Activity Score Research Articles

Disease response in rheumatoid arthritis across four biologic therapies associates with improvement in paraoxonase-1 activity and oxylipins

ObjectiveParaoxonase-1 (PON1) is a high-density lipoprotein (HDL)-associated enzyme, that has been implicated as a biomarker of cardiovascular risk in patients with rheumatoid arthritis (RA). We aimed to investigate how different...

Geographical Differences in the Safety and Efficacy of Tofacitinib Versus TNFi: APost Hoc Analysis of ORAL Surveillance.

In ORAL Surveillance, incidence rates (IRs) of major adverse cardiovascular events (MACE) and malignancies (excluding non-melanoma skin cancer [NMSC]) in cardiovascular (CV)-risk-enriched patients with rheumatoid arthritis (RA) were numerically greater with tofacitinib in North America versus the rest of the world, due to underlying risk factors. Here, we evaluated the safety and efficacy of tofacitinib versus tumor necrosis factor inhibitors (TNFi) among patients with RA across geographical regions. Patients with RA in ORAL Surveillance (NCT02092467), who were aged ≥ 50years with ≥ 1additional CV risk factor, received tofacitinib 5 or 10mg twice daily or TNFi; 45.9% were from either Poland or North America. This post hoc analysis stratified patients by region (Poland, North America, Other countries). Efficacy endpoints included Clinical Disease Activity Index, Disease Activity Score in 28 joints, with C-reactive protein (DAS28-4[CRP]), and Health Assessment Questionnaire-Disability Index (HAQ-DI). IRs and hazard ratios for adverse events were reported. Of 4362 patients (Poland, N = 759; North America, N = 1243; Other countries, N = 2360), more patients from North America versus Poland/Other countries had CV risk factors such as body mass index ≥ 30kg/m2 and history of diabetes/hypertension; however, more patients from Poland versus other regions were ever smokers and more patients from Poland/North America versus Other countries had history of coronary artery disease. MACE IRs were similar in North America and Poland, and numerically higher versus Other countries. IRs for malignancies (excluding NMSC) were numerically higher in NorthAmerica versus Poland/Other countries with tofacitinib. Serious infections IRs werenumerically higher in North America versus Poland across treatments. Venousthromboembolism/all-cause mortality IRs were generally comparable across regions. DAS28-4(CRP)/HAQ-DI improvements were generally lowest in North America. Differences in safety outcomes were driven by the presence of baseline risk factors; North America and Poland demonstrated a higher proportion of patients with some baseline CV risk factors/comorbidities versus Other countries. NCT02092467 (ClinicalTrials.gov).

Artemisia argyi polysaccharide alleviates osmotic diarrhea by enhancing intestinal barrier protection and anti-inflammation

Artemisia argyi polysaccharide (AAP) is a homogeneous polysaccharide with a molecular weight of 16 kDa, displaying anti-inflammatory, antioxidant, and anti-tumorigenic properties, and potential protective effects on intestinal barrier function. It is anticipated to serve as an efficient component in diarrhea treatment. This study aims to examine the impact of AAP on diarrhea severity, intestinal barrier function, and inflammation in diarrhea-induced rats. The results demonstrated that AAP treatment notably decreased the incidence of diarrhea, reduced its severity, and lowered the disease activity score in rats, while also increasing body weight. Oral administration of AAP augmented goblet cell counts and elevated mucin-2 expression, aiding in the restoration of the mucus barrier. Additionally, AAP treatment enhanced colonic microbial diversity by increasing the abundance of S24–7 and Lactobacillus, while decreasing the levels of Bacteroides, Clostridium, and Sutterella. Moreover, the AAP administration elevated the levels of steroid hormones, prostaglandins, and their derivatives. By inhibiting the TLR4/MyD88/NF-κB pathway, AAP mitigated the release of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) and increased the secretion of anti-inflammatory factor (IL-10). Overall, oral AAP administration effectively combats osmotic diarrhea by fortifying mucus barrier integrity and exerting anti-inflammatory effects, suggesting its potential use as an adjunctive agent in oral rehydration therapy.

Efficacy and Safety of Biologics in Polymyalgia Rheumatica: A Retrospective Study.

The study aimed to determine the efficacy and safety of biological disease-modifying antirheumatic drugs (bDMARDs) in the treatment of polymyalgia rheumatica (PMR) complicated by rheumatoid arthritis (RA). Patients with PMR which could be classified as RA and who were treated with bDMARDs were included in the analysis. The primary endpoint was the clinical Polymyalgia Rheumatica Activity Score (Clin-PMR-AS) after 26weeks of treatment, and the secondary endpoint was adverse events during the observation period. A total of 203 patients with PMR which was resistant or intolerant to glucocorticoids and could be classified as RA were receiving bDMARDs and were enrolled in the study. There were 83, 82, and 38 patients in the tumor necrosis factor inhibitor (TNFi), interleukin-6 receptor inhibitor (IL-6Ri), and cytotoxic Tlymphocyte-associated antigen-4-immunoglobulin(CTLA4-Ig) groups, respectively. Twenty-six weeks after bDMARD initiation, Clin-PMR-AS levels were significantly lower in the IL-6Ri group as compared to other groups. Multiple regression analysis was performed with Clin-PMR-AS as the objective variable. Body mass index (BMI), history of bDMARDs, and IL-6Ri use were identified as factors involved in Clin-PMR-AS. After adjustment for group characteristics using inverse probability of treatment weighting with propensity scores, the Clin-PMR-AS score at 26weeks was significantly lower in the IL-6Ri group (9.0) than in both the TNFi (12.4, p = 0.004) and CTLA4-Ig (15.9, p = 0.003) group. IL-6Ri may potentially improve the disease activity of PMR compared to other bDMARDs.

Combining patient-reported outcome measures to screen for active disease in rheumatoid arthritis and psoriatic arthritis

ObjectivesTo investigate whether a combination of general health (Visual Analogue Scale (VAS)), Health Assessment Questionnaire-Disability Index (HAQ-DI), pain (VAS/Numerical Rating Scale (NRS)), quality of life (EQ-5D), fatigue (VAS/NRS) and presenteeism...

Return to activities in younger individuals (

Arthrodesis is a common procedure in the treatment of forefoot conditions affecting the first metatarsophalangeal (MTP) joint. Although this procedure has been shown to significantly improve individuals’ activities of daily living and effectively relieve pain, there is a lack of research specifically investigating younger patients below 60 yrs of age wishing to return to sports. Our aim is to evaluate their ability to return to sports after 1st MTP joint arthrodesis. A retrospective analysis of clinical records of 159 patient that had undergone first MTP arthrodesis performed by a single surgeon was undertaken to determine pre- and postoperative sf-FAOS and sporting activity scores. The Tobit constant censoring limit model was used to analyze change in sf-FAOS scores. After the application of inclusion and exclusion criteria, 58 patients (median age 54 years, range 30 – 59) were included in the final cohort with a mean follow up of 5.3 years (range 2.0 to 9.44, SD 2.10). There was a significant improvement in the mean pain score (p<0.001), as well as an improvement in the mean function score (p<0.001). The number of hours spent in sporting activities per week were significantly higher (p<0.001) post-surgery (5.29 hours, SD 5.0) in comparison to preoperative levels (4.26 hours, SD 3.1). There was no significant change in the intensity of sporting activities (p=0.176). First MTP joint arthrodesis remains a good treatment option for younger individuals wishing to achieve a satisfactory return to sports. Level of evidenceLevel 4

The role of pulmonary rehabilitation in improving lung functions in patients with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial and peripheral entheseal inflammation and new bone production(1). The development of syndesmophytes, enthesophytes, and spinal fusion along the course of the disease is linked to chronic pain, functional impairment, and disability(2). Fibrosis of the upper lobes of the lungs (interstitial lung disease) and chest wall abnormalities are two of the emerging forms of pulmonary involvement in AS. (3). Pulmonary rehabilitation is a multifaceted program of education, counselling, breathing exercises, and other modalities that can increase the patient’s independence and ease of functioning(4). Aim To estimate the role of pulmonary rehabilitation in enhancing lung function in AS individuals in relation to disease activity, clinical, and functional parameters. Patients and methods This study was an interventional study: single-arm group (prospective randomized clinical study). Thirty people (30) participated in that study from those presented to Physical Medicine, Rheumatology and Rehabilitation inpatient and outpatient clinic at Ain Shams University hospitals, diagnosed as radiographic axial spondyloarthropathy (SPA) from 02/2022 to 12/2022. All patients underwent pulmonary rehabilitation program and were exposed to a detailed history, clinical, and pulmonary function testing. Disease activity was evaluated by Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), Valuation of function by using Bath Ankylosing Spondylitis Functional index (BASFI), 6-Minute walk test (6MWT), the Modified Borg Dyspnoea Scale (MBS), and Timed Up and Go (TUG) test. All function and clinical scores were done at baseline and repeated after completing pulmonary rehabilitation program. Result The mean age of patients was 36.57 ± 7.83 years (23–45 years), with a median disease duration of (5 (3–9) years). In total, there were 19 out of the studied patients with restrictive pattern. With comparison between pre- and postintervention of pulmonary rehabilitation, there was a significant statistical difference in all, disease activity (ASDAS and BASFI) and functional (MBS, TUG, and 6MWT) parameters (P &lt;0.001), except for occiput to the wall. Regarding pulmonary function tests, including forced vital capacity (FVC), expiratory volume in one second (FEV1), and peaked expiratory flow (PEF), there was a statistically significant change at baseline and at the end of exercise (P &lt;0.001). Conclusion Improved respiratory function and disease activity and overall functional activity are possible outcomes of pulmonary rehabilitation programs in combination with other rehabilitation interventions.

Alterations in peripheral T-cell and B-cell subsets in the ankylosing spondylitis patients with gut inflammation.

This study investigates changes in immune cell subsets in peripheral blood of ankylosing spondylitis (AS) patients with colitis or terminal ileitis. It aims to explore the connection between changes in lymphocyte subsets and gut inflammation, providing insights for early detection. Overall, 50 AS patients undergoing colonoscopy were enrolled. Flow cytometry was employed to analyze lymphocyte subsets, including T and B cells, in peripheral blood. Disease activity was assessed using CRP, ESR, BASDAI, ASDAS-CRP, and ASDAS-ESR. Compared to AS patients without gut inflammation, those with colorectal inflammation showed a significant increase in total T cells (p < .05), an increase in exhausted CD4+ T cells (p < .05), and a decrease in Th2 cells and total Tc cells (p < .05). Notably, in AS patients with terminal ileitis, there was an increase in total B cells and classic switched B cells (p < .05), with a decrease in double-positive T cells (p < .05). However, no significant differences were observed in the distribution of Tfh-cell subpopulations (Tfh1, Tfh2, Tfh17) and Tc-cell subpopulations (Tc1, Tc2, Tc17) between AS patients with either colorectal inflammation or terminal ileitis (p > .05). We explored the relationship between disease activity scores, ESR, CRP, and lymphocyte subsets, but found no statistically significant correlation between them. Distinct immune patterns may exist in AS with different types of intestinal inflammation. Colitis in AS is primarily characterized by a significant increase in exhausted CD4+ T cells, along with a decrease in Th2 cells. In contrast, terminal ileum inflammation in AS is marked by an increase in total B cells and classic switched B cells. These findings offer new insights for early detection and therapeutic intervention.

The Therapeutic Efficacy of Abatacept for Rheumatoid Arthritis-Associated Interstitial Lung Disease: Insights from a 12-Month Trial Using Semi-Quantitative Chest High-Resolution Computed Tomography Imaging.

Background: Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a major complication of rheumatoid arthritis (RA), but effective treatment remains an unmet need in its management. Our aim was to evaluate the therapeutic efficacy of abatacept for RA-ILD. Methods: This observational retrospective study included patients with RA-ILD treated with abatacept between 2012 and 2021. Indices of RA disease activity and interstitial lung disease (Disease Activity Score in 28 joints using C-reactive Protein [DAS28-CRP], Simplified Disease Activity Index [SDAI], Clinical Disease Activity Index [CDAI], serum Krebs von den Lungen-6 levels, % forced vital capacity [%FVC], and semi-quantified chest high-resolution computed tomography scores) were evaluated before and 1 year after the start of abatacept administration. Results: Overall, 38 patients were included. DAS28-CRP, SDAI, and CDAI were significantly improved (all with p < 0.0001). Total ground-glass opacity scores were decreased in both patients with usual interstitial pneumonia (UIP)-like patterns and with non-UIP-like patterns (p = 0.008 and <0.002, respectively). Total fibrosis scores were also decreased in the UIP-like pattern group (p < 0.042). The %FVC remained stable. Conclusions: Abatacept significantly improves RA disease activity and reduces pulmonary inflammation in patients with RA-ILD.

Association of RIPK1 and RIPK2 Gene Polymorphisms with Rheumatoid Arthritis in a Chinese Han Population.

Rheumatoid arthritis (RA) is a systemic autoimmune disease with an obscure pathogenesis. This study aims to identify the susceptibility conferred by specific single nucleotide polymorphisms (SNPs), namely rs17548629 within the RIPK1 gene and rs10094579 within the RIPK2 gene, in RA. Additionally, it investigates the associations between inflammatory markers and biochemical parameters at various stages of the disease. We analyzed 394 patients with RA and 258 normal controls (NCs), examining SNPs within the RIPK1 (rs17548629) and RIPK2 (rs10094579) genes using polymerase chain reaction (PCR) and sequencing techniques. Profiles of RA patients were evaluated for inflammatory markers, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), as well as biochemical parameters such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea, glucose, uric acid, and creatinine. Additionally, disease-specific indicators included cyclic citrullinated peptide (CCP), rheumatoid factor (RF), antinuclear antibodies (ANA), and anti-keratin antibodies. The Disease Activity Score 28 (DAS28), based on ESR, was used to categorize RA patients into groups of high, moderate, or low disease activity. We found a significant association between the RIPK1 rs17548629 genotype and RA in the additive model (p < 0.001; OR = 3.23), over-dominant model (p < 0.001; OR = 0.27), and dominant model (p < 0.001; OR = 3.94). The frequency of the C allele at rs17548629 was significantly higher in NCs than in RA patients (p < 0.001; OR = 0.322). When compared with normal controls, the RIPK1 rs17548629 genotype demonstrated significant associations with both anti-CCP-positive RA patients (p < 0.001) and anti-CCP-negative RA patients (p < 0.001). Similarly, this genotype was associated with RF-positive RA patients (p < 0.001). Furthermore, the RIPK2 rs10094579 genotype was significantly associated with CRP levels in RA patients with low disease activity in the over-dominant model (p = 0.029; OR = 0.065, adjusted for age and sex). The presence of the RIPK1 rs17548629 genotype is associated with RA under additive, co-dominant, and dominant models. The T allele mutation at rs17548629 increases the risk of RA in the Chinese population. The RIPK1 rs17548629 genotype was identified as being associated with RF-positive RA patients, whereas no significant association was observed in RF-negative individuals. These findings suggest that this SNP may modulate the risk of RA in an RF-dependent manner. Furthermore, the RIPK2 rs10094579 genotype correlates with CRP levels in RA patients exhibiting low disease activity. This association underscores the necessity for caution when reducing the dosage of therapy in RA patients with low disease activity who carry the CA genotype at RIPK2 rs10094579. Additional research is warranted to explore other genotypes that may influence RA susceptibility and to refine potential treatment strategies.

Survivorship and outcomes of intra- and perimeniscal corticosteroids injections with structured physiotherapy for degenerative medial meniscus tears

BackgroundDegenerative medial meniscus tears are a common pathology in the general population. Recent randomized trials demonstrated non-superiority of arthroscopic partial meniscectomy over conservative management. However, there is a paucity of information regarding the outcomes of combined conservative treatments. HypothesisIt was hypothesized that combined intra- and perimeniscal corticosteroid injections with structured physiotherapy, for degenerative medial meniscus tear, would result in high surgery-free and second injection-free survivorship. MethodsA retrospective review of 671 patients with symptomatic degenerative medial meniscus tears who received combined intra- and perimeniscal corticosteroids injection combined with structured physiotherapy, was conducted. An ultrasound-guided injection of Triamcinolone Hexacetonide 20 mg/ml comprised; 1.5 ml intra-meniscal,1.5 ml in the meniscal wall, and 2 ml in the peri-meniscal space, was performed. Surgery free- and a second injection free-survivorship were analysed. Western Ontario and Macmaster University scores (WOMAC), Tegner activity scores, patient satisfaction, return-to-work status and average time to return to work were recorded. ResultsA total of 481 patients who met the inclusion criteria were included. The mean age was 51.1 ± 7.9 years. At five years post-procedure, surgery-free, and second injection-free survivorship of the ipsilateral knee was 83 %, and 52 %, respectively. A multivariate analysis adjusting survival on parametric risk factors identified that only effusion before steroid injection was an independent risk factor of treatment failure. At a mean follow-up of 4 ± 2 years, there was an improvement in WOMAC scores by 5.2 ± 4.9 for pain, by 2 ± 2 for stiffness, by 7.3 ± 7.4 for function, and by 12.4 ± 12.7 for the global scores. In addition to significant improvements in the Tegner activity scores (All p < 0.001). Knee effusion and advanced osteoarthritis (Kellgren-Lawrence > III) were significantly associated with poorer outcomes; p < 0.003 and p < 0.0004, respectively. ConclusionA combination of intra- and perimeniscal corticosteroid injections and structured physiotherapy for degenerative medial meniscus tears, results in high surgery-free (83%) and second injection-free (52%) survivorship, as well as, effective clinical outcomes and satisfaction at 5 years. Level of evidenceIV; Retrospective Case Series.

Efficacy and safety of CT-P47 versus reference tocilizumab: 32-week results of a randomised, active-controlled, double-blind, phase III study in patients with rheumatoid arthritis, including 8 weeks of switching data from reference tocilizumab to CT-P47

ObjectivesTo demonstrate efficacy equivalence of CT-P47 and EU-approved reference tocilizumab (r-TCZ) in patients with rheumatoid arthritis (RA).MethodsThis double-blind, phase III study randomised (1:1) patients to receive CT-P47 or r-TCZ (8...

Unlocking vitiligo’s metal code: an analytical cross-sectional study of serum levels of trace elements in vitiligo patients

Background: Vitiligo is an acquired depigmenting skin disorder often associated with social stigma and having a significant psychological impact on patients. The study aimed to determine the correlation between serum levels of copper (Cu), zinc (Zn), selenium (Se), lead (Pb), mercury (Hg), cadmium (Cd), and Cu/Pb, Cu/Hg, Cu/Cd, Se/Hg, Se/Pb, Se/Cd, Zn/Hg, Zn/Pb, and Zn/Cd ratios in vitiligo patients. Materials and methods: In this analytical cross-sectional study, we enrolled 110 vitiligo patients as cases and 110 normal adults as controls. VIDA (Vitiligo Disease Activity Score) and VASI (Vitiligo Area Severity Index) were used to assess the activity and severity of vitiligo in patients. Venous blood samples of all study participants (aged &gt;12 years) were examined for serum levels of Zn, Cu, Se, Pb, Hg, and Cd using inductively coupled plasma mass spectrometry. SPSS.21 version software was used for the analysis of the data. Results: We noted a statistically significant (p-value &lt; 0.05, student’s t-test) difference in mean serum levels of Cu, Zn, and Se (microgram/liter) between cases and controls, denoted as 1370.67 ± 484.36 versus 2887.30 ± 3744.15, 1324.50 ± 555.02 versus 1603.81 ± 551.03, 248.95 ± 120.06 versus 287.15 ± 117.37, respectively. A significantly low serum level of Se was observed in female vitiligo patients, unlike controls. Vegetarian patients had low levels of Pb (p-value &lt;0.05) in comparison to non-vegetarian patients. Significantly low Zn/Hg and Cu/Hg ratios were observed in cases compared to controls. Limitations: Our study was limited by a small sample size. Being an observational study done from a single center, chances of inclusion of patients from a limited geographical area cannot be ruled out. Conclusion: Low levels of Zn, Cu, and Se could play a crucial role in the etiopathogenesis of vitiligo, which can vary based on the gender and diet pattern of the patient.

Efficacy and safety of first-line biological DMARDs in rheumatoid arthritis patients with chronic kidney disease

ObjectiveTo evaluate the efficacy and safety of first-line biological disease-modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) with chronic kidney disease (CKD), including those undergoing haemodialysis (HD).MethodsThis retrospective...

Impact of social, familial and personal factors on depressive symptoms in middle-aged and older adults from the national CHARLS cohort

BackgroundThis study aimed to evaluate whether social, familial and personal factors can predict incident and prevalent depressive symptoms in Chinese adults aged ≥ 45 years using data from the China Health and Retirement Longitudinal Study (CHARLS).MethodsStudy subjects without depressive symptoms from CHARLS at baseline were enrolled. Depressive symptoms were defined by the 10-item Center for Epidemiologic Studies Depression Scale. Statistical adjustment, subgroup exploration and unmeasured confounding assessment were undertaken to derive reliable estimates.Results1681 (27.04%) of 6215 subjects who had no depressive symptoms in 2011, suffered one or more depressive symptoms in 2018. Multivariate analyses showed that number of grandchildren (odds ratio [95% confidence interval]: 1.06 [1.02, 1.10]), social activity score (0.95 [0.91, 0.98]), instrumental activities of daily living (IADL) (1.35 [1.11, 1.65]) and number of comorbidities (1.16 [1.10, 1.22]) were independently and significantly associated with the presence of incident depressive symptoms. Further categorization revealed significance for social activity score (odds ratio [95% confidence interval]: 0.78 [0.69, 0.89] and 0.71 [0.53, 0.95] for 1–5 and > 5 vs. 0), IADL (1.35 [1.11, 1.65] for yes vs. no) and number of comorbidities (1.38 [1.20, 1.58], 1.44 [1.16, 1.81] and 2.42 [1.54, 3.80] for 1–2, 3–4 and > 4 vs. 0) associated with incident depressive symptoms. Restricting analysis to wave IV data in 2018 observed significant association of number of grandchildren, social activity score, IADL and number of comorbidities with prevalent depressive symptoms.ConclusionsThe present study findings support the marked contribution of social activity score, IADL and number of comorbidities to incident and prevalent depressive symptoms in Chinese middle-aged and older adults.

Predictors for severe persisting pain in rheumatoid arthritis are associated with pain origin and appraisal of pain

ObjectivesTo determine the proportion of patients with rheumatoid arthritis (RA) with severe persisting pain and to identify predictive factors despite treatment-controlled disease activity.MethodsThis prospective multicentre study included outpatients with RA...

High disease activity influences the presence of vertebral fractures in rheumatoid arthritis.

It is important to assess the risk of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA), as RA is associated with a high risk of VFs. However, the epidemiology and risk of VFs in patients with RA remain inconclusive. The present study therefore clarified the prevalence and associated factors of VFs in patients with RA. We included 107 patients (19 men and 88 women) and retrospectively investigated the number and location of VFs, bone mineral density (BMD), RA disease activity score for 28 joints based on C-reactive protein (DAS28-CRP), and history of medication for RA and osteoporosis. Based on the investigated items, we assessed the prevalence of VFs in patients with RA and the association between the clinical parameters of RA patients and VFs. The average age, disease duration, and DAS28-CRP were 67.9 years old, 14.9 years, and 2.2, respectively. We found that the prevalence of VFs in patients with RA was 30.8%, and 84.8% of patients with VFs and 62.2% of those without VFs had been treated for osteoporosis. We further found that the prevalence of VFs in patients with RA with a history of anti-osteoporotic agent use was 37.8%. In univariate analyses, patients with RA with VFs had significantly higher DAS28-CRP values, a higher rate of corticosteroid use, and lower BMD (p = 0.018, p = 0.004, and p < 0.001, respectively) than those without VFs. A multivariable logistic regression analysis and ordinal logistic analysis revealed that the DAS28-CRP and BMD were independent factors associated with the presence (p = 0.042 and p = 0.011, respectively) and number (p = 0.036 and p = 0.048, respectively) of VFs. The prevalence of VFs was relatively high in patients with RA, regardless of the use of anti-osteoporotic agents. A high disease activity score and low BMD are associated with the presence and number of VFs in patients with RA. Based on these findings, to reduce VFs in RA patients, it is important to tightly control the disease activity of RA in addition to osteoporosis treatment.

Association between triglyceride glucose-body mass index and the staging of non-alcoholic steatohepatitis and fibrosis in patients with non-alcoholic fatty liver disease

Objective The objective of this study was to thoroughly investigate the clinical value of triglyceride glucose-body mass index (TyG-BMI) in patients diagnosed with non-alcoholic fatty liver disease (NAFLD). Specifically, we aimed to determine its association with non-alcoholic steatohepatitis (NASH) and the progression of liver fibrosis. Methods The study included 393 patients diagnosed with NAFLD after liver biopsy. The patients were divided into two distinct cohorts: a training cohort (N = 320) and a validation cohort (N = 73). The training cohort was further divided into four groups based on TyG-BMI quartiles. The clinical characteristics of the patients in each group were compared in detail, and the association between TyG-BMI and NASH, NAFLD Activity Score (NAS) ≥ 4, at-risk NASH, significant fibrosis, advanced fibrosis, and cirrhosis was analyzed using multiple models. Additionally, we generated receiver operating characteristic (ROC) curves to evaluate the predictive ability of TyG-BMI for NASH and fibrosis staging in patients with NAFLD. Results Patients with higher TyG-BMI values had a significantly higher prevalence of NASH, NAS ≥ 4, at-risk NASH, significant fibrosis, advanced fibrosis, and cirrhosis (all p < .05). TyG-BMI was an independent predictor of these diseases in both unadjusted and adjusted models (all p < .05). ROC curve analysis further revealed the excellent performance of TyG-BMI in predicting NASH, NAS ≥ 4, at-risk NASH, significant fibrosis, advanced fibrosis, and cirrhosis. The validation cohort yielded analogous results. Furthermore, we constructed three multivariate models of TyG-BMI in conjunction with elastography metrics, which demonstrated elevated diagnostic AUC values of 0.782, 0.792, 0.794, 0.785, 0.834, and 0.845, respectively. Conclusion This study confirms a significant association between insulin resistance and NAFLD, including at-risk NASH and fibrosis staging, as assessed using the TyG-BMI index. TyG-BMI and its associated multivariate models can be valuable noninvasive indicators for NAFLD diagnosis, risk stratification, and disease course monitoring.

Ultrasound 7 score and serum chemerin in rheumatoid arthritis: Relation to disease activity

Background and objectives. Chemerin is an adipokine associated with inflammation. Musculoskeletal ultrasonography is now widely used for detecting and monitoring RA due to its availability, practicality, and cost-effectiveness. The aim of the study is to determine how accurate serum chemerin levels are as a biomarker of active rheumatoid arthritis (RA) disease and to find a link between these levels and ultrasonographic findings. Materials and methods. This case-control study included 44 RA cases and 44 matched-age and sex-healthy controls. Seven joints in the hand and foot were assessed by the German-ultrasound 7 (GUS 7) score through greyscale (GSUS) and power Doppler US (PDUS) in all cases. Disease activity score 28 (DAS28) evaluated RA activity, and serum chemerin levels were measured in cases and controls. Both DAS28-CRP and DAS28-ESR were used in the assessment of the disease. Outcomes. The mean age of patients was 43.48 years versus 39.18 years of controls. 86.4% of patients were females; versus 75% of the control group. 47.7% of the studied patients had moderate disease activity, 31.8% had high disease activity, and 20.5% had low disease activity. There was a statistically significant higher median chemerin serum level among RA cases compared to the control group (898.94 versus 247.81 ng/ml, p &lt;0.001). There was a significant difference in median chemerin between inactive and active patients (352.1 versus 1032.6 ng/ml (p &lt;0.001). The serum chemerin can differentiate between RA patients and controls with a higher sensitivity of 81.8%, a specificity of 88.6%, and an accuracy of 85.2%. There was a statistically significant positive association between chemerin and RA activity (p &lt;0.001). The combination of serum chemerin level and tenosynovitis GSUS score and DAS2-ESR to differentiate between active and inactive RA patients was highly significant with the highest sensitivity of 100%. Conclusions. Chemerin can serve as an advantageous marker for assessing RA activity. The US-7 score is a complementary method used in standard assessment to determine synovial inflammation in RA. The combined use of serum chemerin and the US 7 score could be of high value for detecting disease activity in RA.

Physical Activity, Kinesiophobia, Pain Catastrophizing, Body Awareness, Depression and Disease Activity in Patients With Ankylosing Spondylitis and Rheumatoid Arthritis: A Cross-Sectional Explorative Study.

The aim was to compare the levels of physical activity, kinesiophobia, pain catastrophizing, body awareness, and depression in patients with Ankylosing Spondylitis (AS) and Rheumatoid Arthritis (RA) and to explore the associations between these outcomes and disease activity. Seventy-eight patients with AS (n=30) and RA (n=48) were included. Outcomes were assessed using the International Physical Activity Questionnaire-Short Form, the Tampa Scale of Kinesiophobia, the Pain Catastrophizing Scale, the Body Awareness Questionnaire, and the Beck Depression Inventory. Disease activity levels were determined using the Bath Ankylosing Spondylitis Disease Activity Index for AS and the Disease Activity Score 28 score for RA. AS patients were younger, had a higher proportion of men, and were more physically active than RA patients (p<0.05). Both groups exhibited high levels of kinesiophobia but low levels of pain catastrophizing, similar body awareness and mild depression scores. Moderate correlations (r≥0.5) were observed between kinesiophobia and depression, body awareness and pain catastrophizing and depression, and pain catastrophizing and disease activity in AS patients. In RA patients, moderate correlations (r≥0.5) were found between kinesiophobia and pain catastrophizing. Addressing physical activity, kinesiophobia, pain catastrophizing, body awareness, and depression is important in managing AS and RA patients. Notably, correlations among outcomes differed between groups, with more significant correlations in AS. Further studies are needed to explore these in greater detail.