Type Of Inflammatory Arthritis Research Articles

Diet affects inflammatory arthritis: a Mendelian randomization study of 30 dietary patterns causally associated with inflammatory arthritis.

The causal associations between dietary intake and the risk and severity of Inflammatory Arthritis (IA) are currently unknown. In this study, we aimed to investigate the causal relationship between nine dietary categories (30 types of diet) and IA using Mendelian randomization (MR). We analyzed data from 30 diets and IA in a genome-wide association study (GWAS). Single nucleotide polymorphisms (SNPs) that could influence the results of MR analyses were screened out through the Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test. SNPs were analyzed through two-sample bidirectional MR using inverse variance weighting, MR-Egger regression, and weighted median method. The multiplicity and heterogeneity of SNPs were assessed using MR-Egger intercept term tests and Cochran's Q tests. FDR correction was used to correct the p-values. IVW results showed that Beef intake [Odds ratio (OR) = 2.862; 95% confidence interval (CI), 1.360-6.021, p = 0.006, p_fdr < 0.05] was positively associated with rheumatoid arthritis(RA); Dried fruit intake (OR = 0.522; 95% CI, 0.349-0.781, p = 0.002, p_fdr < 0.05), and Iron intake (OR = 0.864; 95%CI, 0.777-0.960, p = 0.007, p_fdr < 0.05) were negatively associated with RA, all of which were evidence of significance. Fresh fruit intake (OR = 2.528. 95% CI, 1.063-6.011, p = 0.036, p_fdr > 0.05) was positively associated with psoriatic arthritis (PsA); Cheese intake (OR = 0.579; 95% CI, 0.367-0.914, p = 0.019, p_fdr > 0.05) was negatively associated with PsA; both were suggestive evidence. Processed meat intake (OR = 0.238; 95% CI, 0.100-0.565, p = 0.001, p_fdr < 0.05) was negatively associated with reactive arthritis (ReA), a protective factor, and significant evidence. All exposure data passed the heterogeneity check (Cochrane's Q test p > 0.05) and no directional pleiotropy was detected. Leave-one-out analyses demonstrated the robustness of the causal relationship in the positive results. Our study presents genetic evidence supporting a causal relationship between diet and an increased risk of IA. It also identifies a causal relationship between various dietary modalities and different types of IA. These findings have significant implications for the prevention and management of IA through dietary modifications.

P011 Time to diagnosis for different types of inflammatory arthritis

Abstract Background/Aims Timely diagnosis of inflammatory arthritis (IA) is crucial for optimising patient outcomes. However, it is appreciated that some types of inflammatory arthritis may be more challenging to diagnose as they present very differently. The National Early Inflammatory Arthritis Audit (NEIAA) provides the opportunity for rheumatology services to benchmark the care they provide. This project used NEIAA to investigate if there is a difference in time to diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA). Methods Lancashire and South Cumbria Foundation Trust (LSCFT) recruited patients diagnosed with an IA to NEIAA over a five-year period (May 2018 to March 2023). Information on demographics, duration of symptoms prior to referral, GP referral time and rheumatology waiting time were analysed. Results A total of 393 patients with either RA, PsA or AxSpA were included in the analysis. There was a higher proportion of patients from minority ethnic backgrounds in the AxSpA group. The ratio of female to male was &amp;gt;1 in RA and PSA but approximately 1:1 in AxSpA. The mean ages of patients in the RA, PsA and AxSpA groups were 60, 49 and 40 years, respectively. Table 1: Difference in time to diagnosis for the different types of IA, highlights the median time to diagnosis. Median was used due to outliers in data. Patients with AxSpA had the longest average duration of symptoms prior to presenting to the GP, with nearly 80% having symptoms for over a year. GP referral time was significantly shorter in the AxSpA group. Time to first rheumatology appointment was similar across the three groups. Conclusion There is a difference in time to diagnosis for the different types of IA. Further work is needed to understand why patients with AxSpA are presenting so late to their GP before being referred. We recognise the importance of exploring whether patients with AxSpA have been referred to other specialities or healthcare professionals. Investment in clinical triage and education sessions for primary care may help explain these results. More focus is needed on raising public awareness locally. Disclosure S. Jeyaratnam: None. S. Fish: None. S. Horton: None. A. Madan: None. C. Rao: None. E. MacPhie: None.

THE MULTIFUNCTIONAL ROLE OF HERBAL PRODUCTS IN THE MANAGEMENT OF GOUT (VATARAKTA): A COMPREHENSIVE REVIEW

Introduction: Vatarakta is a Vata Vyadhi that occurs due to exacerbated Vata and Rakta Dosha by their causa-tive factors. It can occur in the whole body but since joints of the hand and foot are more affected it resembles gouty arthritis as described in allopathic science. Gout is a disease described in conventional medicine that has similarities to the Vatarakta. It is a type of inflammatory arthritis that is triggered by the crystallization of uric acid within the joints and is often associated with hyperuricemia. Hyperuricemia can be caused by overproduc-tion of uric acid, or, more commonly by inefficient excretion by the kidneys. The clinical presentation of gout ranges from the typical episodic acute inflammation of the joint to chronic tophaceous gout, chronic polyarticular arthritis, urate nephrolithiasis, and interstitial nephropathies. Several herbal drugs are well known for their thera-peutic effects and lower toxicity and are important substances for new drug development. Objective: The objective of this systematic review was to explore and validate the efficacy of herbal medicines in the management of gout. This review aims to update some research findings regarding the biological activities of the herbal ingredients of Ayurvedic medicines used in gout and also to collect an adequate basis for the opti-mal integration of Ayurvedic medicines into the conventional health system (Allopath). Materials &amp; Methods: Systematic literature searches were carried out and the available information on Vatarak-ta and gout was collected via electronic search and a library search for articles published in peer-reviewed jour-nals and locally available books. Literature searches were also carried out to find the biochemical effects of vari-ous herbs mentioned in the management of hyperuricemia and gout. Conclusion: It has been demonstrated that plant-derived biochemicals have a potential effect on gout. These ef-fects comprise XOD inhibitory action, uricosuric, anti-inflammatory, anti-oxidant effects, etc. During the analy-sis of the literature available in Ayurveda, Allopathy, and related other branches of health science it was found that integrative medicine would be the optimal strategy to develop more effective agents in the treatment of gout (Vatarakta) and a combination of therapies may be very effective in reducing both the effect and frequency of disease.

Added value of high-resolution ultrasound and MRI in the evaluation of rheumatologic diseases.

Rheumatologic diseases are a widespread group of disorders affecting the joints, bones, and connective tissue, and leading to significant disability. Imaging is an indispensable component in diagnosing, assessing, monitoring, and managing these disorders, providing information about the structural and functional alterations occurring within the affected joints and tissues. This review article aims to compare the utility, specific clinical applications, advantages, and limitations of high-resolution ultrasound and magnetic resonance imaging in the context of rheumatologic diseases. It also provides insights into the imaging features of various types of inflammatory arthritis with clinical relevance and a focus on high-resolution ultrasound and magnetic resonance imaging. By understanding the comparative aspects of high-resolution ultrasound and magnetic resonance imaging, it is easier for the treating physicians to make informed decisions when selecting the optimal imaging modality for specific diagnostic purposes, effective treatment planning, and improve patient outcomes. The patterns of soft tissue and joint involvement; bony erosion and synovitis help in differentiating between various type of arthritis. Involvement of various small joints of the hands also gives an insight into the type of arthritis. We also briefly discuss the potential applications of emerging techniques, such as ultrasound elastography, contrast-enhanced ultrasound, and dual-energy CT, in the field of rheumatology.

The Role of Interleukin-22 in The Diagnosis and Evaluation of Disease Activity in Rheumatoid Arthritis

Background: Rheumatoid Arthritis (RA) is a chronic autoimmune disease that primarily affects small joints, resulting in joint inflammation, pain, and limited mobility. The identification of novel biomarkers specific to RA could enhance early diagnosis and treatment and also improve the monitoring of the disease activity and treatment response. In this study, the levels of IL-22 were measured in 133 patients with inflammatory arthritis using the ELISA method with the aim of assessing the diagnostic value of IL-22 in the diagnosis of RA and evaluating the disease activity. The findings revealed that serum IL-22 levels were significantly higher in RA patients compared to patients with other types of inflammatory arthritis. Additionally, positive correlations were observed between IL-22 and disease activity scores as determined by CDAI, DAS-28 ESR, and DAS-28 CRP. Notably, when IL-22 was used as a diagnostic tool, with a cut-off value of ≥ 26.9 pg/ml, it exhibited a sensitivity of 83%, specificity of 75%, and an AUC of 0.838. Furthermore, significant associations were found between IL-22 levels and the age of RA patients, while no significant correlations were observed with gender, BMI, and smoking index. It is noteworthy that IL-22 levels were significantly correlated with ESR, RF titer, and ACPA levels. Consequently, IL-22 can be regarded as a valuable biomarker for diagnosing RA and evaluating disease activity. Subjects and method: This cross-sectional study was conducted from September 2022 to January 2023, involving 133 patients with inflammatory arthritis, including RA and other forms of inflammatory arthritis. All patients were recruited from As-Sader Teaching Hospital in Najaf. The ages of the patients included in the present study range from 20 to 70 years, with a sample comprising 116 females and 17 males. Results: The higher median (IQR) value of IL-22 was observed among the RA patients [36.9 (28.6-63.7) pg/ml] compared to that of the other patients with inflammatory arthritis [23.6 (19.8-26.8) pg/ml]. The difference between the two groups of patients was highly significant (P &lt; 0.0001). Among the RA patients, a highly significant difference in the median (IQR) level of IL-22 was observed among the disease activity groups according to CDAI, DAS-28 ESR, and DAS-28 CRP (P &lt; 0.0001). Conclusion: Interleukin-22 can be regarded as a reliable biomarker for the diagnosis of RA and holds potential for assessing disease activity.

Ankle and Foot: Focus on Inflammatory Disease.

The ankle and foot have numerous bones and complex joints that can be affected by several types of inflammatory arthritis with different patterns and various radiologic signs, depending on the phase of the disease. Involvement of these joints is most frequently seen in peripheral spondyloarthritis and rheumatoid arthritis in adults and juvenile idiopathic arthritis in children. Although radiographs are a mainstay in the diagnostic process, ultrasonography and especially magnetic resonance imaging allow early diagnosis and are crucial diagnostic tools. Some diseases have typical features based on target populations (e.g., adults versus children, men versus women), but others may have overlapping imaging characteristics. We highlight key diagnostic features and describe appropriate investigations to guide clinicians toward the correct diagnosis and provide support during disease monitoring.

Common Anesthesia Challenges in a Case of Ankylosing Spondylitis Posted for the Correction of Spinal Deformity

Background: Ankylosing spondylitis (AS) is a type of inflammatory arthritis. Due to the rigid and brittle nature of spinal joints and multisystem involvement in the patients affected by ankylosing spondylitis, they are more prone to developing various complications. Different deformities require several surgical manipulations and perioperative anesthetic challenges, such as difficult intubation and positioning within the operating room. Case presentation: A 42-year-old man was diagnosed with ankylosing spondylitis, which has progressed over the last six years. He suffered from increasing pain and could not look forward, therefore; he has been scheduled for a corrective surgical procedure to address his spinal deformity to alleviate his pain and enhance the quality of his life by improving his functional abilities. Conclusion: Effective management of difficult airway cases with ankylosing spondylitis involving anatomical changes and reduced spinal mobility can be achieved by using awake fiberoptic-assisted nasal intubation. Intraoperative neuromonitoring and careful attention to proper positioning should be considered during the corrective spinal surgery to reduce complications.

Glucagon-Like Peptide 1 Receptor Agonists in Patients With Inflammatory Arthritis or Psoriasis: A Scoping Review.

Obesity is a proinflammatory state associated with increased disease severity in various types of inflammatory arthritis. Weight loss is associated with improved disease activity in certain forms of inflammatory arthritis such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA). We conducted a scoping review summarizing the literature evaluating the effect of glucagon-like peptide 1 (GLP-1) receptor agonists on weight and disease activity in patients with inflammatory arthritis or psoriasis. MEDLINE, PubMed, Scopus, and Embase were searched for publications evaluating the role of GLP-1 analogs in RA, PsA, psoriasis, axial spondyloarthritis, systemic lupus erythematosus, systemic sclerosis, gout, and calcium pyrophosphate deposition disease. Nineteen studies were included: 1 gout study, 5 RA studies (3 basic science, 1 case report, and 1 longitudinal cohort), and 13 psoriasis studies (2 basic science, 4 case reports, 2 combined basic science/clinical studies, 3 longitudinal cohorts, and 2 randomized controlled trials). No psoriasis study reported on PsA outcomes. Basic science experiments demonstrated weight-independent immunomodulatory effects of GLP-1 analogs through inhibition of the NF-κB pathway (via AMP-activated protein kinase phosphorylation in psoriasis and prevention of IκBα phosphorylation in RA). In RA, improved disease activity was reported. In psoriasis, 4 of 5 clinical studies demonstrated significant improvements in Psoriasis Area Severity Index and weight/body mass index with no major adverse events. Common limitations included small sample sizes, short follow-up periods, and lack of control groups. GLP-1 analogs safely cause weight loss and have potential weight-independent anti-inflammatory effects. Their role as an adjunct in patients with inflammatory arthritis and obesity or diabetes is understudied, warranting future research.

Regulatory T cells in psoriatic arthritis: an IL-17A-producing, Foxp3intCD161 + RORγt + ICOS + phenotype, that associates with the presence of ADAMTSL5 autoantibodies

In psoriatic arthritis (PsA), predisposing class I HLA alleles, the presence of synovial clonally proliferated CD8 + T cells and autoantibodies all point towards the loss of immune tolerance. However, the key mechanisms that lead to immune dysregulation are not fully understood. In other types of inflammatory arthritis, T regulatory cell (Treg) dysfunction and plasticity at sites of inflammation were suggested to negatively affect peripheral tolerance. We here addressed if Treg variances associate with psoriatic disease. We collected clinical data, sera and peripheral blood mononuclear cells from 13 healthy controls, 21 psoriasis and 21 PsA patients. In addition, we obtained synovial fluid mononuclear cells from 6 PsA patients. We studied characteristics of CD4 + CD25 + CD127loFoxp3 + Tregs by flow cytometry and used ELISA to quantify antibodies against ADAMTSL5, a recently discovered autoantigen in psoriatic disease. In comparison with their circulating counterparts, Tregs from inflamed joints express increased levels of ICOS, CTLA-4 and TIGIT. Furthermore, synovial fluid-derived Tregs have a distinct phenotype, characterized by IL-17A production and upregulation of CD161 and RORγt. We identified a subset of Tregs with intermediate Foxp3 expression as the major cytokine producer. Furthermore, ICOS + Tregs associate with PsA disease activity as measured by PASDAS. Lastly, we observed that presence of the Foxp3int Tregs associates with an increased abundance of anti-ADAMTSL5 autoantibodies. Tregs derived from the inflammatory environment of inflamed PsA joints exhibit a distinct phenotype, which associates with loss of peripheral immune tolerance in psoriatic disease.

S1978 A Rare Case of Leflunomide-Induced Colitis: Clinical, Endoscopic and Microscopic Findings

Introduction: Leflunomide-induced colitis is a rare entity, which can be difficult to diagnose. We present a case of an elderly woman with rheumatoid arthritis (RA) who complained of subacute diarrhea. Colonoscopy with biopsy was performed and investigation of inflammatory and infectious causes were negative. Cessation of leflunomide resolved diarrhea. A wide range of endoscopic findings and late-onset of symptoms makes this a challenging diagnosis. Our hope is to aid in the recognition of this drug-induced colitis to reduce hospitalization stays and improve treatment. Case Description/Methods: A 79-year-old female with a past medical history of RA, COPD and gout, presented to the hospital with 7 days of watery diarrhea. She reported more than 6 bowel movements daily. She denied recent sick contacts, travel, or changes in diet. Patient did not have a family history of inflammatory bowel disease or colorectal cancer. Vitals were stable. CT abdomen/pelvis demonstrated continuous wall thickening of the splenic flexure to rectum. Labs included CRP at 40.7, ESR at 58, and a positive fecal lactoferrin. Patient was empirically treated for infectious colitis with ceftriaxone and metronidazole. Stool cultures and C. difficile toxin were negative. Colonoscopy showed areas of congested and erythematous mucosa from the rectum to the transverse colon. Biopsies demonstrated increased lymphocytic infiltration of the lamina propria, thickened epithelial layer and crypts with increased intraepithelial lymphocytes. Upon further questioning, the patient reported starting leflunomide 2 months prior. She was asked to trial cessation of leflunomide upon discharge. Upon 2 week follow up, diarrhea had resolved. Discussion: Leflunomide is a disease modifying drug used to treat RA among other types of inflammatory arthritis. In approximately 20% of patients, adverse gastrointestinal side effects of abdominal pain, diarrhea and nausea are well recognized. However, drug-induced colitis has only been described in a few case reports, and even fewer endoscopic descriptions exist. Paucity of this diagnosis may be attributed to its nebulous presentation. Unlike most typical drug reactions, symptom onset can range from 18-24 months. As our case exemplifies, this can lead to unnecessary testing and prolonged hospital stays. Due to this patient's symptom improvement with supportive care, we opted for drug cessation. However, for severe colitis, steroids, cholestyramine wash, and biologics may be considered.

OA10 Sequential biologic usage in refractory psoriatic arthritis using ultrasound to detect psoriatic arthritis specific sub-clinical active disease

OA10 Sequential biologic usage in refractory psoriatic arthritis using ultrasound to detect psoriatic arthritis specific sub-clinical active disease

Safety and efficacy of probiotic supplementation in 8 types of inflammatory arthritis: A systematic review and meta-analysis of 34 randomized controlled trials.

ObjectiveTo evaluate Safety and efficacy of probiotic supplementation in inflammatory arthritis.MethodsThe literature on the treatment of inflammatory arthritis with probiotics has been collected in databases such as CNKI, Pubmed, Cochrane library, Embase, etc. The search time is for them to build the database until May 2022. The included literatures are randomized controlled trials (RCTs) of probiotics in the treatment of hyperuricemia and gout. The Cochrane risk assessment tool was used for quality evaluation, and the Rev Man5.3 software was used for meta-analysis.ResultsA total of 37 records were finally included, involving 34 RCTs and 8 types of autoimmune disease (Hyperuricemia and gout, Inflammatory bowel disease arthritis, juvenile idiopathic arthritis [JIA], Osteoarthritis [OA], Osteoporosis and Osteopenia, Psoriasis, rheumatoid arthritis (RA), Spondyloarthritis). RA involved 10 RCTs (632 participants) whose results showed that probiotic intervention reduced CRP. Psoriasis involved 4 RCTs (214 participants) whose results showed that probiotic intervention could reduce PASI scores. Spondyloarthritis involved 2 RCTs (197 participants) whose results showed that probiotic intervention improved symptoms in patients. Osteoporosis and Ostepenia involving 10 RCTs (1156 participants) showed that probiotic intervention improved bone mineral density in patients. Hyperuricemia and gout involving 4 RCTs (294 participants) showed that probiotic intervention improved serum uric acid in patients. OA involving 1 RCTs (433 participants) showed that probiotic intervention improved symptoms in patients. JIA involving 2 RCTs (72 participants) showed that probiotic intervention improved symptoms in patients. Inflammatory bowel disease arthritis involving 1 RCTs (120 participants) showed that probiotic intervention improved symptoms in patients. All of the above RCTs showed that probiotics did not increase the incidence of adverse events.ConclusionProbiotic supplements may improve Hyperuricemia and gout, Inflammatory bowel disease arthritis, JIA, OA, Osteoporosis and Osteopenia, Psoriasis, RA, Spondyloarthritis. However, more randomized controlled trials are needed in the future to determine the efficacy and optimal dosing design of probiotics.Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021286425, identifier CRD42021286425.

Treating ‘Septic’ With Enhanced Antibiotics and ‘Arthritis’ by Mitigation of Excessive Inflammation

Bacterial infection within the synovial joint, commonly known as septic arthritis, remains a clinical challenge as it presents two concurrent therapeutic goals of reducing bacterial burden and preservation of articular cartilage from destructive host inflammation. We hypothesized that mitigation of MRSA-induced inflammatory signaling could diminish destruction of articular cartilage in the setting of septic arthritis when used in conjunction with antibiotics. Herein, we provide evidence which supports a new therapeutic notion that concurrent antimicrobial therapy to address the ‘septic’ component of the disease with inflammation mitigation to manage the destructive ‘arthritis’ component. We established a murine model to mimic septic knee arthritis, as well as a variety of other inflammatory joint conditions. This murine septic arthritis model, in conjunction with in vitro and ex-vivo models, was utilized to characterize the inflammatory profile seen in active septic arthritis, as well as post-antibiotic treatment, via transcriptomic and histologic studies. Finally, we provided the clinical rationale for a novel therapeutic strategy combining enhanced antibiotic treatment with rifampin and adjuvant immunomodulation to inhibit post-infectious, excess chondrolysis and osteolysis. We identified that septic arthritis secondary to MRSA infection in our murine model led to increased articular cartilage damage compared to various types of inflammatory arthritis. The activation of the pERK1/2 signaling pathway, which is implicated with the mounting of an immune response and generation of inflammation, was increased in intracellular MRSA-infected synovial tissue and persisted despite antibiotic treatment. Trametinib, an inhibitor of ERK signaling through suppression of MEK1/2, alleviated the inflammation produced by the addition of intra-articular, heat-killed MRSA. Further, when combined with vancomycin and rifampin, mitigation of inflammation by pERK1/2 targeting improved outcomes for MRSA septic arthritis by conferring chondroprotection to articular cartilage and diminishing inflammatory osteolysis within bone. Our results support a new therapeutic notion that cell/biofilm-penetrating antibiotics alongside adjuvant mitigation of excessive intra-articular inflammation accomplish distinct therapeutic goals: reduction of bacterial burden and preservation of articular cartilage integrity.

COVID-19 in Patients with Psoriatic Arthritis

The COVID-19 pandemic has a negative impact on all aspects of human life and can lead to the exacerbation of chronic diseases. At the same time, it is known that a higher risk of infection and a more severe course of coronavirus infection is found in the elderly, as well as in people with serious comorbidities. Psoriatic arthritis (PsA) is a type of inflammatory arthritis that is often diagnosed in patients with psoriasis. Specific treatment of patients with chronic inflammatory joint disease include nonsteroidal anti-inflammatory drugs, glucocorticosteroids, disease-modifying antirheumatic drugs, new biological agents, including monoclonal antibodies to IL-6, IL-1, TNF-a, target disease modifying drugs. Medications used for PsA treatment can potentially have both negative and positive effects on the course of COVID-19. The objective: to analyze the features of COVID-19 in patients with PsA and to study the comorbid pathology after coronavirus infection. Materials and methods. The study involved 174 people with a verified diagnosis of PsA. Patients were divided into two groups. Group I included 112 (64.4%) persons who had COVID-19, and group II - 62 (35.6%) who had not had coronavirus infection at the time of first examination. Patients in group I significantly differed from group II in age (p &lt;0.001) and duration of PsA (p &lt;0.001), showed a significantly higher degree of psoriatic skin lesions and activity of the underlying disease (p = 0.001) compared to patients from group II. The participants of the study underwent examination characterize the course of the psoriatic disease and skin lesions and risk of cardiovascular disease. Results. To date, there are no clear scientific data that reveal the specific features of COVID-19 infection and the effect of antirheumatic therapy on the development of dangerous complications associated with coronavirus infection in patients with PsA. The analysis of comorbid pathology has found cardiovascular pathology in 67 (59.8%) of patients, including arterial hypertension – in 58 (51.8%) people, metabolic syndrome – in 34 (30.4%), diseases of the digestive system – in 32 (28.6%) and respiratory system – in 24 (21.4%) of persons. Conclusions. Patients with higher activity and duration of the PsA were significantly more likely to get COVID-19 and demonstrated higher total cardiovascular risk for the next 10 years. Further research is needed to study the impact of specific basic rheumatological drugs on the outcomes of COVID-19 and to analyze the broader effects of the pandemic on the course of psoriatic arthritis.

P109 Early diagnosis of inflammatory arthritis (IA) using machine learning analysis of GP referral letters and blood tests to improve pre-hospital referral triage

Abstract Background/Aims The diagnosis of inflammatory arthritis (IA) from referral letters is challenging. We aimed to develop a model integrating GP referral letter data and pre-referral blood test results (BTR) to identify clusters of patient phenotypes (characteristics) that predict at referral that patients will have any of three types of IA (rheumatoid arthritis, seronegative inflammatory arthritis and psoriatic arthritis) requiring early DMARD treatment. Methods The anonymised text of original GP referral letters of patients on our departmental DMARD monitoring database with diagnoses of IA was compared with referral letters of patients with other inflammatory rheumatological conditions (OICs) entered into the same database over the same period. We developed and used novel natural language processing (NLP) methods based on bidirectional encoder representations from transformers (BERT) to identify patients with IA and OICs for triage purposes. Results We have analysed 867 OIC patients and 267 IJD letters using our NLP methods. Data augmentation was used to address imbalance and small data challenges in this real-world application. Our method using only GP referral letters achieved overall accuracy (using confirmed diagnosis as the outcome) of 80% in identifying IJD and OCIs, reaching 86% sensitivity and 84% precision (reproducibility) at detecting OICs, compared with 71% sensitivity and 68% precision in detecting IA patients. Conclusion Our NLP methods alone identified OIC with &amp;gt;80% sensitivity and precision. In data science terms our NLP based method thus has high sensitivity for identifying a wide variety of OICs likely to need DMARD treatment. Our methodology may have great practical value if GP referral letters can be analysed at source. For high specificity and precision very large amounts of data are required to train the NLP model; we had many more OIC letters than IA letters available in analysable formats from other databases in our department. Analysable text of referral letters from primary care is currently difficult to obtain and performing NLP on photographs of referral letters in electronic patient records (EPRs) is a major challenge. These significant bottlenecks in NHS data systems must be removed to allow direct access and analysis of GP referral letters in the compatible format. BTR will be easier to analyse in the EPRs. Combined analysis of pre-referral NLP and BTR may increase the efficiency of automated triage of GP referrals with suspected early IA. Machine learning analysis of GP referrals potentially allows triage of the right patient into the right clinic first time, assisting demand management and capacity in stretched rheumatology clinics and improving patient experience by ensuring the right clinic appointment. Further work is underway to improve the precision of the system with a view to embedding this into our advanced Advice and Guidance triage process. Disclosure A. Bradlow: None. B. Wang: None. W. Li: None. E. Bazuaye: None. A.T.Y. Chan: Member of speakers’ bureau; UCB, Novartis, Sanofi, AbbVie, Celgene and Janssen.

Evaluation of cardiovascular autonomic function in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a type of inflammatory arthritis that affects people all over the world. RA is a chronic systemic inflammatory autoimmune disease. It primarily affects the joints and is frequently accompanied by extra-articular symptoms such as rheumatoid nodules, neuropathy, and normochromic normocytic anaemia. Objectives- The aim of this study was to evaluate cardiac autonomic function in patients with rheumatoid arthritis and compare with healthy individuals. An observational, cross-sectional study was done between 50 having RA &amp; 50 normal healthy subjects not on any medication, on both males &amp; females between the age group of 30-60 years. Evaluation of autonomic nervous system was done with the help of non-invasive tests. Parasympathetic system was assessed by heart rate response to standing &amp; heart rate response to lying down position. Sympathetic system was assessed by blood pressure response to standing, BP response to Valsalva Maneuverer &amp; BP response to sustained hand grip. In individuals with Rheumatoid Arthritis, the diastolic blood pressure in standing position was significantly lower(p&amp;#60;0.01) than control group. Other parameters showed non- significant changes in RA group compared to control group. Discussion- study confirmed autonomic dysfunction occurs in patient with rheumatoid arthritis. Therefore, autonomic function may be the part of routine clinical examination in RA to reduce the cardiovascular autonomic morbidity Cardiovascular autonomic function tests in daily clinical examination helpful in early detection of autonomic dysfunction in rheumatoid arthritis.

Advances of Genomic Medicine in Psoriatic Arthritis.

Psoriatic arthritis (PsA) is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Although early diagnosis is important for reducing the risk of irreversible structural damage, there are no adequate screening tools for this purpose, and there are no clear markers of predisposition to the disease. Much evidence indicates that PsA disorder is complex and heterogeneous, where genetic and environmental factors converge to trigger inflammatory events and the development of the disease. Nevertheless, the etiologic events that underlie PsA are complex and not completely understood. In this review, we describe the existing data in PsA in order to highlight the need for further research in this disease to progress in the knowledge of its pathobiology and to obtain early diagnosis tools for these patients.

Functions of 1,25-dihydroxy vitamin D3, vitamin D3 receptor and interleukin-22 involved in pathogenesis of gout arthritis through altering metabolic pattern and inflammatory responses.

BackgroundGouty arthritis (GA) is a common type of inflammatory arthritis. Recent studies demonstrated that 1,25-dihydroxy vitamin D3 (1,25(OH) 2 VD3) and vitamin D3 receptor (VD-R) play a protective role in acute inflammation, but interleukin-22(IL-22) promotes inflammation, especially for arthritis. However, our understanding of the responses of 1,25(OH) 2VD3 and IL-22 to gout was still unclear. Presently, in-depth metabolomics, bioinformatics and clinical characteristics analyses were performed to elucidate the pathogenesis and valuable clinical indicators of gouty arthritis.MethodsPeripheral venous blood was taken for investigation. The levels of IL-22 and 1,25(OH)2VD3 were determined in patient’s plasma via ELISA, and the mRNA levels of IL-22 and VD-R were measured via qRT-PCR. The interaction network of VD-R and IL22 were constructed by the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING), and the biological function of the related proteins were analyzed by Clusterprofiler Metabolomics were performed to decipher the metabolic variations of GA.ResultsThe levels of VD-R and 1,25(OH) 2 VD3 were identified to be low. What,s more, GA patients were reported to have high expression of IL-22. And IL-22 levels positively correlated with C-reactiveprotein (CRP) serum levels in the bivariate correlation analysis, whereas the level of 1,25(OH) 2VD3 negatively correlated with that of CRP. GO and KEGG analyses revealed that IL-22 and 1,25(OH) 2 VD3 were involved in stress immunity and inflammatory responses. These pathways are known to play a role in GA pathogenesis. Meanwhile, the metabolic profiles of GA serum showed that the increase in various amino acids and uric acid are involved in GA pathogenesis. Importantly, VD-R and IL22 closely correlated with the level of key metabolites uric acid, whose increase promoted the occurrence of GA.ConclusionGA patients have low levels of VD-R and 1,25(OH) 2 VD3, and high levels of IL-22 together with various amino acids and uric acid. The levels of IL-22 and 1,25(OH) 2VD3 were positively and negatively correlated with C-reactive protein (CRP) serum levels, respectively. Both IL-22 and 1,25(OH) 2 VD3 functioned in GA-related immune and inflammatory responses, and closely correlated with the level of GA-related uric acid. Overall, IL-22, VD-R and 1,25(OH) 2 VD3 play functionally important roles in inflammatory responses and are relevant to gout pathogenesis.

A proposed HLA-B*27 screening method for ankylosing spondylitis detection based on tag-single nucleotide polymorphisms: a preliminary study.

Ankylosing spondylitis (AS) is a type of inflammatory arthritis that affects primarily the spine. There is a strong association of the HLA-B*27 allele with AS pathogenesis, but recent studies have demonstrated the participation of ERAP1 gene in the genetic susceptibility. The aim of this study was to determine whether HLA-B tag-single nucleotide polymorphisms (SNPs) and ERAP1-related genetic variations associated with AS have equal or similarly performance in patients´ screening compared to HLA-B*27 standard genotyping in Mexican population. Genomic DNA from patients with AS and population-based controls from Mexico City was analyzed for five single nucleotide polymorphisms (SNPs): rs4349859, rs13202464, rs116488202, tagging HLA-B*27; and rs30187 and rs27044 in ERAP1 gene. TaqMan genotype assay method was used for SNPs genotyping. We found a significant association between AS and the heterozygote genotypes and minor alleles of the HLA-B*27 tag-SNPs, as well as for their haplotypes. With respect to ERAP1 polymorphisms, no significant associations were observed (p > 0.05). The sensitivity and specificity analysis showed values of 0.96 and 1.00 for the rs4349859 SNP, and 0.96 and 0.94 for the rs116488202 SNP, respectively, in detecting HLA-B*27 compared to the B27 test as the gold standard. HLA-B*27 tag-SNPs are associated with AS susceptibility; furthermore, the rs4349859 SNP by its own have an outstanding performance in detecting HLA-B*27 and therefore can be proposed as screening marker in the identification of HLA-B*27 in our population.

The CRTAC1 Protein in Plasma Is Associated With Osteoarthritis and Predicts Progression to Joint Replacement: A Large-Scale Proteomics Scan in Iceland.

ObjectiveBiomarkers for diagnosis and progression of osteoarthritis (OA) are lacking. This study was undertaken to identify circulating biomarkers for OA that could predict disease occurrence and/or progression to joint replacement.MethodsUsing the SomaScan platform, we measured 4,792 proteins in plasma from 37,278 individuals, of whom 12,178 individuals had OA and 2,524 had undergone joint replacement. We performed a case–control study for identification of potential protein biomarkers for hip, knee, and/or hand OA, and a prospective study for identification of biomarkers for joint replacement.ResultsAmong the large panel of plasma proteins assessed, cartilage acidic protein 1 (CRTAC1) was the most strongly associated with both OA diagnosis (odds ratio 1.46 [95% confidence interval 1.41–1.52] for knee OA, odds ratio 1.36 [95% confidence interval 1.29–1.43] for hip OA, and odds ratio 1.33 [95% confidence interval 1.26–1.40] for hand OA) and progression to joint replacement (hazard ratio 1.40 [95% confidence interval 1.30–1.51] for knee replacement and hazard ratio 1.31 [95% confidence interval 1.19–1.45] for hip replacement). Patients with OA who were in the highest quintile of risk of joint replacement, based on known risk factors (i.e., age, sex, and body mass index) and plasma CRTAC1 level, were 16 times more likely to undergo knee replacement within 5 years of plasma sample collection than those in the lowest quintile, and 6.5 times more likely to undergo hip replacement. CRTAC1 was not associated with other types of inflammatory arthritis. A specific protein profile was identified in those patients who had undergone joint replacement prior to plasma sample collection.ConclusionThrough a hypothesis‐free approach, we identified CRTAC1 in plasma as a novel promising candidate biomarker for OA that is both associated with occurrence of OA and predictive of progression to joint replacement. This biomarker might also be useful in the selection of suitable patients for clinical trial enrollment.