Serum Levels Of Rheumatoid Factor Research Articles

Serum Rheumatoid Factor Levels at Acute Phase of Ischemic Stroke are Associated with Poststroke Cognitive Impairment

Background: The effect of serum rheumatoid factor (RF) on poststroke cognitive impairment remains unknown. We aimed to investigate the association of serum RF in the acute phase with cognitive impairment at 3 months after ischemic stroke onset. Methods: Our study was based on a random sample from the China Antihypertensive Trial in Acute Ischemic Stroke, a total of 582 patients from 7 of 26 participating sites of the trial with serum RF levels were included in this analysis. Cognitive impairment was defined as Mini-Mental State Examination less than 27 or Montreal Cognitive Assessment less than 25. Results: According to Mini-Mental State Examination score, the multivariate-adjusted odds ratio and 95% confidence interval of cognitive impairment for the highest tertile of serum RF was 1.79 (1.08-2.99) compared with the lowest tertile. Each standard deviation increase of log-transformed RF was associated with 33% (95% confidence interval: 7%-66%) increased risk of cognitive impairment, and a linear association between serum RF and risk of poststroke cognitive impairment was observed (P for linearity < .01). Adding log-transformed RF to a model containing conventional risk factors improved the predictive power for poststroke cognitive impairment (net reclassification improvement: 26.21%, P < .01; integrated discrimination index: 1.24%, P = .02). Similar significant findings were observed when cognitive function was defined by Montreal Cognitive Assessment score. Conclusions: Elevated serum RF levels in the acute phase were independently associated with 3-month cognitive impairment among ischemic stroke patients. Further studies are needed to replicate our findings and to clarify the potential mechanisms.

Systemic treatment with resveratrol reduces the progression of experimental periodontitis and arthritis in rats.

Rheumatoid arthritis and periodontitis are chronic inflammatory diseases which has been closely associated due to the nature of immune-inflammatory imbalance response. Resveratrol is a naturall product with biological proprieties that may promote immunomodulatory effects on host response. This study investigated resveratrol continuous administration effect on experimental periodontitis and arthritis progression in rats. Thirty-five rats were assigned to the following groups: 1—experimental arthritis + experimental periodontitis + placebo (RA+EP +PL) (n = 12); 2 –RA+EP+ ibuprofen (RA+PE+IB) (n = 11); 3—RA+EP+ resveratrol (RA+PE+RSV) (n = 11). After euthanasia, the specimens were processed for morphometric analysis of bone loss, and the gingival tissue surrounding the first molar was collected for quantification of inflammatory markers using a Luminex/MAGpix assay and anti-citrullinated protein antibody (ACCPA) levels were measured by ELISA assay. Serum level of rheumatoid factor (RF) was measured by ELISA assay. Paw edema was analyzed using a plethysmometer. Higher bone loss was observed in PL group, when compared to IB and RSV groups. RSV group presented higher IL-4 concentration than PL and IB groups. Resveratrol reduced RF serum levels and both IB and RSV decreased ACCPA gingival levels. Besides, paw swelling level was significantly lower in IB and RSV groups in the 21th day and only in RSV group in the 28th day. Histological analyzes showed smooth articular surface and higher width of the subchondral cortical in RSV group. Resveratrol showed modulatory effect and seems to reduce the inflammatory signs of arthritis and articular damage throughout the time.

مستوى عامل الروماتويد والأجسام المضادة النووية في مرضى هيليكوباكتر بيلوري المسببه لآفات المعدة

إن المسببات الدقيقة للأمراض الروماتيزمية غير واضحة، ولكن منذ فترة طويلة اقترح أن التعرض لعوامل بيئية معينة، مثل العدوى البكتيرية، في الأفراد المعرضين وراثيا قد يكون السبب في بدء عمليات المناعة الذاتية. تعتبر هيليكوباكتر بيلوري واحدة من أكثر العوامل المعدية التي تمت دراستها على نطاق واسع والتي تم اقتراحها كعوامل تحفيز للمناعة الذاتية. تم اختيار ثمانين مريضا يعانون من عسر الهضم، لتقييم مستوى عامل الروماتويد والأجسام المضاده النووية في المرضى الذين يعانون من آفات المعدة المرتبطة بالهيلكوباكتر بيلوري. وفقا لنتائج التنظير الداخلي واختبار الأنسجة السريع للهيلكوباكتر بيلوري ، تم تقسيم مرضانا إلى 4 مجموعات 20 مريضًا لديهم نتائج إيجابية بالمنظار ومصابين هيلكوباكتر بيلوري و 20 مريضًا لديهم نتائج إيجابية بالمنظار وغير مصابيت هيلكوباكتر بيلوري و 20 مريضًا لديهم نتائج سلبية بالمنظار و ومصابين هيلكوباكتر بيلوري و 20 مريضًا يعانون من نتائج سلبية بالمنظار و غير ومصابين هيلكوباكتر بيلوري لجميع مجموعة المرضى، تم إجراء التقييم السريري الكامل، والتحقيقات المخبرية الروتينية، والتنظير العلوي مع واختبار الأنسجة السريع للهيلكوباكتر بيلوري، و مستوى عامل الروماتويد والاجسام المضاده النووية كانت مستويات مستوى عامل الروماتويد والأجسام المضاده النووية بين المرضى المصابين بالبكتيريا أعلى بشكل ملحوظ بالمقارنة مع المجموعات غير المصابة، علاوة على ذلك، كانت مستويات مستوى عامل الروماتويد والاجسام المضاده النووية أعلى في المرضى المصابين بـ البكتيريا مع آفات المعدة مثل القرحة المعوية والتهاب المعدة أو التهاب الإثنى عشر. ينصح بشدة دراسة إضافية لتقييم تأثير القضاء على هيليكوباكتر بيلوري

Relation between FRAX index and ACPA serum level in premenopausal rheumatoid arthritis patients

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis in adults and is characterized by synovial inflammation and hyperplasia, autoantibody production: rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), cartilage and bone destruction, and systemic features, including cardiovascular, pulmonary, psychological, and skeletal disorders. Fracture Risk Assessment Tool (FRAX) is a computer-based algorithm developed by the World Health Organization (WHO) Collaborating Centre for metabolic bone diseases and first released in 2008. The outputs of FRAX are the 10-year probability of a major osteoporotic fracture (hip, spine, humerus or wrist fracture) and the 10-year probability of hip fracture. The study included 25 premenopausal RA patients and 20 healthy subjects. The serum ACPA level was assessed by ELISA technique, RF using Rose Waaler test in IU/mL was measured as well. BMD in (g/cm 2 ) has been measured for all subjects enrolled in the study by a Lunar Prodigy Advanced DEXA scanner system and were carried out by the same technician. FRAX index was calculated for all members in both groups by using online FRAX calculator. Femoral neck BMD was added to enhance fracture risk prediction. The range of ACPA in the patients group ranged between 11.40–525.0 U/mL. Eighty percent of our patients were ACPA positive. While RF range was from 8.30 to 648.0 IU/mL. Strong statistically significant difference between both groups was found where FRAX index was significantly higher in patients group compared to control group as regards major osteoporotic and hip fractures ( P < 0.001). Serum ACPA and RF level showed insignificant correlation with FRAX index in premenopausal RA patients. FRAX index was found to be high in RA patients but it was not correlated to ACPA nor RF serum level.

The relationship between serum rheumatoid factor level and no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

This study aimed to evaluate the relationship between serum rheumatoid factor (RF) levels and no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). This single-center, cross-sectional study included a total of 318 consecutive patients who were diagnosed with STEMI and underwent primary PCI within 12hours of the onset of symptoms. Baseline serum RF levels of all patients were measured. The diagnosis of no-reflow phenomenon was defined as a flow of TIMI II or less without the presence of dissection, mechanical obstruction, significant residual stenosis, or other plausible causes. The patients were divided into reflow group (n=283) and no-reflow group (n=46) regarding the angiographic features of thrombolysis in myocardial infarction (TIMI) flow of the infarct-related artery. No-reflow phenomenon was observed in 13.8% of the patients. Median RF level was significantly higher in no-reflow group than in reflow group (18.5 (7.0-27.6) vs 8.0 (4.6-50.8), P<.001). Forward conditional logistic regression analysis demonstrated that body mass index (OR=0.845, 95% CI: 0.765 to 0.933, P=.001), diabetes mellitus (OR=5.257, 95% CI: 1.124 to 24.587, P=.035), baseline RF level (OR=1.198, 95% CI: 1.108 to 1.295, P<.001), and SYNTAX score I (OR=1.065, 95% CI: 1.025 to 1.107, P=.001) were the independent predictors of no-reflow phenomenon. Baseline serum RF concentrations are independently associated with the no-reflow phenomenon in patients undergoing primary PCI for acute STEMI.

A Case of Rheumatoid Cerebral Vasculitis Presenting to the ED

Central nervous system involvement in rheumatoid arthritis is infrequent. The most frequent neurological manifestations of rheumatoid arthritis are peripheral neuropathy and cervical spinal cord compression due to subluxation of the cervical vertebrae. Cerebral rheumatoid vasculitis is an uncommon and serious complication which can be life-threatening Neurological involvement in RA is rare, present in only 1% of patients. Disorders of the central nervous system (CNS) include cervical myelopathy, vasculitis, RNs located within the CNS, or meningitis. Stroke also occurs with increased frequency. CNS vasculitis is extremely rare. The diagnosis is supported by magnetic resonance imaging (MRI), alone or with magnetic resonance angiography (MRA), showing the segmental vascular stenosis characteristic of vasculitis. Peripheral neuropathy is usually manifested as sensorimotor neuropathy or mononeuritis multiplex. The underlying mechanism is small vessel vasculitis of the vasa vasorum of the nerves with ischaemic neuropathy and demyelinisation as part of the rheumatoid vasculitis (RV) syndrome. Rheumatoid vasculitis typically affects small and medium-size blood vessels. It is associated with high rates of premature mortality with up to 40% of patients dying by 5 years as well as significant morbidity due to both organ damage from vasculitis and consequences of the treatment. High levels of circulating immune complexes have been observed in atients with rheumatoid vasculitis, and in particular high serum levels of rheumatoid factor are often detected at the time of onset of vasculitis.Deposition of immune complexes most likely contributes to small vessel inflammation and organ damage. Anti CCP levels also tend to be higher in patients with RA who have systemic vasculitis than in those who do not. Histologically, rheumatoid vasculitis involves blood vessels of the small arteries, and all layers of the vessel wall are infiltrated by neutrophils, lymphocytes, and plasma cells.

Relationship between autoantibody associated with rheumatoid arthritis and tooth loss.

This study evaluated the relationship between serum Rheumatoid Factor (RF) levels and tooth loss in a community-dwelling elderly Japanese women. It was hypothesised that women with high baseline RF levels would experience greater tooth loss over 10years than age-matched women with lower baseline serum RF levels. The study population consisted of 197 women aged 70years with ≥12 teeth at baseline. One hundred and twenty-four participants completed a 10-year follow-up and were divided into 2 groups according to their baseline serum RF levels as follows: RF negative (<15U/mL; n=114) and RF positive (>15U/mL; n=10). Negative binomial regression was used to investigate the relationship between baseline RFs and tooth lost over the 10-year period. RF and its interaction with the baseline number of teeth were independent variables, with 9 other adjustment covariates. Baseline RFs were significantly associated with tooth loss (P=.035). In addition, a statistical interaction between baseline RFs and baseline number of teeth was identified (P=.023), modifying the association between RFs and tooth loss. The adjusted incidence rate ratio (IRR) for RF-positive participants with 21 baseline teeth was 1.88 (95% confidence interval (95% CI): 0.76, 4.65). IRRs obtained for participants who had 25 baseline teeth (3.02; 95% CI: 1.03, 8.83) or 30 baseline teeth (5.47; 95% CI: 1.29, 23.13) suggested that RF-positive participants with a high number of baseline teeth would exhibit greater tooth loss than RF-negative participants. High serum RF levels were associated with a greater IRR for future tooth loss in elderly Japanese women.

Risk Factors for Systemic Reduced Bone Mineral Density in Premenopausal Female Patients with Early Untreated Rheumatoid Arthritis

Abstract Background Systemic osteoporosis (OP) is evident among patients with early rheumatoid arthritis (ERA). This study aimed to investigate the OP risk factors in patients with ERA and who was treatment-naïve at inclusion. Subjects and Methods Systemic bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN) and total hip (TH) was measured in 135 treatment-naïve premenopausal females with early Rheumatoid Arthritis (ERA). For all patients, demographic data, vitamin D status, and the specific parameters of the disease, including disease activity, serum levels of rheumatoid factor and anti-citrullinated protein antibodies (ACPA) were evaluated. Results T score was&lt;−1.0 in the LS in 16.2%, in the FN in 22.2% and in the TH in 23.7%. Among our patients, 29.6% had below normal T score at any site. Demographic characteristics, RA duration, diseases activity did not significantly impact BMD. However, patients with decreased BMD were more prevalent ACPA- and rheumatoid factor (RF)-positive than patients with normal BMD. Also, high titer ACPA or RF is associated with more marked reduction in BMD. In regression analysis, after adjustment for possible confounders, patient stratification according to ACPA status and RF status (into negative, low-positive and high positive) still a significant independent variable associated with lower BMD values. Conclusion Presence of ACPA or RF is associated with increased risk for development of reduced systemic BMD from very early stage of rheumatoid arthritis. Furthermore, this risk increases more with higher levels of ACPA or RF. Measurement of BMD should be performed for ACPA- or RF-positive patients with early RA.

The Potent Inhibitory Effect of β-D-Mannuronic Acid (M2000) as a Novel NSAID with Immunosuppressive Property on Anti-Cyclic Citrullinated Peptide Antibodies, Rheumatoid Factor and Anti-dsDNA Antibodies in Patients with Rheumatoid Arthritis.

To investigate the inhibitory effect of β-D-mannuronic acid (M2000) on anti-cyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF), antidouble strand DNA (anti-dsDNA) and acute phase reactants in rheumatoid arthritis (RA) patients. The study included 40 patients with RA who had an inadequate response to conventional therapy (identifier: IRCT2014011213739N2). The patients were permitted to continue the conventional therapy excluding NSAIDs. 21 of them were treated orally by M2000 at a dose of 500 mg twice daily for 12 weeks and the others did not. Serum samples were collected at baseline, 4 weeks and 12 weeks after treatment and were tested for the serum level of anti-CCP and anti-dsDNA antibodies using enzyme linked immunosorbent assay. The serum level of RF and C-reactive proteins (CRP) was determined by the immunoturbidimetric assay, respectively. At baseline, all patients in the M2000 treated group and the control group were positive for anti-CCP, RF. moreover, 4 of 21 (19%) in the M2000 treated group and 2 of the 19 (10.5%) patients in the control group were positive for anti-dsDNA antibodies, respectively. The serum levels of anti-CCP, RF and anti-dsDNA were decreased significantly after M2000 therapy (p<0.001, p<0.001 and p<0.001, respectively). The reduction in the level of anti-CCP was positively correlated with disease activity, swollen joint count and CRP. Furthermore, the level of inflammatory markers ESR and CRP decreased significantly after M2000 therapy (p<0.001 and p<0.004, respectively). M2000 shows inhibitory effect on anti-CCP, RF, anti-dsDNA antibodies and acute phase reactants in RA patients.

Enhanced Bruton's Tyrosine Kinase Activity in Peripheral Blood B Lymphocytes From Patients With Autoimmune Disease.

Bruton's tyrosine kinase (BTK) transmits crucial survival signals from the B cell receptor (BCR) in B cells. Pharmacologic BTK inhibition effectively diminishes disease symptoms in mouse models of autoimmunity; conversely, transgenic BTK overexpression induces systemic autoimmunity in mice. We undertook this study to investigate BTK expression and activity in human B cells in the context of autoimmune disease. Using intracellular flow cytometry, we quantified BTK expression and phosphorylation in subsets of peripheral blood B cells from 30 patients with rheumatoid arthritis (RA), 26 patients with primary Sjögren's syndrome (SS), and matched healthy controls. In circulating B cells, BTK protein expression levels correlated with BTK phosphorylation. BTK expression was up-regulated upon BCR stimulation in vitro and was significantly higher in CD27+ memory B cells than in CD27-IgD+ naive B cells. Importantly, BTK protein and phospho-BTK were significantly increased in B cells from anti-citrullinated protein antibody (ACPA)-positive RA patients but not in B cells from ACPA-negative RA patients. BTK was increased both in naive B cells and in memory B cells and correlated with frequencies of circulating CCR6+ Th17 cells. Likewise, BTK protein was increased in B cells from a major fraction of patients with primary SS and correlated with serum rheumatoid factor levels and parotid gland T cell infiltration. Interestingly, targeting T cell activation in patients with primary SS using the CTLA-4Ig fusion protein abatacept restored BTK protein expression in B cells to normal levels. These data indicate that autoimmune disease in humans is characterized by enhanced BTK activity, which is linked not only to autoantibody formation but also to T cell activity.

Periodontitis increases rheumatic factor serum levels and citrullinated proteins in gingival tissues and alter cytokine balance in arthritic rats.

This study investigated some immunological features by experimental periodontitis (EP) and rheumatoid arthritis (RA) disease interact in destructive processes in arthritic rats. Rats were assigned to the following groups: EP +RA; RA; EP; and Negative Control. RA was induced by immunizations with type-II collagen and a local immunization with Complete Freund’s adjuvant in the paw. Periodontitis was induced by ligating the right first molars. The serum level of rheumatoid factor (RF) and anti-citrullinated protein antibody (ACCPA) were measured before the induction of EP (T1) and at 28 days after (T2) by ELISA assay. ACCPA levels were also measured in the gingival tissue at T2. The specimens were processed for morphometric analysis of bone loss, and the gingival tissue surrounding the first molar was collected for the quantification of interleukin IL-1β, IL-4, IL-6, IL-17 and TNF-α using a Luminex/MAGpix assay. Paw edema was analyzed using a plethysmometer. Periodontitis increased the RF and ACCPA levels in the serum and in the gingival tissue, respectively. Besides, the level of paw swelling was increased by EP and remained in progress until the end of the experiment, when EP was associated with RA. Greater values of IL-17 were observed only when RA was present, in spite of PE. It can be concluded that periodontitis increases rheumatic factor serum levels and citrullinated proteins level in gingival tissues and alter cytokine balance in arthritic rats; at the same time, arthritis increases periodontal destruction, confirming the bidirectional interaction between diseases.

Rheumatoid Nodules and Lung

Among the pulmonary manifestations of rheumatoid arthritis (RA), rheumatoid nodules (RN) are frequent even if mostly asymptomatic. They are generally peripheral and different for sizes (up to 8 centimeter in diameter) and number (one or more). RN can be a consequence of RA or of the drugs used for RA. In the first case, they usually appear in patients with more aggressive and seropositive longstanding RA and are often associated with cutaneous RN. Methotrexate, leflunomide, azathioprine among the disease-modifying anti-rheumatic drugs (DMARDS) and etanercept among “biological” ones are the more frequent responsible drugs. RN induced by drugs are histologically identical to non-drugsinduced RN. In these cases, drug withdrawal is the first therapeutic choice. Differential diagnosis with other causes of pulmonary nodule is imperative, especially when RN is the first clinical manifestation of RA and serum levels of rheumatoid factor (RF) and/or anti-citrullinated peptides antigens (ACPA) are in the normal ranges. Cancer (primitive or metastatic) and infectious diseases represent the main diagnostic dilemma. The exclusion of neoplastic or infectious causes is particularly important in the course of immunosuppressive therapy for RA. As highlighted by some authors, bronchogenic carcinoma can grow on RN and RN can be associated with metastatic nodules or infectious nodules in the lung, but these are outstanding events. Percutaneous biopsy or thoracotomy remain the gold standard for diagnosis especially when high-resolution computed tomography (HRCT) or positron emission tomography (PET) -CT features and laboratory tests are not conclusive. Keywords: Caplan's syndrome, diagnostic algorithm, differential diagnosis, drug-toxicity, pulmonary involvement, rheumatoid arthritis, rheumatoid nodules.

Clinical Characteristics of Rheumatoid Arthritis Patients Achieving Functional Remission with Six Months of Biological DMARDs Treatment.

Objective Although previous studies have reported the prognostic factors for functional remission, no reports have cited the predictive factors. Our aim was to study the predictive factors for functional remission, which is a treatment goal in rheumatoid arthritis (RA), after receiving biological disease-modifying antirheumatic drugs (bDMARDs) treatment for six months. Methods The study consisted of 333 RA patients treated with bDMARDs for six months. The following patient characteristics were investigated: age, gender, disease duration, type of bDMARDs, baseline steroid and methotrexate dosage, and levels of serum rheumatoid factor, matrix metalloprotease, anti-cyclic citrullinated peptides antibody, tumor necrosis factor-α, and interleukin-6. In our evaluation, we used the Simplified Disease Activity Index (SDAI) for RA disease activity, health assessment questionnaire disability index (HAQ-DI) for activity of daily living, Short Form (SF)-36 for quality of life, and Hamilton Depression Rating Scale (HAM-D) or Self-rating Depression Scale (SDS) to determine the patients' depression status. The subjects were divided into two groups: patients with HAQ-DI≤0.5 and HAQ-DI>0.5 at 6 months. Results A univariate analysis comparing a group of RA patients without functional remission (n=68) showed that the patients with functional remission (n=164) had the following in common compared with those without remission: younger age, shorter disease duration, lower baseline steroid dosage, lower SDAI, lower HAQ-DI, higher SF-36, and lower HAM-D. Only lower HAQ-DI scores and “mental health” score on the SF-36 were detected using a logistic regression analysis. Conclusion These findings suggested that RA patients with lower HAQ-DI and lower depression scores at baseline were more likely to achieve functional remission using bDMARDs treatment than those without these variables.

Effect of Artemisia annua extract on treating active rheumatoid arthritis: A randomized controlled trial.

To investigate the effect and safety of the complementary use of the extract of Artemisia annua L. (EAA) on treating active rheumatoid arthritis (RA). A randomized controlled clinical trial was performed. All the 159 participates with active RA were randomly assigned to the control group (80 cases) and EAA group (79 cases) using concealed random allocation method. In the control group, patients were medicated with leflflunomide and methotrexate for 48 weeks; and patients in the EAA group were administrated with leflflunomide, methotrexate plus EAA (30 g/d). At the time points of 0, 12, 24 and 48 weeks, the clinical outcome measures, including objective pain score, tenderness score, number of painful joints, number of swollen joints, health assessment questionnaire (HAQ) score for quality of life, levels of serum rheumatoid factor (RF), anti-cyclic citrullinated protein antibodies (CCP-Ab), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue score for pain (VAS), and the overall effificacy were detected and recorded. The objective pain score, number of painful joints and ESR at 12 weeks, tenderness score and HAQ at 24 weeks, and the tenderness score, number of painfull joints, number of swollen joints, HAQ, CRP, RF and CCP-Ab at 48 weeks were signifificantly improved in the EAA group compared with the control group (P<0.01 or P<0.05). At 24 and 48 weeks, the overall effificacy of the EAA group was signifificantly higher than the control group (P<0.01). There were signifificantly higher withdrawal rate of corticosteroids within 12 weeks post-treatment and lower incidence rate of adverse effects in the EAA group compared with the control group (P<0.01 or P<0.05). EAA plus methotrexate and leflflunomide were more effective and safer than the routine use of methotrexate and leflflunomide in the treatment of active RA.

Role of vascular disorders in lung injury in patients with rheumatoid arthritis

Introduction. The incidence of respiratory system involvement in patients with rheumatoid arthritis (RA) has currently increased; thereby new diagnostic methods have been developed actively. Meanwhile role of vascular disorders in pathogenesis of lung injury is almost unknown and single-photon emission computed tomography (SPECT) isn't used as method of lung assessment in RA. The detector of endothelial glycocalyx damage syndecan-1 is little known but potentially perspective serum marker of lung injury in RA. Objective. The purpose of the study was to investigate the role of vascular disorders in lung injury in patients with RA. Materials and methods. 61 patients with RA without comorbid lung diseases were enrolled in the study. Control group consisted of 26 healthy persons. Patients underwent survey and physical examination, high-resolution computed tomography (HRCT) and SPECT of the lungs and pulmonary function tests (PFTs). Also serum levels of rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (ACCP) and syndecan-1 were measured. Results. All patients developed microcirculation impairment on SPECT. Vascular disorders were according to changes of lung structure detected by HRCT (r = 0.434; p = 0.044). Areas of hypoperfusion matched with ground glass opacities, lung fibrosis, branching linear structures and airway obstruction on HRCT-SPECT fusion scans. Syndecan-1 level was higher in patients with RA compared with healthy controls (р = 0.019). Conclusion. Vascular disorders are important in pathogenesis of lung injury in RA, and SPECT has high sensitivity in lung assessment. Perfusion impairment in lungs correlates with syndecan-1 level, thus syndecan-1 could be used as marker of lung injury in RA thereafter.

Long-snake moxibustion for rheumatoid arthritis:a randomized controlled trial

To observe the clinical efficacy differences among long-snake moxibustion, warm needling and western medication on rheumatoid arthritis and explore its effect mechanism. One hundred and twenty patients were randomized into a long-snake moxibustion group, a warm needling group and a western medication group, 40 cases in each one. In the long-snake moxibustion group, the long-snake moxibustion was used. The ginger-isolated moxibustion was applied along the governor vessel, from Dazhui (GV 14) to Yaoshu (GV 2), once a month, for 2 months. In the warm needling group, the main points included Dazhui (GV 14), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Zhiyang (GV 9), Mingmen (GV 4) and Yaoyangguan (GV 3). The warm needling technique was used at 4 to 5 points each time, and 3 moxa cones were required at each points. The treatment was given once every two days, for 2 months. In the western medication group, methotrexate was prescribed for oral administration, 10 mg each time, once a week. If the joint pain score or joint swelling score was up to 6, diclofenac sodium was combined, 25 mg each time, 3 times a day, for 2 months. The symptom score, physical sign score, the visual analogue scale (VAS) score, levels of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), immunoglobulin M (IgM) and immunoglobulin G (IgG) were observed before and after treatment in the patients of the three groups. The treatments relieved the symptoms and physical signs of rheumatoid arthritis and improved VAS score and the levels of serum RF, ESR, CRP, IgM and IgG in all of the three groups (all P<0.01). The efficacy in the long-snake moxibustion group was significantly better than that in the warm needling group and the western medication group (P<0.05, P<0.01). The long-snake moxibustion achieves the significant clinical efficacy on rheumatoid arthritis, better than warm needling therapy and methotrexate. This therapy much better reduces immune response and alleviates the sickness.

A novel paradigm in the clinical context of rheumatoid arthritis: role of Tfh and Th17 Cells in autoimmunity

Abstract Introduction Rheumatoid Arthritis (RA) is an autoimmune disease characterized by chronic inflammation of synovium causing progressive joint destruction. Recently, T follicular helper (Tfh) cells and Th17 cells have emerged as novel T cell subsets controlling autoimmunity. Identifying their roles may break the traditional Th1/Th2 axis dichotomy and bridge knowledge gap of T cell lineages on RA immunopathogenesis. We examined the frequency of circulating Tfh (cTfh) and cTh17 cells in RA patients, and investigated their correlation with disease activity, autoantibody level, and inflammation. Methods Peripheral blood was collected from 51 RA patients and healthy donors. RA patients were divided into remission (&amp;lt;2.6) and active groups (&amp;gt;2.6) based on disease activity score (DAS-28). Clinic parameters including Rheumatoid Factor (RF), Anti-CCP, ESR and CRP were obtained. The frequency of cTfh, cTh17 cells, and plasmablasts were measured by flow cytometry. Correlation of the frequency of cTfh and cTh17 cells with DAS-28, plasmablasts, and clinic parameters were statistically determined. Results Both cTfh and cTh17 cells were significantly increased in RA patients, expecially in active patients comparing to healthy donors (p&amp;lt;0.05). The frequency of cTfh cells correlated with the percentage of plasmablasts and the level of pathogenic anti-CCP antibody, whereas the frequency of cTh17 cells correlated with serum level of RF and CRP as well as DAS-28. Conclusions Tfh cells may contribute to B cell differentiation and autoantibody production, while Th17 cells may involve in the inflamation and pathogenesis of RA. Thus, disrupting the signals provided by Tfh and Th17 cells may offer new therapeutic stategies for active RA patients.

Heterophilic antibody interference affecting multiple hormone assays: Is it due to rheumatoid factor?

ABSTRACTAssay interference with heterophilic antibodies has been well described in literature. Rheumatoid factor is known to cause similar interference leading to falsely elevated hormone levels when measured by immunometric methods like enzyme-linked immunosorbent assay (ELISA) or multiplex immunoasays (MIA). We report a case of a 60-year-old male patient with a history of rheumatoid arthritis referred to our endocrine clinic for investigation of hypogonadism and was found to have high serum levels of LH, FSH, SHBG, Prolactin, HCG and TSH. We suspected assay interference and further tests were performed. We used Heteroblock tubes and PEG precipitation to eliminate the interference and the hormone levels post treatment were in the normal range. We believe the interference was caused by high serum levels of rheumatoid factor. Although he was treated with thyroxine for 3 years, we believe he may have been treated inappropriately as his Free T4 level was always normal despite high TSH due to assay interference. Our case illustrates the phenomenon of heterophilic antibody interference likely due to high levels of rheumatoid factor. It is essential for clinicians and endocrinologists in particular to be aware of this possibility when making treatment decisions in these groups of patients.

Immunoglobulin G-Rheumatoid Factor Interferes Negatively with Serum Hepatitis B Envelope Antigen Chemiluminescent Microparticle Immunoassay.

Rheumatoid factor (RF) can interfere both positively and negatively in immunoassays. It remains unclear whether the negative interference is an exceptional phenomenon or a denominator of immunoassays and which RF subgroup plays a key role in its causation. Serum models comprising hepatitis B envelope antigen (HBeAg) and RF were made by blending HBeAg-positive sera and RF-positive sera at a ratio of 1:9. Paramagnetic microparticles coated with P human chorionic gonadotropin (betaHCG)-anti-betaHCG complexes were used to remove RFs from the models, and HBeAg was determined in models using the chemiluminescent microparticle immunoassay (CMIA). HBeAg sample/cutoff (S/CO) relative light units (RLUs) measured in 27.06% of the serum models were significantly lower than those in the control models with a maximum decline rate of > 70.00%. The discrepancies between the HBeAg S/CO RLUs measured in serum and control models were not associated with the serum RF levels when these ranged from 20 to 1510 IU/mL. Pretreatment of the serum models with the paramagnetic microparticles increased the HBeAg S/CO RLUs measured and decreased the immunoglobulin (Ig) A-RF and IgG-RF levels significantly. However, the discrepancies between the HBeAg S/CO RLUs measured in serum models before and after pretreatment were only associated inversely with the discrepancies in IgG-RF levels. Measurement of HBeAg by CMIA is susceptible to negative interference from RFs. The level of IgG-RF played a key role in interfering with HBeAg CIMA and predominantly caused falsely low results. The pretreatment of samples with blocking reagents is therefore advisable prior to the interpretation of test results.

Serologic Markers Are Associated With Ocular Staining Score in Primary Sjögren Syndrome.

To investigate the relationship between serologic markers and dry eye severity in subjects with primary Sjögren syndrome (SS). This study evaluated 64 patients diagnosed with primary SS according to the 2012 Sjögren's International Collaborative Clinical Alliance (SICCA) classification criteria. Serum anti-Ro/SSA, anti-La/SSB, rheumatoid factor (RF), and antinuclear antibody (ANA) levels, Ocular Surface Disease Index (OSDI), Schirmer I test values, tear film breakup time, and SICCA ocular staining score (OSS) were determined. The conjunctival staining scores were 3.3 ± 1.9, 3.6 ± 2.0, 3.4 ± 1.9, and 3.5 ± 1.9 in the positive anti-Ro (≥25 EU), positive anti-La (≥25 EU), positive RF (≥20 IU/mL), and positive ANA (≥1:320) group, respectively. Subjects with positive anti-Ro, anti-La, RF, or ANA had significantly higher conjunctival staining scores compared with those with negative levels (P < 0.05). The total OSS in the positive ANA group was 5.5 ± 3.0, which was significantly higher than the total OSS (3.4 ± 2.1) in the negative ANA group (P = 0.005). Serum RF and ANA levels had strong correlations with conjunctival staining scores and the total OSS but not with corneal staining scores (r = 0.53, P < 0.001 and r = 0.382, P = 0.002). Other ocular parameters (OSDI, Schirmer I test values, and tear film breakup time) did not differ by the serologic marker level. Interestingly, the OSDI was positively correlated with the corneal staining score and total OSS (r = 0.646, P < 0.001 and r = 0.476, P < 0.001). Serum RF and ANA levels are associated with conjunctival staining scores and the total OSS according to the SICCA OSS in primary SS.