Serum Rheumatoid Factor Research Articles

Anti-arthritic activity of Trayodashang guggulu, a classical Ayurvedic formulation against complete Freund’s adjuvant-induced rheumatoid arthritis in rats

BackgroundRheumatoid arthritis is a chronic autoimmune disease affecting millions of people across the world. Trayodashang guggulu (TG) is a classical Ayurvedic formulation used for the treating joint diseases since decades in the Indian system of traditional medicine. The aim of the study was to evaluate anti-arthritic activity of TG against complete Freund’s adjuvant-induced arthritis in Wistar rats.MethodsArthritis was induced by single injection of 0.1 ml complete Freund’s adjuvant into the intraplanter surface of left hind paw of Wistar rats. TG was administered orally at the doses of 100, 200, 400 and 800 mg/kg body weight for 14 days. In the preventive dose group, TG was administered at the dose of 100 mg/kg body weight, orally for 28 days. Paw swelling, joint circumference, serum rheumatoid factor, C-reactive protein, serum IL-1β, TNF-α and histopathological parameters were assessed for the evaluation of arthritis. Effects of TG were compared with standard allopathic drug ibuprofen.ResultsTG reversed complete Freund’s adjuvant-induced arthritis in rats when used for 14 and 28 days. Serum rheumatoid factor, C-reactive protein, IL-1β and TNF-α were decreased in rats treated with both standard drug ibuprofen and TG.ConclusionOral administration of TG reduced experimentally induced rheumatoid arthritis in rats by reversing elevated level of serum biochemical markers as well as reducing joint destruction similar to ibuprofen. Results obtained from the study paved the way in exploring more specific mechanisms of action of TG involving in vitro and in silico models.

High risk of misclassification of acute Parvovirus B19 infection into a systemic rheumatic disease.

Parvovirus B19 most frequently causes epidemics of erythema infectiosum in children but also affects adults often leading to rheumatologic manifestations. While the serum profile allows the diagnosis, manifestations may mimic autoimmune conditions. The aim was to evaluate the proportion of patients with acute Parvovirus B19 infection fulfilling classification criteria for rheumatic diseases (RA and SLE). We evaluated the clinical and serological features of 54 patients diagnosed with acute Parvovirus B19 infection seeking rheumatological attention between March and June 2024. The majority of patients were females (78%), with a mean (s.d.) age of 45 (13) years and 54% could not recall any known exposure. Fifty-one/54 (94%) had arthralgia, 27 (50%) arthritis (oligoarthritis in 67% of them), 24 (44%) fever, 19 (35%) skin rash and 7 (13%) purpura. Symptoms resolution generally occurred within 6 weeks. Complement levels were low in 14/33 (42%) tested patients, while the presence of serum ANA, anti-dsDNA, anti-phospholipids and rheumatoid factor was detected in 21/38 (55%), 10/26 (38%), 6/12 (50%) and 5/37 (13%) patients, respectively. Classification criteria for SLE were fulfilled in 93% of ANA-positive patients and RA criteria in 38% of patients with arthritis. Parvovirus B19 infection manifestations may vary and nearly all patients with positive serum ANA fulfil the classification criteria for SLE. The risk of misclassification in patients with viral infection should not be overlooked.

Evaluation of Anti-arthritic Activity of hydro-alcoholic Root Extract of Moringa concanensis in complete Freund’s Adjuvant-induced Arthritic Rats

Background: Arthritis, a debilitating inflammatory disorder, has been a target for numerous therapeutic interventions. Natural plant extracts, especially those rich in phytochemicals like terpenoids, have demonstrated potential as alternative remedies. In this context, Moringa concanensis, a traditionally known medicinal plant, needs further elucidation regarding its anti-arthritic efficacy. Objective: This study aimed to investigate the anti-arthritic potential of the hydro-alcoholic root extract of Moringa concanensis in a Complete Freund’s Adjuvant (CFA)-induced arthritis rat model. Methods: An initial phytochemical screening and GC-MS analysis were executed on the hydro-alcoholic root extract of Moringa concanensis. Arthritis was subsequently induced in rats using CFA. Comprehensive assessments were made on various parameters such as body weight, paw volume, joint diameter, serum rheumatoid factor, serum C-reactive protein, ALP, ALT, total protein, total cholesterol, and urea. Additionally, histopathological studies of the liver and ankle joints were carried out. For comparative efficacy, methotrexate was employed as a positive control. Results: Rats receiving the hydro-alcoholic extract at dosages of 200mg/kg (p.o) and 400mg/kg (p.o) exhibited a notable reduction in the physical and biochemical indicators of arthritis, in comparison to the untreated arthritic model. Histopathological observations further confirmed that the anti-arthritic effects of the hydro-alcoholic extract were on par with methotrexate. Conclusion: The hydro-alcoholic root extract of Moringa concanensis exhibited significant anti-arthritic activity, possibly attributed to its terpenoid content. The findings advocate for its potential application as a therapeutic agent in managing arthritis.

Eye involvement in patients with rheumatoid arthritis: a cross-sectional study

Background: Rheumatoid arthritis (RA) is a systemic immune disease. The authors aimed to report the characteristics of ocular manifestations in patients with RA. Methods: Demographic and clinical characteristics were collected including: age, sex, and BMI. Disease data included the duration, the present main complaint, including the number of painful and swollen joints, duration of morning stiffness, and the patient’s self-evaluation form had also been applied and registered. Eye symptom including pain, dryness, redness, photophobia, discharge, and blurred vision was asked and registered, in addition to full medical history, treatment, and evaluation of clinical disease activity index. Rheumatologic examination included: the number of tender and swollen joints in patients was done. All study subjects underwent complete ophthalmological examination in the following manner: visual acuity assessment by Snellen’s chart, evaluation of pupil diameter and reflexes as well as eyeball movements, tear film evaluation by using Schirmer’s test, intraocular pressure measurement, slit-lamp evaluation of the anterior segment with concentration on ocular surface assessment, followed by installation of topical mydriatic/cycloplegic eyedrops for posterior eye segment exam and fundoscopy. Laboratory tests included rheumatic factor, anti cytoplasmic citrulinted peptide, C-reactive protein, and erythrocyte sedimentation rate were performed and analyzed. Results: Mean age of study group was 41.5±10 years,78.59% of which were females. Ocular manifestations were present in 31.14%. Dry eye was diagnosed in (36.71%), among which burning sensation was found in (35.15%), and photophopia in (27.34%). The most frequent ocular manifestation was episcleritis (66.40%), while scleritis was diagnosed in (22.65%), and keratoconjuctivitis was present in (7.04%). Discussion: The most common manifestations of ocular involvement in our RA patients was episcleritis, dry eye, and scleritis. Positive serum rheumatoid factor and anticitrulinated peptide antibody significantly increased the risk of having ocular manifestations, especially dry eyes, and the ocular manifestations prevalence was higher among male patients, long disease duration and treatment with biologics and disease-modifying antirheumatic drugs. Conclusion: Ocular symptoms are relatively frequent manifestation of RA. Regular ophthalmological examinations are essential among patients with RA.

The first presentation of a case of nail-patella syndrome newly diagnosed at the onset of rheumatoid arthritis: a case report

/SummaryBackgroundNail-patella syndrome (NPS) is a rare autosomal dominant disorder that is characterized by dysplasia of the nails, hypoplasia and/or dislocation of the patella and the presence of iliac horns. Using the CARE guidelines, we present the first reported case of NPS that was newly diagnosed at the onset of rheumatoid arthritis (RA).Case presentationA 74-year-old man was admitted to our hospital due to an 8-month history of arthralgia in bilateral wrists, elbows and fingers. He had a past history of glaucoma and left patella dislocation that had been operatively recentered at the age of 15 years. Laboratory data showed elevated levels of serum C-reactive protein and rheumatoid factor and an elevated titer of anti-SS-A antibodies, while estimated glomerular filtration rate (eGFR), titers of other antibodies and the results of a urinary test were normal. An X-ray showed deformity of bilateral radial heads and the right elbow, and magnetic resonance imaging (MRI) of his hands showed synovitis and erosion in the multiple swollen joints of the wrists and fingers. In addition to these typical features of RA, he had bilateral thumb nail dysplasia with mild hypoplasia of bilateral patellae and iliac horns as shown by the X-ray. He was diagnosed as having autosomal dominant disorder NPS co-existing with RA and he was treated with methotrexate in combination with an oral Janus kinase (JAK) inhibitor, leading to induction of remission.ConclusionsWe have presented a rare case of NPS that was newly diagnosed at the onset of RA. Clinical and radiographic findings of NPS are highlighted in this case report for diagnosing NPS on the basis of typical manifestations.

Association of Cathepsin K and Tartrate- Resistant Acid Phosphatase-5b in Different Stages of Rheumatoid Arthritis Patients in South Indian Population

The aim of the study was to identify effective biomarkers of changes in bone mineral density (BMD) at different stages of rheumatoid arthritis patients from South Indian population, using disease activity score in 28 joints (DAS28) which is being used as a measurement for assessing disease activity in patients with rheumatoid arthritis. The study was carried out in 92 rheumatoid arthritis patients. Serum level of tartrateresistant acid phosphatase-5b (TRAP-5b) and cathepsin K was measured using ELISA. Serum rheumatoid factor (RF) and C-reactive protein (CRP) was recorded by the attending rheumatologists. The C-reactive protein (CRP) was quantified using a latex immunoturbidimetric method. The rheumatoid arthritis (RA) was measured by turbidimetric immunoassay method. The bone mineral density (BMD) T-score was calculated according to WHO guidelines. Reverse transcription PCR (RT-PCR) was used to determine the expression of cathepsin K. The rheumatoid arthritis (RA) patients were categorized into three groups based on the DAS28 score as inactive (DAS ≤ 3.2), moderately active (DAS > 3.2 ≤ 5.1) and very active (DAS > 5.1) at the time of admission. Out of 92 patients, 16 (17.4%) patients had inactive disease condition, 42 (45.6%) patients had moderately active disease condition and 34 (37%) patients had very active disease condition. The mean BMD was significantly lower in very active (0.28 ± 0.04; p < 0.001) as compared with moderately active (0.71 ± 0.13; p < 0.001) and inactive (1.21 ± 0.14). TRAP5b and cathepsin K showed significant increases in very active group (p < 0.001) as compared with moderately active (p < 0.001) and inactive groups. In conclusion, The biomarker TRAP-5b and cathepsin K identified in this study may become a new and highly specific biomarker for rheumatoid arthritis

TNF-α versus IL-6 Genes Expression levels in Active Rheumatoid Arthritis: Clinical and Laboratory Determinants

This study intended to compare the expression levels of tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) genes in active rheumatoid arthritis (RA) patients who were receiving conventional synthetic disease-modifying drugs (csDMARDs) and to find the clinical and laboratory determinants affecting TNF-α and IL-6 genes expression levels among active RA patients. This was a cross sectional study that included 108 active RA patients who were receiving csDMARDs. A detailed history was reviewed for all patients in addition to a complete physical examination and assessment of the 28-joint disease activity score (DAS28). Some laboratory measures were recorded as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and serum rheumatoid factor (RF). Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure expression levels of TNF- α and IL-6 genes. In active RA patients, TNF-α and IL-6 genes expression levels were significantly correlated to each other (p<0.001, r=0.788). Also, both had positive correlations with the age and DAS28 among RA patients (p<0.001). IL-6 and TNF-α expression levels were significantly higher in RA patients with high DAS28 scores (p<0.001). Most RA patients (81.5%) had relatively higher IL-6 gene expression levels than TNF-α. RA patients with relatively high IL-6 expression levels were younger in age and had shorter disease duration and less DAS28 than RA patients with relatively high TNF-α gene expression levels. In addition, they had higher CRP and RF levels. Young age was detected as a significant predictor for relatively higher IL-6 gene expression levels than TNF-α. In conclusion, most active RA patients had higher IL-6 gene expression levels than TNF-α. Young age could be considered a significant predictor for relatively high IL-6 gene expression levels among active RA patients.

Comparison of rheumatoid arthritis factors, adenosine deaminases and uric acid in arthritis and non-arthritis patients: A protocol

Rheumatic disorders are viewed as a public health issue because they affect thousands of individuals around the world and increase health care expenses. Numerous biochemical markers may play a role in the pathophysiology and etiology of rheumatoid arthritis (RA) due to its local as well as systemic inflammatory effects. Rheumatoid factors (RF) can be found in a variety of people, including young, healthy people, the elderly, and people with RA. In this study we will assess and compare the occurrence, clinical presentation, effects and possible risk of biochemical parameters such as uric acid, adenosine deaminase (ADA,), RA factor between arthritis patients and non - arthritis patients. A total of 82 participants — 41 RA patients and 41 healthy controls (non-arthritis patients) —will be included in the study. The levels of serum ADA, uric acid, and rheumatoid factor will be examined, and independent tests will be used for the statistical analysis. Serum ADA rheumatoid factors levels in RA patients is higher in healthy control. When comparing the uric acid levels of RA patients with healthy controls, there is no significant change in the uric acid level. The degree underlying ADA activity between RA patients and healthy individuals should differ noticeably, confirming the test’s value in the diagnosis of the condition.

Remitting seronegative symmetrical synovitis with pitting edema syndrome postsecond COVID-19 vaccination: a case report.

A 52-year-old woman presented with hand edema, arthralgia, and morning stiffness, after receiving the second dose of m RNA COVID-19 vaccination. Examination revealed edema in the dorsum of both hands and symmetrical tenderness of the shoulders, elbows, wrists, knees, and ankles. Blood test results were normal except for elevated levels of C-reactive protein. The immune profile and the tuberculin test were also negative. A hand radiograph showed soft tissue edema. Ultrasonography of the extremities has shown tenosynovitis. Remitting seronegative symmetrical synovitis with pitting edema syndrome was diagnosed according to the diagnostic criteria. She was treated with 30mg/day prednisolone, with a complete disappearance of edema and arthralgia after 10 days, and the C-reactive protein level was decreased. Vaccines are still the most effective and protective method against COVID-19 infection, but it may trigger an immunological response. Remitting seronegative symmetrical synovitis with pitting edema (or sometimes RS 3 PE) is a rare nonunderstood syndrome identified by symmetric polyarthritis, synovitis, acute pitting edema of hands and/or feet, and a negative serum rheumatoid factor, with an excellent prognosis to treatment with steroid. Usually occurred in the old aged population, young patients' cases were mentioned. As the authors did not find any data about our subject, this is the first case of this syndrome development after the second dose of COVID-19 vaccination. The occurrence of acute symmetrical seronegative polysynovitis with extremities edema, in the elderly, should guide toward the diagnosis of this syndrome.

The MIDORA trial: a phase II, randomised, double-blind, placebo-controlled, mechanistic insight and dosage optimisation study of the efficacy and safety of dazodalibep in patients with rheumatoid arthritis

ObjectivesTo evaluate the safety, efficacy and response duration of four different dosing regimens of dazodalibep (DAZ), a non-antibody biological antagonist of CD40L, in patients with rheumatoid arthritis (RA).MethodsThis double-blind study...

Rupioid psoriasis: A complex, multifactorial presentation

Introduction: Secondary syphilis, also termed the great mimicker due to its vast array of clinical presentations, is associated with skin manifestations including rupioid, macular, psoriasiform, and condylomatous lesions. On clinical examination alone, it can be difficult to differentiate between rupioid syphilis and rupioid psoriasis, especially among cases of human immunodeficiency virus (HIV) and syphilis co-infection; however, histologic examination can aid in their differentiation. Additional testing such as serum rapid plasma reagin (RPR), anti-HIV antibody, rheumatoid factor, and fungal cultures should be performed to exclude other causes of rupioid lesions. Case Report: A 19-year-old HIV-positive male developed numerous hyperkeratotic skin lesions involving the head, trunk, and extremities over a 4-week period. His RPR was positive (1:64), suggesting a diagnosis of rupioid syphilis. The patient was treated with doxycycline, given a reported history of penicillin allergy. Rapid plasma reagin titers decreased to 1:2 following treatment; however, the skin eruption did not improve. A biopsy of a lesion demonstrated psoriasiform acanthosis with confluent hyperkeratosis, clusters of intracorneal neutrophils, and negative spirochete immunostaining. Based on histopathology and clinical presentation, a diagnosis of rupioid psoriasis was favored. The patient was started on targeted anti-psoriatic therapy with apremilast and maintains close follow-up with his dermatologist every three months. Conclusion: Although the patient’s presentation was initially presumed to be secondary to syphilis, his lack of response to treatment prompted further workup to assess the etiology of the patient’s skin findings more accurately. In doing so, a diagnosis of rupioid psoriasis was favored based on the histologic findings observed.

Associations of Rheumatoid Factor, Rheumatoid Arthritis, and Interleukin-6 Inhibitor with the Prognosis of Ischemic Stroke: a Prospective Multicenter Cohort Study and Mendelian Randomization Analysis.

Rheumatoid factor (RF), an established diagnostic biomarker for rheumatoid arthritis (RA), is associated with cardiovascular diseases, but its impact on clinical outcomes of ischemic stroke remains unclear. We aimed to investigate the observational associations between serum RF and prognosis of ischemic stroke, and further examined the genetic associations of RA and its therapeutic strategy, interleukin-6 (IL-6) inhibitor, with prognosis of ischemic stroke. We measured serum RF levels in 3474 Chinese ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke. The primary outcome was the composite outcome of death or major disability (modified Rankin Scale score ≥3) at 3 months after stroke onset. Mendelian randomization (MR) analyses were performed to examine the associations of genetically predicted RA and IL-6 inhibition with prognosis of ischemic stroke. During 3 months of follow-up, 866 patients (25.43%) experienced death or major disability. After multivariate adjustment, RF-positive was significantly associated with a high risk of primary outcome (OR, 1.47; 95% CI, 1.08-2.00; P =0.016) compared with RF-negative. The two-sample MR analyses suggested that genetically predicted RA was associated with an increased risk of primary outcome (OR, 1.09; 95% CI, 1.01-1.18; P=0.021), while genetically predicted IL-6 inhibition was associated with a decreased risk of primary outcome (OR, 0.88; 95% CI, 0.77-0.99; P=0.041). We found that positive RF was associated with increased risks of adverse outcomes after atherosclerotic ischemic stroke, and genetically predicted RA and IL-6 inhibition increased and decreased the risks of adverse outcomes after ischemic stroke, respectively.

Elevated serum soluble CD27 levels are associated with both disease activity and humoral immune activity in patients with rheumatoid arthritis.

To investigate the serum level of soluble CD27 (sCD27) and its potential clinical significance in rheumatoid arthritis (RA). Serum sCD27 levels in RA patients, idiopathic inflammatory myopathy (IIM) patients, systemic lupus erythematosus (SLE) patients and healthy controls (HCs) were detected by enzyme-linked immunosorbent assay. The medical information and laboratory data of the patients were collected. Serum sCD27 levels in RA patients with different clinical features were analysed, as was the correlation between the clinical data and serum sCD27 levels. Independent samples t test, the Mann-Whitney U-test or Wilcoxon signed-rank test, and Spearman correlation were used for statistical analysis. Levels of sCD27 were elevated in RA patients (3898 [2525, 5834] pg/mL) compared with IIM patients (2467 [1939, 3324] pg/mL) or HCs (1659 ± 648 pg/mL) (p 0.001). In addition, serum sCD27 levels correlated with age, erythrocyte sedimentation rate, C-reactive protein (CRP), rheumatoid factor (RF), immunoglobulin A, immunoglobulin G, complement 4 and disease activity score in 28 joints in RA patients. Levels of sCD27 were higher in RF-positive RA patients (6054 ± 5842 pg/mL) than in RF-negative patients (3902 ± 2098 pg/mL), and a similar finding was also observed in anti-cyclic citrullinated peptide (anti-CCP) antibody-positive (5810 ± 5671 pg/mL) and anti-CCP-negative (4183 ± 2187 pg/mL) RA patients. Serum ESR, RF, IgA, IgG levels and DAS28-CRP were elevated in RA patients with higher sCD27 levels than in those with lower sCD27 levels (p<0.01). Serum sCD27 might be a promising biomarker that reflects both disease activity and humoral immunity activity in RA.

Uveitis in spondyloarthropathies

Background: Uveitis is associated with several systemic disorders. It may be the initial presentation or manifestation of a systemic disease. It is the most common ocular complication and is sometimes the earliest manifestation of spondyloarthropathies. This study aimed to review the current literature on spondyloarthropathies and associated uveitis.&#x0D; Methods: A narrative review was performed using various combinations of the keywords spondyloarthropathies, seronegative spondylarthritis-related uveitis, and human leukocyte antigen-associated uveitis using PubMed/MEDLINE and Google Scholar from January 1, 2000, to September 30, 2022. We describe the disease mechanisms, genetics, and classification of spondyloarthropathies, the clinical patterns of their related ocular diseases, and the current modalities for the management of their ocular or systemic manifestations.&#x0D; Results: Seronegative spondyloarthropathies are a group of rheumatic disorders including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, inflammatory bowel disease-related spondyloarthropathy, juvenile-onset spondyloarthritis, and undifferentiated spondyloarthritis. These are characterized by enthesitis in the absence of serum rheumatoid factor and have a strong association with human leukocyte antigen B27. The clinical courses and features of spondyloarthropathies are remarkably diverse. Ocular inflammation is common in spondyloarthropathies, often precedes the onset or diagnosis of systemic disease, and responds well to topical therapy. Timely diagnosis of systemic diseases may improve quality of life and help avoid ocular and skeletal complications. Recurrence of ocular inflammation is frequent; on occasion, it may be associated with etanercept administration.&#x0D; Conclusions: Eye care professionals should be able to recognize spondyloarthropathies, manage ocular disease, and collaborate with related specialties for modification of systemic treatment if associated with ocular complications. Timely referral and early management could attenuate or prevent ocular or systemic morbidities associated with spondyloarthropathies.

Genetic variant in SPAG16 is associated with the susceptibility of ACPA-positive rheumatoid arthritis possibly via regulation of MMP-3

ObjectivesIn two previously published genome-wide association studies, a cluster of variants of sperm-associated antigen16 (SPAG16) were reported to be associated with the radiological progression rate of ACPA-positive rheumatoid arthritis (RA) patients from North American and Southern European ancestry. In this study, we aimed to investigate whether the reported RA-risk loci in SPAG16 are associated with the disease in the Chinese population and to further validate the functional role of the susceptible locus in RA tissues.MethodsA total of 500 ACPA-positive RA patients and 1000 age-matched healthy subjects were recruited. Two SNPs of SPAG16, including rs7607479 (C/T) and rs6435818 (A/C), were genotyped, and the genotyping data were compared with chi-square test. Gene expression analysis was performed in synovial tissues obtained from 40 RA patients and 30 non-RA controls surgically treated for bone fracture. The tissue expression of SPAG16 and matrix metalloproteinase 3 (MMP-3) was compared between the two groups by the Student’s t test. The relationship between serum indexes and mRNA expression of SPAG16 and MMP-3 were evaluated by Spearman’s correlation analysis.ResultFor rs7607479, the frequency of genotype TT was significantly higher in RA patients than in the controls (49.0% vs. 40.4%, p = 0.002). The RA patients were found to have significantly lower frequency of allele C than the controls (30.9% vs. 36.8%, p = 0.001). As for rs6435818, there was no significant difference of genotype or allele frequency between the two groups. The mRNA expression of MMP-3 was 1.63-fold higher in the RA patients than in the controls (p < 0.001). The expression of SPAG16 was comparable between the two groups (p = 0.43). The mRNA expression of MMP-3 was 1.39-fold higher in patients with genotype TT than in the patients with genotype CC (p = 0.006). The mRNA expression level of MMP-3 was significantly correlated with serum rheumatoid factor (r = 0.498, p < 0.001) and C-reactive protein (r = 0.272, p = 0.01), weakly correlated with erythrocyte sedimentation rate (r = 0.236, p = 0.09).ConclusionsWe validated a common genetic risk factor in ACPA-positive patients with RA, which is associated with the tissue production of MMP-3 and disease progression. Further functional analysis into the role of rs7607479 in MMP-3 expression can shed new light on the genetic architecture of ACPA-positive RA.

Spontaneous tendon rupture in a patient with systemic sclerosis: a case report

BackgroundSystemic sclerosis (SSc) is an incurable autoimmune disease characterized by progressive skin fibrosis and organ failure. Tenosynovitis is a common musculoskeletal manifestation, but tendon rupture has seldom reported in SSc.Case presentationWe present a rare case of a 49-year-old female with SSc who has suffered from bilateral tendon rupture of the fourth and fifth digits with positive antinuclear antibody (ANA) and anti-centromere B antibody, but negative rheumatoid factor in serum. In the extensor tendons of the patient’s hands, inflammation, edema, hypertrophy and tendon interruption were detected with ultrasound and magnetic resonance imaging(MRI). Tendon transfer repair surgery was performed and 10 mg/week methotrexate was then used in this patient. Her hand function was improved well with methotrexate and rehabilitation treatment postoperatively.ConclusionsEarly detection of tenosynovitis is necessary to prevent tendon rupture in SSc patients. Ultrasound and Magnetic Resonance Imaging appear to be useful examinations for evaluating tendon pathology for early detection.

Serum protein electrophoresis and rheumatoid factor analysis is an effective screening strategy for cryoglobulinaemia

Accurate serum cryoglobulin detection is important to allow prompt treatment but laboratory testing requires stringent pre-analytical conditions and has long turnaround times. Serum protein electrophoresis (EPG) for paraproteinaemia and rheumatoid factor (RF) analysis may offer an effective initial screening strategy for the presence of cryoglobulinaemia. We retrospectively assessed the sensitivity of ancillary EPG and RF testing for the presence of serum cryoglobulinaemia in 586 eligible cryoglobulin positive samples received at the Royal Prince Alfred and Liverpool Hospital immunopathology laboratories over an 11-year period. Ninety-one percent of all cryoglobulin positive samples had either a detectable paraprotein or RF activity, with greatest sensitivity for type I and type II cryoglobulins (97% and 98%, respectively). The sensitivity remained high irrespective of whether EPG and RF analysis was performed with the same, or different, pre-analytical collection conditions to the cryoglobulin collection (92% vs 90%, p=0.46). Only two patients with detected cryoglobulins and no associated paraprotein or RF activity had clinical features of cryoglobulinaemia and neither required treatment. This study demonstrates that serum EPG and RF analysis has high sensitivity for the detection of clinically relevant cryoglobulinaemia, even when not collected under ideal pre-analytical conditions, and potentially offers a prompt and effective screening strategy.

Bone resorption during therapy with denosumab in patients with rheumatoid arthritis, positive for the main immunological markers

Objective. Inflammation in rheumatoid arthritis (RA) leads to the development of local and generalized bone loss. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACCP) are believed to play a negative role in the radiological progression of RA. The use of such antiresorptive therapy as denosumab – monoclonal antibodies to RANKL (receptor activator of nuclear factor kappa-B ligand), reduces the activity of osteoclasts, increases bone mineral density (BMD), and also potentially affects the erosive process at RA. The aim of the study is to evaluate the effect of denosumab therapy on BMD and erosion count in patients with RA and osteoporosis (OP) in consideration of the positivity in the RF and ACCP in serum and the baseline RA activity. Materials and methods. The 12-month prospective study of the efficacy of denosumab therapy (60 mg subcutaneously every 6 months) in patients with RA and OP included 66 postmenopausal women; age – 59.4±7.5 years, duration of RA – 17.8±10.6 years, RF-positive – 47 (72%) patients, ACCP-positive – 48 (74%) patients. At baseline and after 12 months, dual-energy X-ray absorptiometry was performed with an assessment of BMD in the lumbar spine (L1– L4), proximal femur (hip neck and total hip), distal forearm; X-ray of the hands and distal parts of the feet in direct projection, followed by assessment of erosive-destructive changes according to the Sharp/van der Heijde method. Results. A significant increase in BMD was established in all studied sites of the skeleton despite the positivity of the RF and ACCP (for the hip neck p=0.05), while a significant increase in BMD in the RF- and ACCP-negative group was detected only in L1–L4 site. The progression of the increase in erosion count was noted in the RF- and ACCP-positive group while in the RF- and ACCP-negative group this indicator did not change. Regardless of the baseline activity of RA (by DAS28 (Disease Activity Score 28)) the BMD of most parts of the skeleton were stabilized. In patients with moderate RA activity, BMD increased significantly in L1–L4 in both groups: RF- and ACCP-positive and -negative , as well as in the total hip – in RF- and ACCP-positive group. The dynamics of the erosion count in RA patients did not depend on the baseline degree of DAS28 activity, no significant changes were detected in the analyzed groups. Conclusions. RF and ACCP positivity in serum in patients with RA and OP treated with denosumab did not have a negative effect on the dynamics of BMD, while the number of erosions increased. The baseline RA activity level did not affect the dynamics of the erosion count and the dynamics of BMD in most subgroups – BMD levels have been increased or stabilized.

Influence of periodontitis on levels of autoantibodies in rheumatoid arthritis patients: A systematic review.

Periodontitis (PD) is a dysbiotic disease of tooth-supporting structures that has been associated with various systemic diseases including rheumatoid arthritis (RA). To date, evidence demonstrated increased prevalence of RA among PD patients and postulated PD to have a role in the development of autoantibodies in RA patients. Therefore, a systematic review was conducted to assess the available evidence to ascertain the effect of PD on levels of autoantibodies in the serum, saliva and gingival crevicular fluid (GCF) of RA patients. The systematic review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Relevant literature was searched from PubMed, Web of Science, Scopus and Ebscohost databases from inception until 31 August 2020. The risk of bias in each study was determined based on the Newcastle-Ottawa Scale tool. Results from random-effect meta-analyses were presented as summary estimates of odds ratios (ORs) for seropositivity and standardised mean difference (SMD) of autoantibody levels with 95% confidence intervals. Sensitivity tests and meta-regression were performed to assess the robustness of the results and potential cause of heterogeneity. The electronic and manual searches gathered 932 articles. Following screening and full-text assessment, a total of 29 studies were included in the analysis. Twenty-eight published observational studies were included in the quantitative analysis in the form of random-effect meta-analysis which revealed that PD was associated with anti-citrullinated proteins autoantibodies (ACPAs) and Rheumatoid Factor (RF) seropositive RA patients (OR for ACPA seropositivity: 1.82; 95% CI: 1.13-2.93) (OR for RF seropositivity: 1.53; 95% CI: 1.05-2.24). Also, RA patients with PD had increased serum levels of ACPA and RF. However, high heterogeneity among studies' results, partially ascribed to the unstandardised case definition of PD and laboratory testing of autoantibodies. Apart from ACPA and RF in serum, studies which reported on other RA-related autoantibodies, as well as autoantibody levels in saliva and GCF were scarce. RA patients with PD tend to have greater ACPA and RF levels in their serum when compared with the RA patients without PD supporting the plausible role of PD in the development of systemic autoimmunity in RA patients.

Effects of low-level laser therapy and therapeutic ultrasound on Freund's complete adjuvant-induced knee arthritis model in rats.

The aim of this study was to evaluate and monitor the effect of low-level laser therapy (LLLT) and therapeutic ultrasound (TU) alone, or combined with intra-articular prednisolone (P) in Freund's complete adjuvant (FCA)-induced knee arthritis model in rats. A total of 56 adult male Wistar rats were divided into seven groups: control (C), disease control (RA), P, TU, LLLT (L), P + TU (P+TU), P + LLLT (P+L) groups. The skin temperature, radiography, joint volume, serum rheumatoid factor (RF), interleukin (IL)-1β, serum tumor necrosis factor-alpha (TNF-α), and histopathological evaluation of joint were performed. Thermal imaging and radiographic examination provided results consistent with the severity of the disease. The mean joint temperature (°C) was the highest in the RA (36.2±1.6) group on Day 28. The P+TU and P+L groups significantly decreased radiological scores at the end of the study. The rat serum TNF-α, IL-1β, and RF levels in all groups were significantly higher compared to the C group (p<0.05). Compared to the RA group, serum TNF-α, IL-1β, and RF levels were significantly lower in the treatment groups (p<0.05). The P+TU and P+L group was showed minimal chondrocyte degeneration and cartilage erosion and mild cartilage fibrillation and mononuclear cell infiltration of synovial membrane compared to the P, TU, and L group. The LLLT and TU effectively reduced inflammation. In addition, a more effective result was obtained from the use of LLLT and TU combined with intra-articular P. This result may be due to insufficient dose of LLLT and TU, thus further studies should be focus on at higher dose ranges on FCA arthritis model in rats.