Circulating fibroblast activation protein and dipeptidyl peptidase 4 in rheumatoid arthritis and systemic sclerosis.

AIM: To quantify circulating fibroblast activation protein (cFAP) and dipeptidyl peptidase 4 (cDPP4) protease activities in patients with rheumatoid arthritis (RA), systemic sclerosis (SSc), and a control group with mechanical back pain and to correlate plasma levels with disease characteristics. METHODS: Plasma was collected from patients with RA (n = 73), SSc (n = 37) and control subjects (n = 26). DPP4 and FAP were quantified using specific enzyme activity assays. RESULTS: Median cDPP4 was significantly lower in the RA group (P = 0.02), and SSc group (P = 0.002) compared with controls. There were no significant differences in median cFAP between the three groups. DPP4 and FAP demonstrated a negative correlation with inflammatory markers and duration of disease. There were no associations with disease subtypes in RA, including seropositive and erosive disease. Decreased cDPP4 was found in SSc patients with myositis. Plasma FAP was lower in RA patients receiving prednisone (P = 0.001) or leflunomide (P = 0.04), but higher with biologic agents (P = 0.01). RA patients receiving leflunomide also had decreased cDPP4 (P = 0.014). SSc patients receiving prednisone (P = 0.02) had lower cDPP4 but there was no association with cFAP. CONCLUSIONS: No association was found between cFAP and RA or SSc. Plasma DPP4 was decreased in RA and SSc when compared with controls. cDPP4 and cFAP correlated negatively with inflammatory markers and there were no significant correlations with disease characteristics in this RA cohort.

The role of 99mTc-labelled glucosamine (99mTc-ECDG) in the evaluation of rheumatic joint disease: a screening experience.

OBJECTIVES: We investigated the localization pattern of a novel imaging agent, (99m)Tc-labelled glucosamine (ECDG), in a variety of rheumatic conditions. MATERIALS AND METHODS: Sixteen patients were recruited into the study, with either active rheumatoid arthritis or osteoarthritis. (99m)Tc-ECDG was prepared in-house and patients received 400 MBq intravenously; thereafter, static images were acquired 15 min, 2 h and 4 h later, using a dual-head Siemens e-cam. Images were interpreted by an experienced physician for (a) accumulation of tracer at sites of known disease; (b) relative activity over time; (c) detection of subclinical disease; (d) detection of unrelated disease; and (e) distribution of tracer at involved joints. RESULTS: Optimal images were obtained by 2 h after injection in all patients. (99m)Tc-ECDG accumulated at all clinically known sites of disease. Uptake was most pronounced in the patients with active but untreated disease. Relative tracer activity at involved joints increased with time when compared with activity in the adjoining soft tissue, liver and cardiac blood pool. Focal uptake was seen with local pathology such as supraspinatus tendinitis. Tracer uptake correlated well with disease severity, and insignificant tracer accumulation was evident at sites with no documented disease. Tracer distribution in joints appeared to conform predominantly to the synovium in patients with rheumatoid arthritis, whereas it was articular in patients with degenerative joint disease. CONCLUSION: (99m)Tc-ECDG accumulates at sites of active rheumatic disease and is able to differentiate between synovial and bone uptake. This agent may have a role in the assessment and monitoring of rheumatic conditions.

Failure of anti-TNF therapy to reactivate previously septic prosthetic joints.

A patient with long-standing rheumatoid arthritis was admitted with Streptococcus pneumoniae septicaemia and bilateral septic knee joints. He was treated conservatively with intravenous antibiotics and arthroscopic washouts and discharged home on oral antibiotics. Six months posthospital discharge, following re-exacerbation of arthritis, an informed consent was given by the patient to continue antitumour necrosis factor therapy. After 5 years of observation, there has been no recurrence of sepsis and the rheumatoid arthritis remains in remission.

A preliminary investigation of cognitive function in rheumatoid arthritis patients on long-term methotrexate treatment.

Some studies suggest that cognitive function is impaired in rheumatoid arthritis patients. One possible influence may be commonly used rheumatoid arthritis treatment, methotrexate. This study examined cognitive function in long-term methotrexate users with rheumatoid arthritis and, using a 24-hour pre- and post-methotrexate dose administration, investigated whether there may be transient cognitive function changes. Rheumatoid arthritis patients (n = 35) were assessed immediately before taking methotrexate and 24 hours later. Low and high methotrexate dose groups were then compared. Cognitive performance was unchanged across two assessment points and was within the normal range, although lower in high methotrexate dose group.

Pseudohypercalcaemia in mixed cryoglobulinaemia (IgMkappa/polyclonal IgG): a rare complication of Sjögren's syndrome.

This is the first reported case of pseudohypercalcaemia associated with type 2 cryoglobulinaemia, secondary to primary Sjögren's syndrome. Pseudohypercalcaemia is an asymptomatic syndrome and does not require specific treatment. However, cryoglobulins have been demonstrated to bind to calcium, affecting the cryoprecipitability, and consequently, altering the pathogenicity of the cryoglobulins. This first report highlights potential for further research into this intriguing phenomenon.

Magnetic resonance imaging in Löfgren's syndrome: demonstration of periarthritis.

In Löfgren's syndrome, pain and swelling commonly involves the ankle joints. In this prospective case series, the magnetic resonance imaging findings of ankle joint involvement are described. Extensive subcutaneous and soft tissue oedema was commonly seen around the ankles. Bone, cartilage, ligaments and tendons were typically uninvolved. Small amounts of joint and tenosynovial fluid were present without evidence of synovial thickening or synovitis. The fluid is probably reactive to adjacent inflammation in the para-articular soft tissues and probably not representing a primary site of involvement. These findings demonstrate that the arthritis in Löfgren's syndrome stems primarily from periarthritis. This is consistent with prior descriptions using ultrasonography.

Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors.

OBJECTIVE: To confirm the prevalence of depression in a sample of rheumatoid arthritis (RA) patients; to identify the most significant predictors of depression in RA and to explore patients attitudes to medication in relation to depression. METHODS: A cross-sectional survey was used to collect data from 134 RA patients (77% female, 23% male). Participants were divided into depressed and nondepressed groups based on their scores on the Center for Epidemiological Studies-Depression (CES-D) scale. Discriminant analysis was conducted to identify the predictors that would best categorise patients into those two groups. RESULTS: Twelve predictors correctly classified 80% of patients into depressed or nondepressed groups. The strongest predictors of depression were high tension and low self-esteem followed by the perceived impact of RA, fatigue, passive coping, pain, and physical disability. Other predictors included medication effectiveness and importance as well as perceived lack of control over pain. CONCLUSION: Both physical and psychological factors have an impact on depression in RA. The key predictors identified in this study need to be considered within the regular RA management as possible cues to depression development.