ACR look at this?»)

The authors comment on the discussion article «Definition of the term “rheumatology”: do we need this and how do the EULAR and the ACR look at this?» by Sh. Erdes.

Study on correlation between serum uric acid level and brachial ankle pulse wave velocity in patients with systemic lupus erythematosus

Objective To investigate the relationship between serum uric acid (UA) level and brachial-ankle pulse wave velocity (baPWV) in patients with systemic lupus erythematosus (SLE) and lupus nephritis (LN). Methods A total of 110 hospitalized, out-patient and healthy examinees from January 2017 to September 2017 were selected from Kailuan General Hospital.They were divided into three groups: (1)Fifty-five healthy controls were examined at the same time, and those who had no history of hypertension, myocardial infarction and stroke were excluded by physical examination.(2)Thirty-four SLE patients without LN were diagnosed according to the SLE classification standard revised by the American Society of Rheumatology (ACR) in 1997, excluding those with lupus nephritis.(3)21 SLE patients with LN were diagnosed according to the SLE classification standard revised by the American Society of Rheumatology (ACR) in 1997.Pearson correlation coefficient and multivariate linear regression model were used to analyze the related factors affecting baPWV. Results The level of baPWV and the proportion of baPWV (≥1400 cm/s) in SLE without LN group and SLE with LN group were higher than those in healthy control group (all P<0.05). In SLE without LN group, baPWV was positively correlated with age, systolic blood pressure(SBP)and total cholesterol(CHOL)(r=0.623, 0.528, 0.402, P<0.01 or P<0.05), and negatively correlated with blood uric acid(UA) (r=-0.371, P<0.05), but the correlation was not significant.The correlation between UA and baPWV disappeared after after correction of age, SBP, diastolic blood pressure (DBP) by partial correlation analysis.In SLE with LN group, baPWV was positively correlated with SBP, DBP and serum creatinine(Cr) (r=0.815, 0.725, 0.464, P<0.01 or P<0.05). Multivariate stepwise regression analysis showed that SBP was independently correlated with baPWV in SLE group (t=2.54, P=0.026); UA in SLE group without LN was independently negatively correlated with baPWV(t=-2.96, P=0.042); UA(t=4.24, P=0.013) and SBP(t=7.70, P=0.002) were independently positively correlated with baPWV in SLE group with LN.Logistic regression analysis showed that SLE was a risk factor for baPWV (≥1 400 cm/s), and the OR (95% CI) was 4.31 (1.56-11.88), P=0.005, and there was statistical significance after adjusting for age, SBP, DBP, body mass index (BMI). However, UA was not a risk factor for baPWV (≥ 1 400 cm/s) (P values were 0.163 and 0.519, respectively). Conclusion The degree of arteriosclerosis in SLE patients is higher than that in normal subjects, and the level of UA in SLE patients may be related to baPWV. Key words: Systemic lupus erythematosus; Lupus nephritis; Blood uric acid; Brachial-ankle pulse wave velocity

Mediterranean Journal of Rheumatology June 2019 Highlights.

Mediterranean Journal of Rheumatology June 2019 Highlights.

New Draft Lyme Disease Guidelines Issued

The Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology have issued new draft guidelines on

Romatolojide Hedef 2019 Sempozyumu Bildiri Özetleri, 17-20 Nisan 2019, Fairmont Quasar İstanbul Hotel, İstanbul

Romatolojide Hedef 2019 Sempozyumu Bildiri Özetleri, 17-20 Nisan 2019, Fairmont Quasar İstanbul Hotel, İstanbul

Beyond Rheumatology. A new challenge devoted to the advancement of knowledge in all rheumatology-related fields

Not available

Pregnancy and lactation-associated osteoporosis in a patient with rheumatoid arthritis: case report and literature review

Clinical data of a 33-year-old rheumatoid arthritis patient accompanied with pregnancy and lactation-associated osteoporosis (PLO) was retrospectively reviewed. The patient had two pregnancies within three years, and bone pain occurred during lactation of the second pregnancy after 2 months of delivery. Dual-energy X-ray (DEXA) showed decreased bone density, while thoracolumbar spine and pelvic X-ray film suggested osteoporosis. Her rheumatoid arthritis was stable and previous treatment did not include glucocorticoids. Other causes of metabolic bone diseases were excluded and the diagnosis of PLO was confirmed. The breastfeeding was stopped; calcium, active vitamin D, alendronate sodium were administrated, and the treatment was effective. Domestic and international literature from January 2000 to January 2019 was searched and no cases of PLO accompanied with rheumatoid arthritis were reported. There were only 100 cases of PLO retrieved in the literature, including 19 cases of PLO in China reported by four articles. It is suggested that PLO should be considered in RA patients presenting with arthragia during the lactation, in addition to relapse of disease. Awareness of PLO should be increased in physicians, especially rheumatologists, and anti-osteoporosis therapy is effective in patients with PLO. Key words: Rheumatoid arthritis; Osteoporosis; Pregnancy; Lactation

Late-onset spondyloarthritis: a study of 133 patients in Dakar, Senegal.

Reports of late-onset spondyloarthritis in sub-Saharan Africa are sparse. This series allows us to describe the characteristics of this disease in Senegal. This is a retrospective study conducted in the Rheumatology Department of the Dantec University Hospital (Dakar) where we reviewed records of spondyloarthritis cases. Its diagnosis met the modified ASAS and New York criteria. Late-onset was defined as after the age of 55 years. During the study period, the department managed 133 late-onset patients, or 38% of all spondyloarthritis cases (350). Age ranged from 65 to 74 years, with a mean of 66. HLA B 27 phenotyping was performed in 89 patients; 39 patients were HLA B27 positive (29%). The treatments were based on DMARDs (salazopyrin and methotrexate).

Neuropsychiatric Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a representative autoimmune disease that is characterized by a variety of manifestations affecting multiple organs. Damage to the central nervous system is one example of how SLE can manifest and cause significant morbidity and mortality. The American College of Rheumatology defines neuropsychiatric SLE (NPSLE) as involving the central and peripheral nervous systems, which can include overt symptoms such as stroke, seizures, and psychosis. Recommendations from the international task force regarding the treat-to-target approach in SLE include targeting remission, preventing further damage, and improving quality of life. When a patient exhibits high disease activity and organ damage, treatment is initiated with a high dose of glucocorticoid and immunosuppressants. Recent innovative approaches to treatment include using biologics and JAK inhibitors, with high expectations of improving SLE management.

Anti-mutant citrullinated vimentin antibody in the diagnosis of rheumatoid arthritis

Objective This study aimed to assess the diagnostic value of anti-mutated citrullinated vimentin (MCV) antibodies in rheumatoid arthritis (RA) and its correlation with disease progression, extra-articular manifestations and overlap syndrome. Methods Retrospective Studies. Clinical data of 837 patients in PekingUnionMedicalCollegeHospitalfrom June to August 2017 were collected, including the result of anti-MCV, anti-cyclic citrullinated peptide (anti-CCP) antibodies, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and High-sensitivity-C-reactive protein (CRP). According to the 1987 American College of Rheumatology classification criteria for rheumatoid arthritis, there were 323 patients diagnosed with RA, including 59 males and 264 females with the average age of 51 years. According to whether the RA patients have overlap syndrome with other autoimmune disease (AID) or have extra-articular manifestations, 258 cases were categorized into RA group, including 47 males and 211 females with the average age of 50 years; 14 cases were categorized into the group of overlap syndrome, including 1 male and 13 females with the average age of 36 years; 51 cases were categorized into the group of extra-articular manifestations, including 11 males and 40 females with the average age of 59 years.According to 2010 rheumatoid arthritis classification criteria for destruction in joints, the radiographic changes were divided into 4 stages.There were 203 casesenrolled in our study, 88 caseswere fitted into early stage group (stage I)including 21 males and 67 females with the average age of 48 years; 115 caseswere fitted into progressive stage group, which compromisedstageⅡ (interim stage), stage Ⅲ (severe stage) and stage Ⅳ (final stage) cases, including 19 males and 96 females with the average age of 53 years. Mann-Whitney U test, χ2 test,Receiver operating characteristic (ROC) curves and Spearmancorrelation coefficientwere used in Statistical analysis. Results Ⅰ Amongdiagnosed RA patients, 199 (61.6%) cases were positive for anti-MCV, anti-CCP and RFsimultaneously, 42 (13%) cases were positive for anti-MCV, which was higher than anti-CCP positive (1 cases, 0.3%) or RF positive (7cases, 2.2%). The difference was statistically significant(P<0.001, P<0.001). Ⅱ ROC was calculated and MCV=35.95 U/ml was used as best-fit cut-off value. The AUC for anti-MCV was 0.867, while the sensitivity was 80.5% and specificity was 80.9%. Ⅲ The detection levels of anti-MCV (682.8 (106.4-1000.0)), anti-CCP (407 (4.0-1536.0)) and RF (82.8 (21.1-244.9)) in the group of progressive stage were higher than those in the group of early stage (114.5 (28.5-1000.0), 62.5 (5.0-1020.7), 50.1 (6.7-127.1)), which showed a significant difference (P<0.05, P<0.05, P<0.05). The anti-MCV, anti-CCP and RF were positively related to the degree of joint destruction (r=0.229, P<0.05; r=0.187, P<0.05; r=0.167, P<0.05); anti-MCV and anti-CCP were positively related to extra-articular manifestation (r=0.152, P<0.05; r=0.136, P<0.05). Conclusion Anti-MCV antibodies are more sensitive in patients with RA, and have complementary diagnostic value for anti-CCP and RF-negative patients; high levels of anti-MCV and anti-CCP in RA patients are associated with RA progression and extra-articular involvement. Key words: Arthritis, rheumatoid; Autoantibodies; Peptides, cyclic; Vimentin

The application of exercise intervention based on the self-efficacy theory in patients with rheumatoid arthritis

Objective To explore the effect of exercise intervention based on the self-efficacy theory on quality of life, physical function, fatigue and pain in patients with rheumatoid arthritis. Methods The convenience sampling method was used to select 64 rheumatoid arthritis patients who visited the department of rheumatology of Tianjin Medical University General Hospital from December 2017 to August 2018. Thirty-two rheumatoid arthritis patients were divided into the intervention group and other 32 rheumatoid arthritis patients were divided into the control group according to the visiting time. Patients in the control group received the conventional nursing care, and patients in the intervention group received the conventional nursing care and exercise intervention based on the self-efficacy theory. The 36-Item Short Form Health Survey (SF-36), Health Assessment Questionnaire (HAQ), Fatigue Severity Scale (FSS), Visual Analog Scale (VAS) were assessed three months after the intervention. Results After the intervention, the scores of the SF-36 in the intervention group and the control group were (68.04±12.27) and (54.32±21.66) points, respectively. The difference between the two groups was statistically significant (t=-3.119, P<0.05). After the intervention, the scores of the HAQ, FSS and VAS were (0.60±0.57), (3.68±1.75) and (4.08±2.17) points, respectively in the intervention group and (1.00±0.78), (4.65±2.07) and (5.44±2.75) points in the control group. The difference between the two groups was statistically significant (t=2.329, Z=-2.024, Z=-2.058, P<0.05). Conclusions The exercise intervention based on the self- efficacy theory can improve the quality of life, physical function, fatigue and pain in patients with rheumatoid arthritis, which is worthy of further promotion in clinical practice. Key words: Arthritis, rheumatoid; Self-efficacy; Exercise; Quality of life

E004 What’s in a name? Quite a lot when it comes to rheumatology diagnoses?

E004 What’s in a name? Quite a lot when it comes to rheumatology diagnoses?

Mediterranean Journal of Rheumatology March 2019 Highlights.

Mediterranean Journal of Rheumatology March 2019 Highlights.

Takayasu Arteritis in Chronic Migraine

Takayasu arteritis (TA) is a systemic granulomatous vasculitis of large vessels with low incidence and nonspecific symptoms, and late diagnosis and management lead to complications such as stroke, acute myocardial infarction or peripheral ischemia. This case illustrates the complexity of TA diagnosis because its symptomatology is frequently mistaken as chronic migraine. Therefore, without a syndromic approach, it is more likely to increase comorbidity and progression of the disease. This paper deacribes a 25-year-old woman with chronic migraine for 8 years, with recurrent admissions to emergency service, and specialist outpatient consultations. The patient has a history of fugax amaurosis, hypertension and claudicating chest pain that required treatment with corticoid, hydroxychloroquine, methotrexate and neflunomide, due to a stenosis of 50-70% of the left carotid artery and thickening of the walls of the distal thoracic aorta and the proximal abdominal aorta, corresponding to TA, with improvement of its subsequent symptomatology to treatment for rheumatology. J Med Cases. 2019;10(1):18-20 doi: https://doi.org/10.14740/jmc3238

The effect of hot intermittent cupping on pain, stiffness and disability of patients with knee osteoarthritis

Objective: The aim of this study was to investigate the effect of hot intermittent cupping on pain, stiffness and inability of patients with knee osteoarthritis (KO). Methods: The present study was a clinical trial, which was performed on 38 patients with KO referring to Gonabad Rheumatology Specialty Clinic. Based on permutation block method, the research units were divided into cupping therapy and control groups. For the cupping therapy group, four sessions of cupping therapy were performed every four days. To collect data, the form of demographic information, Visual Analogue Scale (VAS) and the Western Ontario and McMaster (WOMAC) osteoarthritis scale were used, and the data were analyzed by SPSS software v. 16 using descriptive statistics and independent t-test, paired t-test, Chi-square test and Fishers exact test with a significance level of P < 0.05. Results: Findings showed that there was no significant difference between the cupping therapy and control groups in terms of demographic characteristics and they were homogeneous. Findings indicated that, based on VAS, the mean pain intensity in the left (P < 0.001) and the right knees (P < 0.001), as well as based on WOMAC, stiffness (P = 0.006), pain intensity (P < 0.001) and disability (P < 0.001) in the cupping therapy group significantly decreased compared to the control group. Conclusion: Findings showed that hot intermittent cupping therapy reduced the pain intensity, stiffness and disability in patients with KO.

Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum for the rheumatologist

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) represent a spectrum of mucocutaneous manifestations characterized by widespread epidermal and/or mucosal detachment from dermis. It occurs due to Type IV hypersensitivity leading to keratinocyte apoptosis. Many extrinsic and intrinsic defects in the apoptotic pathway have been postulated to result in its dysregulation. The characteristic skin lesions of SJS/TEN include ill-defined, coalescing, red macules with necrotic centers followed by extensive epidermal detachment. Mucosa is involved in up to 90% of cases causing erosions and crusts that may precede or follow skin lesions. Supportive care is the mainstay of treatment and if not started promptly may result in high mortality and morbidity. Although many immunosuppressive drugs have been tried in treatment, no treatment has proven beneficial except cyclosporine which has been shown to retard the progression of SJS/TEN. A patient with SJS/TEN as a presenting feature poses two-fold challenge to a rheumatologist as it could be a manifestation of lupus or side effects of a myriad of drugs used by the rheumatologist.