Arthritis Syndrome Research Articles

Klebsiella–Candida arthritis model in Wistar rats

MATERIAL AND METHODS: This study was carried out on 20 male Wistar rats, of which 15 were injected with a bacterialfungal suspension into the cavity of the hock (tarsus) joint. Specifically, the rats were injected with KlebsiellaCandida suspension (1:1) with a microbial concentration of 106 CFU/ml prepared by using the museum strains Klebsiella pneumoniae ICIS-278 and Candida albicans ATCC 24433 under the control of an X-ray apparatus and digitizer FireCR+. Five intact animals served as the control. On day 15 of the experiment, a bacteriological and histological examination of the affected joints was carried out while maintaining topography after euthanasia.
 RESULTS: In rats infected with the KlebsiellaCandidiasis suspension, pain syndrome and functional changes typical of arthritis were noted on days 23. The bacteriological examination of the affected joints in 75% of rats isolated K. pneumonia cultures that were identical, according to polymerase chain reaction, to the original strain that was part of the bacterialfungal suspension. At the same time, fungi of the genus Candida, which was also used in the experiment to infect animals, were not detected in the affected joints of rats. The established model of KlebsiellaCandida arthritis was characterized by the pathomorphological signs of panarthritis accompanied by the purulent inflammation of all joint structures (synovial membrane, cartilage, and bone tissue) with the involvement of soft periarticular tissues.
 CONCLUSION: The model of Klebsiella and fungal arthritis presented by this work can be used to test new means of antimicrobial (antibacterial and antifungal) therapies, which are an integral component of the treatment of infection-associated arthritis.

Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai.

Pregnancy, complicated by coronavirus disease 2019 (COVID-19), results in higher hospitalization and mortality rate. Pathogenesis of COVID-19 is similar to any other systemic inflammatory condition but results in a cytokine storm ofhigher magnitude causing severe acute respiratory distress syndrome and multiorgan failure. Tocilizumab, a humanized monoclonal antibody, targets soluble and membrane-bound IL-6 receptors and is used in the treatment ofjuvenile idiopathic arthritis, rheumatoid arthritis, and cytokine release syndrome. However, studies exploring itsrole in pregnancy are minimal. Hence, this study was done to study the effect of tocilizumab on maternal and fetal outcomes incritical COVID-19 pregnant women. A retrospective study was conducted on 28 pregnant women with critical COVID-19 who received tocilizumab. Clinical status, chest x-ray, biochemical parameters, and fetal well-being were monitored and documented. The discharged patients were followed up through telemedicine. On treatment with tocilizumab, improvement was seen in thenumber of zones and patterns of chest x-ray, along with 80% reduction in the c-reactive protein (CRP) levels. Based on the WHO clinical progression scale, 20 patients improved by theend of first week, and by the end of first month, 26 patients became asymptomatic. Two patients died during thecourse of the disease.No fetal adverse effects were noted. Based on the encouragingresponse and as tocilizumab did not impartany adverse effects on the pregnancy, tocilizumab may be administered as an adjuvant to criticalCOVID-19 pregnant women in their second and third trimesters.

The Impact of Treatment with IL-17/IL-23 Inhibitors on Subclinical Atherosclerosis in Patients with Plaque Psoriasis and/or Psoriatic Arthritis: A Systematic Review.

Accumulating evidence considers psoriasis a systemic inflammatory disorder that is associated with comorbidities such as psoriatic arthritis, cardiovascular disease, and metabolic syndrome. Although the precise pathogenetic links between psoriasis and atherosclerosis warrants further investigation, it is believed that chronic systemic inflammation along with the T helper (Th)-1 and Th17 polarization are associated with endothelial dysfunction and subsequent acceleration of atherosclerosis. Considering the above, several studies have evaluated if optimal control of the inflammation in psoriasis by inhibiting interleukins targeting the Interleukin (IL)-23/Th17 axis could subsequently reduce the atherosclerotic process during anti-psoriatic treatment by using a variety of surrogate markers of subclinical atherosclerosis. This systematic review summarizes current knowledge on the pathogenetic mechanisms and diagnostic evaluation of atherosclerosis in the context of psoriasis and provides a systematic review of the literature on the impact of treatment with biologics targeting the IL-23/Th17 axis on subclinical atherosclerosis in patients with plaque psoriasis and/or psoriatic arthritis.

Description of novel capsule biosynthesis loci of Campylobacter jejuni clinical isolates from South and South-East Asia.

Campylobacter jejuni is a major cause of bacterial diarrhea worldwide and associated with numerous sequela, including Guillain-Barré Syndrome, inflammatory bowel disease, reactive arthritis, and irritable bowel syndrome. C. jejuni is unusual for an intestinal pathogen in its ability to coat its surface with a polysaccharide capsule (CPS). The genes responsible for the biosynthesis of the phase variable CPS is located in the hypervariable region of C. jejuni genome which has been used to develop multiplex PCR to classify CPS types based on the Penner serotypes. However, there still are non-typable CPS C. jejuni by the current multiplex PCR scheme. The application of the next generation sequencing and whole genome analysis software were used for the identification of novel capsule biosynthesis of C. jejuni isolates. Unique PCR primers were designed to identify these new capsule biosynthesis loci. The designed primers sets were combined in a new multiplex mix called epsilon. The unique sequences provide an additional information of the biosynthesis loci responsible for some of the common CPS sugars/residues such as heptose, deoxtyheptose and MeOPN among C. jejuni in this new group of CPS multiplex assay. This new primer complements the current C. jejuni multiplex capsule typing system and will help in identifying previously untypeable capsule locus of C. jejuni isolates.

Correlation of Serum Adiponectin Level with Insulin Resistance in Healthy Obese Individuals: A Case-control Study

Introduction: Obesity, emerging as a worldwide health burden having potential risk for development of atherosclerosis, diabetes, coagulopathy, arthritis and metabolic syndrome. Obesity is classified in terms of various anthropometric modalities like Body Mass Index (BMI), Waist Circumference (WC) and Waist Hip Ratio (WHR) etc. Adipocyte secretes adiponectin that has an important role in energy homeostasis and lipid metabolism. Adiponectin level reduces in obesity and its deficiency results in higher incidence of insulin resistance. Adiponectin has insulin sensitising, antiatherogenic and anti inflammatory properties. Aim: To compare the level of serum adiponectin, fasting plasma insulin and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) in healthy obese individuals with healthy non obese controls and also to find out the correlation of serum adiponectin with fasting plasma insulin level and HOMA-IR in healthy obese cases. Materials and Methods: This case-control study was conducted in Department of Biochemistry, MKCG MCH, Berhampur, Odisha, India, during the period of October 2019 to October 2020 which included 86 subjects. Of which 43 were healthy obese individuals and 43 were age and sex matched healthy non obese volunteers, in the age group of 20-45 years were taken as controls. About 4 mL of whole blood was collected to measure fasting plasma glucose, fasting plasma insulin and serum adiponectin. Statistical Package for the Social Sciences (SPSS) version 16.0 was used to do the statistical analysis and for correlation Pearson correlation test was done. Results: In present study, maximum cases and controls were within the range of 20-35 years. Out of 43 cases, 25 were males and 18 were females and out of 43 controls, 27 were males and 16 were females. Insulin resistance and Fasting Plasma Glucose were significantly higher in healthy obese cases as compared to controls. Serum adiponectin in cases (2.35±0.77) was found to be significantly lower than controls (8.10±2.98). Present study found statistically significant negative correlation of serum adiponectin with fasting plasma insulin (r=-0.918, p<0.001) and HOMA-IR (r=-0.934, p<0.001). Conclusion: Negative correlation of adiponectin and positive correlation of insulin resistance in obesity suggest inflammation which may lead to development of metabolic syndrome. So adiponectin is a target for future research to reduce morbidity and mortality in relation to obesity.

Practical Approach to Address Failed ACL Reconstruction Surgery

The causes of ACL reconstruction (ACLR) failure can be divided into 3 major categories. Non-anatomic tunnel placement has been the most widely stated technical error in ACL repair. A thorough medical history is necessary and crucial to determine the likely cause of failure in the initial surgery. As such, the medical history and physical examination should be evaluated. In addition, physical examination of the knee should be performed such as alignment of lower extremities, existence of varus and or valgus deformity, presence of contractures in flexion or extension and special tests to evaluate ACL. Moreover, imaging by radiography which includes anteroposterior, lateral, Merchant and Rosenberg views must be consider evaluating. Failure of an ACLR may not necessarily need revision surgery. Patients with bi/tri-compartmental arthritis or regional pain syndromes, those without recurring instability, those who live a sedentary lifestyle, or those who refuse to participate in post-operative rehabilitation may not be ideal candidates for revision ACLR. Patients with a failed ACL reconstruction commonly presenting with sign and symptoms of instability, stiffness, and pain. The choice of graft is critical to procedure’s success. In the revision setting, fixation is just as critical as graft selection. The aim of the revision surgery is to stabilize the knee joint, prevent further damage to the cartilage and the menisci, and allow the patient to resume normal daily and/or sports activities. A successful revision surgery requires accurate preoperative patient evaluation and knee imaging.

Assessment of complementary and alternative medicine methods in the management of ankylosing spondylitis, rheumatoid arthritis, and fibromyalgia syndrome.

A wide variety of musculoskeletal, arthritic, connective tissue, and vasculitic diseases fall under the umbrella of "rheumatic diseases". Ankylosing spondylitis, rheumatoid arthritis, and fibromyalgia syndrome are the three members of this disease group with relatively high prevalence. Pharmacological options are at the center of therapeutic algorithms in treating rheumatic diseases, particularly in reducing inflammation. Despite significant advances in pharmacological treatment in recent years, achieving complete treatment success in a group of patients is impossible. Therefore, patients with rheumatic diseases frequently utilize alternative treatment options, such as complementary and alternative medicine. Complementary and alternative medicine is a broad category of health practices not part of the leading health system. Patients with rheumatic diseases turn to complementary and alternative medicine for various reasons, including restricted access to some treatments due to high prices and rigorous regulations, worries about drug side effects, and symptoms that continue despite pharmacological treatment. In addition, because complementary and alternative medicine options are considered natural, they are frequently accepted as well tolerated and have few harmful effects. Ankylosing spondylitis, rheumatoid arthritis, and fibromyalgia syndrome are the primary foci of this comprehensive review. First, we attempted to summarize the non-traditional physical medicine and complementary and alternative medicine options that can be utilized to manage these diseases. Second, we addressed the link between exercise and inflammation in rheumatic diseases. We briefly discussed the possible benefits of exercise-based approaches. In addition, we highlighted the benefits of cooperation between rheumatology and physical medicine-rehabilitation clinics.

Detection and Identification of Avian Reovirus in Young Geese (Anser anser domestica) in Poland

Avian reovirus (ARV) is a cause of infections of broiler and turkey flocks, as well as waterfowl birds. This case report describes a reovirus detection in a fattening goose flock. GRV-infected geese suffer from severe arthritis, tenosynovitis, pericarditis, depressed growth, or runting-stunting syndrome (RSS), malabsorption syndrome, and respiratory and enteric diseases. GRV (goose reovirus) caused pathological lesions in various organs and joints, especially in the liver and spleen. GRV infection causes splenic necrosis, which induces immunosuppression, predisposing geese to infection with other pathogens, which could worsen the disease and lead to death. Our results showed that GRV was detected via RT-PCR and isolated in SPF (Specific Pathogen Free) embryos. This is the first report of the involvement of reovirus in arthritis, and the generalized infection of young geese in Poland, resulting in pathological changes in internal organs and sudden death. This study also provides new information about the GRV, a disease that is little known and underestimated.

MTORC1 links pathology in experimental models of Still’s disease and macrophage activation syndrome

Still’s disease is a severe inflammatory syndrome characterized by fever, skin rash and arthritis affecting children and adults. Patients with Still’s disease may also develop macrophage activation syndrome, a potentially fatal complication of immune dysregulation resulting in cytokine storm. Here we show that mTORC1 (mechanistic target of rapamycin complex 1) underpins the pathology of Still’s disease and macrophage activation syndrome. Single-cell RNA sequencing in a murine model of Still’s disease shows preferential activation of mTORC1 in monocytes; both mTOR inhibition and monocyte depletion attenuate disease severity. Transcriptomic data from patients with Still’s disease suggest decreased expression of the mTORC1 inhibitors TSC1/TSC2 and an mTORC1 gene signature that strongly correlates with disease activity and treatment response. Unrestricted activation of mTORC1 by Tsc2 deletion in mice is sufficient to trigger a Still’s disease-like syndrome, including both inflammatory arthritis and macrophage activation syndrome with hemophagocytosis, a cellular manifestation that is reproduced in human monocytes by CRISPR/Cas-mediated deletion of TSC2. Consistent with this observation, hemophagocytic histiocytes from patients with macrophage activation syndrome display prominent mTORC1 activity. Our study suggests a mechanistic link of mTORC1 to inflammation that connects the pathogenesis of Still’s disease and macrophage activation syndrome.

Arthroscopic Management of the Hamate Proximal Pole Arthrosis.

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed. An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01). Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.

Prevalence of Sarcopenic Obesity in Various Comorbidities, Diagnostic Markers, and Therapeutic Approaches: A Review.

The coexistence of sarcopenia and obesity characterizes sarcopenic obesity. In this condition, there is an imbalance between lean and fat mass amounts. It is a prevalent issue that is gaining prevalence among the elderly population. To evaluate the condition, allied health professionals may employ non-invasive diagnostic techniques, such as gait speed, skeletal muscle mass, and muscle strength. Nevertheless, early diagnosis and treatment of pathology are essential for preventing debilitating effects and providing the highest quality of care. This article reviews the prevalence of sarcopenic obesity in numerous medical conditions, such as cancer, arthritis, postoperative cases, diabetes mellitus, obesity, and metabolic syndrome. In addition, this paper aims to examine the available evidence regarding the prevalence of sarcopenic obesity in other conditions along with their diagnostic markers and therapeutic approaches.

Varespladib in the Treatment of Snakebite Envenoming: Development History and Preclinical Evidence Supporting Advancement to Clinical Trials in Patients Bitten by Venomous Snakes.

The availability of effective, reliably accessible, and affordable treatments for snakebite envenoming is a critical and long unmet medical need. Recently, small, synthetic toxin-specific inhibitors with oral bioavailability used in conjunction with antivenom have been identified as having the potential to greatly improve outcomes after snakebite. Varespladib, a small, synthetic molecule that broadly and potently inhibits secreted phospholipase A2 (sPLA2s) venom toxins has renewed interest in this class of inhibitors due to its potential utility in the treatment of snakebite envenoming. The development of varespladib and its oral dosage form, varespladib-methyl, has been accelerated by previous clinical development campaigns to treat non-envenoming conditions related to ulcerative colitis, rheumatoid arthritis, asthma, sepsis, and acute coronary syndrome. To date, twenty-nine clinical studies evaluating the safety, pharmacokinetics (PK), and efficacy of varespladib for non-snakebite envenoming conditions have been completed in more than 4600 human subjects, and the drugs were generally well-tolerated and considered safe for use in humans. Since 2016, more than 30 publications describing the structure, function, and efficacy of varespladib have directly addressed its potential for the treatment of snakebite. This review summarizes preclinical findings and outlines the scientific support, the potential limitations, and the next steps in the development of varespladib's use as a snakebite treatment, which is now in Phase 2 human clinical trials in the United States and India.

Elbow conditions: research priorities setting in partnership with the James Lind Alliance

ObjectiveTo undertake a UK-based James Lind Alliance (JLA) Priority Setting Partnership for elbow conditions and be representative of the views of patients, carers and healthcare professionals (HCPs).SettingThis was a national...

Antithyroid Arthritis syndrome: A rare side effect

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis.

To investigate the effects of yoga on depressive symptoms, anxiety, sleep quality, and mood of patients with rheumatic diseases through a systematic literature review with meta-analysis. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and the Cochrane recommendations and risk of bias tool. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Studies were selected using the PICOS (participants, intervention, comparison, outcome, and study) strategy. Searches were carried out until March 2022 and performed in Web of Science, PubMed, SportDiscus, Scopus, Cochrane, and EBSCO databases. Data were extracted to identify the differences between yoga and control and exercise groups and effect sizes. In total, 27 studies were included for qualitative analysis and 18 for meta-analysis. The studies found investigated yoga in patients with osteoarthritis, fibromyalgia, rheumatoid arthritis, and chronic fatigue syndrome. Regarding the risk of bias, the majority of studies showed a high risk or uncertain risk of bias in several criteria. Regarding the meta-analysis, yoga was favored to decrease depressive symptoms (standard mean difference [SMD]:-0.88; 95% confidence interval [CI]:-1.42; -0.34), anxiety (SMD: -0.51; 95% CI=-0.81 to -0.20), and improve sleep qualitySMD =-0.96; 95% CI=-1.36 to -0.56). No differences were found between yoga and other exercise modalities in depression (p < .01). Yoga is effective in improving depression, anxiety, and sleep quality of patients with rheumatic diseases. However, research in this field still needs further studies, because of methodological issues in the studies and a reduced number of studies conducted on each rheumatic disease and on the effects of yoga on each variable.

Pathogenic roles and diagnostic utility of interleukin-18 in autoinflammatory diseases.

Interleukin (IL)-18 is a pleiotropic, pro-inflammatory cytokine involved in the regulation of innate and adaptive immune responses. IL-18 has attracted increasing attention as a key mediator in autoinflammatory diseases associated with the development of macrophage activation syndrome (MAS) including systemic juvenile idiopathic arthritis and adult-onset Still’s disease. In these diseases, dysregulation of inflammasome activity and overproduction of IL-18 might be associated with the development of MAS by inducing natural killer cell dysfunction. Serum IL-18 levels are high in patients with these diseases and therefore are useful for the diagnosis and monitoring of disease activity. In contrast, a recent study revealed the overproduction of IL-18 was present in cases of autoinflammation without susceptibility to MAS such as pyogenic sterile arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome. The pathogenic and causative roles of IL-18 remain unclear in these autoinflammatory diseases. Further investigations are necessary to clarify the role of IL-18 and its importance as a therapeutic target in the pathogenesis of autoinflammatory diseases.

Estimating the willingness-to-pay to avoid the consequences of foodborne illnesses: a discrete choice experiment

Lost productivity is one of the largest costs associated with foodborne illness (FBI); however, the methods used to estimate lost productivity are often criticised for overestimating the actual burden of illness. A discrete choice experiment (DCE) was undertaken to elicit preferences to avoid six possible FBIs and estimate whether ability to work, availability of paid sick leave and health-related quality of life affect willingness-to-pay (WTP) to avoid FBI. Respondents (N = 1918) each completed 20 DCE tasks covering two different FBIs [gastrointestinal illness, flu-like illness, irritable bowel syndrome (IBS), Guillain–Barre syndrome (GBS), reactive arthritis (ReA), or haemolytic uraemic syndrome (HUS)]. Attributes included: ability to work, availability of sick leave, treatment costs and illness duration. Choices were modelled using mixed logit regression and WTP was estimated. The WTP to avoid a severe illness was higher than a mild illness. For chronic conditions, the marginal WTP to avoid a chronic illness for one year, ranged from $531 for mild ReA ($1412 for severe ReA) to $1025 for mild HUS ($2195 for severe HUS). There was a substantial increase in the marginal WTP to avoid all the chronic conditions when the ability to work was reduced and paid sick leave was not available, ranging from $6289 for mild IBS to $11,352 for severe ReA. Including factors that reflect productivity and compensation to workers influenced the WTP to avoid a range of FBIs for both acute and chronic conditions. These results have implications for estimating the burden and cost of FBI.

A 41-Year-Old Man With an Abdominal Mass and Hepatomegaly

A 41-Year-Old Man With an Abdominal Mass and Hepatomegaly

Assessment of MS-Score and HScore in timeliness of diagnosis of macrophage activation syndrome associated with adult-onset Still's disease

The data of 33 patients with adult-onset still's disease (AOSD)-associated macrophage activation syndrome (MAS) were retrospectively collected from January 2013 to December 2020 in Peking Union Medical College Hospital. Hemophagocytic lymphohistiocytosis (HLH)-2004 criteria, macrophage activation syndrome/juvenile idiopathic arthritis (MS-Score) and hemophagocytic syndrome diagnostic score (HScore) were used to diagnose AOSD-associated MAS, respectively. The time of diagnosis of AOSD-associated MAS by MS-Score was 19.0 (4.5, 31.0) days [M (Q1,Q3)] earlier than by HLH-2004 criteria, and 13.5 (0.5, 21.5) days earlier than by HScore (both P<0.05). The difference was not statistically significant between the time of diagnosis of AOSD-associated MAS by Hscore and by HLH-2004 criteria (P>0.05). There was significant difference among the three criteria (P<0.001). MS-Score can be used to diagnose AOSD-associated MAS earlier than HLH-2004 criteria, while the timeliness of HScore is not certain.

A Case of Chronic Diarrhea With Weight Loss

Question: A 46-year-old Caucasian man with a history of seronegative rheumatoid arthritis and Yao syndrome (NOD2-associated autoinflammatory disorder) presented for evaluation of watery diarrhea and unintentional weight loss of 15–20 pounds over 4 weeks. Over the course of his disease, he had been on various immunosuppressing agents including methotrexate, adalimumab, hydroxychloroquine, certolizumab pegol, leflunomide, sulfasalazine, mycophenolate mofetil, tofacitinib, upadacitinib, tocilizumab, rituximab, anakinra, canakinumab, and sarilumab.