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1.
Gene ; 722: 144098, 2020 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-31494241

RESUMO

This study evaluated the possible association between SNPs in cytokines coding genes, namely IL10, IL6 and IFNG, cytokines serum levels and clinical assessment' scores in patients with Rheumatoid Arthritis(RA). SNPs genotyping was performed in 126 RA patients and 177 healthy individuals with Taqman probes specific for IL10 -1082 (T>C, rs1800896);INFG -1616 (A>G, rs2069705) and IL6 -174 (G>C, rs1800795) variants,positioned in regulatory regions. Cytokine Bead Array (CBA) was used to measure cytokine levels. We found association between INFG -1616 G allele(p = 0.0210; OR = 1.605) and INFG -1616 GG genotype (p = 0.0268; OR =2.609) and RA susceptibility. We also observed association between IL10 -1082 TT genotype and high clinical disease activity index (CDAI) values (p = 0.026; OR = 1.906; 95% CI = 1.082 - 3.359), IL10 -1082 CC genotype and low CDAI values (p = 0.016; OR = 0.256) and INFG -1616 AA and high CDAI values (p = 0.025; OR = 2.919). IL10 -1082 CC also exhibited the lowest IL-10 levels than IL10 -1082 TT (p = 0.020) and IL10 -1082 TC (p = 0.032). Finally, we verified higher IL-6 value in the RA patients than healthy control group (p = 0.007) and an association between high IL-6 levels and increased CDAI (r = 0.4648, p = 0.0015); DAS 28 (r = 0.3933, p= 0.0091), presence of bone erosions (r = 0.3170, p = 0.0361), ESR levels(r = 0.3041, p = 0.0448) and IFN-γ levels (r = 0.3049, p = 0.0468).Altogether, we suggest that IL10 -1082 (T>C, rs1800896) and INFG -1616(A>G, rs2069705) polymorphisms as well as IL-6 levels alterations may play a role for prognostic and disease follow-up.


Assuntos
Artrite Reumatoide/genética , Interferon gama/genética , Interleucina-10/genética , Interleucina-6/genética , Polimorfismo de Nucleotídeo Único , Adulto , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico , Feminino , Frequência do Gene , Genótipo , Humanos , Interferon gama/sangue , Interleucina-10/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade
2.
Wiad Lek ; 72(9 cz 1): 1676-1682, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31586982

RESUMO

Rheumatoid arthritis (RA) is a chronic, systemic connective tissue disease, characterized by progressive, destructive polyarthritis with internal organs involvement due to active, systemic inflammation. The onset of disease occurs usually in 4th or 5th decade of life. Since the general population is ageing, beginning of RA in older age is more and more common. The term elderly onset of rheumatoid arthritis (EORA) describes the disease with onset at age over 60. Several observational studies indicated, that proportion of women and men is comparable in EORA. Clinical course of the disease is characterized by sudden onset with general constitutional symptoms, high disease activity and inflammatory parameters. Involvement of large joints is more common, specially shoulder joints. Antibodies typical for RA (rheumatoid factor, anti-citrullinated peptide) are usually negative. More advanced destructive changes of joints and functional impairment are also characteristic for EORA patients in comparison with younger onset of RA (YORA). In clinical practice the use of methotrexate and biological drugs is less common, and glucocorticosteroids more common in EORA. Due to high RA activity, patients with EORA should be treated in the same way as YORA, with careful monitoring due to higher risk of adverse events associated with treatment.


Assuntos
Artrite Reumatoide/diagnóstico , Idade de Início , Idoso , Artrite Reumatoide/terapia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Inflamação , Masculino , Metotrexato/uso terapêutico
3.
Autoimmun Rev ; 18(11): 102391, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31520804

RESUMO

Over the last decade, many epigenetic mechanisms that contribute in the pathogenesis of autoimmune disorders have been revealed. MicroRNAs (miRNAs) are small, non-coding, RNA molecules that bind to messenger RNAs and disrupt the transcription of target genes. Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease in which a plethora of epigenetic changes take place. Current research on RA epigenetics has focused mainly on miRNAs. Genetic variance of some miRNA genes, especially miR-499, might predispose an individual to RA development. Additionally, altered expression of many miRNAs has been discovered in several cells, tissues and body fluids in patients with RA. MiRNAs expression also differs depending on disease's stage and activity. Serum miR-22 and miR-103a might predict RA development in susceptible individuals (pre-RA), while serum miR-16, miR-24, miR-125a and miR-223 levels are altered in early RA (disease duration <12 months) patients compared to established RA or healthy individuals. Moreover, serum miR-223 levels have been associated with RA activity and disease relapse. What is more, serum levels of several miRNAs, including miR-125b and miR-223, could be used to predict response to RA treatment. Finally, miRNA analogs or antagonists have been used as therapeutic regimens in experimental arthritis models and have demonstrated promising results. In conclusion, the research on the miRNA alterations in RA sheds light to several aspects of RA pathogenesis, introduces new biomarkers for RA diagnosis and treatment response prediction and offers the opportunity to discover new, targeted drugs for patients with RA.


Assuntos
Artrite Reumatoide/genética , MicroRNAs , Animais , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Humanos
4.
Z Rheumatol ; 78(8): 743-752, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31468168

RESUMO

Rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis are the most common chronic autoimmune rheumatic diseases. For all three diseases an early diagnosis and initiation of treatment is crucial. The proof of concept network study "Rheuma-VOR" is a further developed version of the predecessor project ADAPTHERA and was extended to several federal states. The aim of this prospective study is to improve the early diagnosis of rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis and thus positively impact the quality of care for patients with the help of multidisciplinary coordinating centers. To date 3710 disease-specific questionnaires from patients with the suspected diagnosis of rheumatoid arthritis, psoriatic arthritis or axial spondylarthritis from 1298 different primary care providers were registered in the multidisciplinary coordination centers. A total of 1958 appointments were made with 1 of the 53 participating rheumatology specialists. In 876 patients, 1 of the 3 rheumatic diseases was diagnosed in an early stage. The waiting period was on average 42.5 days depending on the federal state, which is well below the nationwide average. It should also be noted that the coordinated cooperation and risk stratification of the Rheuma-VOR coordination centers relieved the capacity of rheumatology specialists by 1281 appointments (34.5%). In addition, the 2­week Rheuma Bus Tour and the accompanying initiatives in Rhineland-Palatinate (Rheuma-VOR screening app and the triage consultation) are showing first promising positive results.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Doenças Reumáticas/diagnóstico , Reumatologia , Artrite Psoriásica/diagnóstico , Artrite Reumatoide/diagnóstico , Prestação Integrada de Cuidados de Saúde/normas , Diagnóstico Precoce , Humanos , Programas Nacionais de Saúde , Estudos Prospectivos , Reumatologia/organização & administração , Espondilartrite/diagnóstico
5.
Med. clín (Ed. impr.) ; 153(3): 106-111, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183432

RESUMO

Introducción y objetivo: Las personas con artritis reumatoide (AR) consideran el dolor como su principal problema. El objetivo del estudio fue evaluar la validez y sensibilidad al cambio de la escala de intensidad del dolor MOS en personas con AR. Pacientes y métodos: Se incluyeron 363 pacientes con AR. La consistencia interna fue valorada con el alfa de Cronbach, la validez de constructo se evaluó mediante el análisis factorial confirmatorio y con pruebas de hipótesis, la sensibilidad al cambio se evaluó mediante la respuesta media estandarizada y con prueba de hipótesis. Resultados: La escala presentó una consistencia interna apropiada (alpha=0,89). El análisis factorial confirmatorio demostró que la escala es unidimensional. La escala MOS presentó una fuerte correlación (rho=0,86) con la escala visual analógica. La validez convergente se demostró al aceptar el 83% de las hipótesis realizadas a priori. La respuesta media estandarizada para la escala MOS fue de 0,33 y de 0,21 para la escala visual analógica, el cambio de la intensidad del dolor de las escalas se correlacionaron fuertemente lo cual apoya su sensibilidad al cambio. Conclusión: La escala de intensidad del dolor MOS es un instrumento válido para medir la intensidad del dolor y el alivio del dolor


Introduction and objective: Patients with rheumatoid arthritis (RA) consider pain to be their main problem. The goal of this study was to evaluate validity and sensitivity to change to measure pain intensity using the MOS scale in RA patients. Patients and methods: Three hundred sixty-three RA subjects were included. Internal consistency of the instrument was assessed with Chronbach́s alpha, construct validity was estimated with confirmatory factor analysis and hypothesis testing and sensitivity to change was evaluated with the standard response mean and hypothesis testing. Results: The MOS scale showed an appropriate internal consistency (alpha=0.89) and confirmatory factor analysis revealed it to be a unidimensional scale. In addition, the MOS scale was strongly correlated (rho=0.86) with the visual analogue scale. Convergent validity was demonstrated with the acceptance of 83% of hypotheses a priori. MOS scale standard response mean was 0.33 and 0.21 for the visual analogue scale, pain intensity changes in scales were strongly correlated, supporting its sensitivity to change. Conclusion: MOS scale is a useful instrument to measure pain intensity as well as pain relief


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Medição da Dor/métodos , Artrite Reumatoide/diagnóstico , Inquéritos Epidemiológicos , Análise Fatorial , Manejo da Dor , Estudos Transversais , Inquéritos e Questionários , Escala Visual Analógica
6.
Egypt J Immunol ; 26(1): 163-175, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31333006

RESUMO

Rheumatoid arthritis (RA) is one of the most common systemic autoimmune diseases. New markers are needed for early diagnosis of RA as seronegativity in both early and established RA remains a major limitation of both anticitrullinated protein antibodies (ACPA) and rheumatoid factor (RF). The 14-3-3η protein may represent a novel biomarker for the detection of RA. We evaluated the diagnostic performance of serum 14-3-3η protein in early and established cases of rheumatoid arthritis and we compared the diagnostic accuracy of it with those of the well-known RA markers (e.g. RF and ACPA). Sera from 50 patients with RA (20 early and 30 established) based on the 2010 ACR / EULAR Rheumatoid Arthritis Classification Criteria, 15 patients with non-RA arthritis as diseases control group (8 patients with OA and 7 patients with SLE) and 14 healthy controls were enrolled in the study. Serum RF was determined by latex, ACPA and 14-3-3η protein were determined by ELISA. Serum 14-3-3η protein levels in patients with RA were significantly higher (P=0.001*) as compared to healthy individuals. For serum 14-3-3η diagnostic accuracy in RA; Receiver operating characteristic curves (ROC) analysis comparing patient with RA with healthy control showed AUC (0.916) at optimum cutoff of > 2.5ng/mL, and a sensitivity of 100%, a specificity of 78.57%, a PPV of 94.3, and an NPV of 100. No significant difference in 14-3-3η protein serum levels was found between early and established RA groups. It was positive in 100% of early and established RA patients who were seronegative for RF and ACPA. It is concluded that, 14-3-3η protein could improve the sensitivity of RA diagnosis and cover the shortage of detection of RF and ACPA in RA patients.


Assuntos
Proteínas 14-3-3/sangue , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Humanos , Curva ROC , Fator Reumatoide , Sensibilidade e Especificidade
7.
Medicina (B Aires) ; 79(3): 161-166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31284249

RESUMO

Rheumatoid arthritis is a clinical autoimmune syndrome that causes joint damage. The positive or negative anti-cyclic citrullinated protein (CCP) antibodies serodiagnosis differentiates two subsets of the disease, each with different genetic background. Previous studies have identified associations between KIR genes and rheumatoid arthritis but not with anti-CCP serodiagnosis. Therefore, we investigated the proportion of patients seropositive and seronegative to anti-CCP and its possible association with KIR (killer cell immunoglobulin-like receptor) genes. We included 100 patients with rheumatoid arthritis from western Mexico, who were determined for anti-CCP serodiagnosis by ELISA, and 16 KIR genes were genotyped by PCR-SSP. The proportion of seropositive anti-CCP patients was 83%, and they presented a higher frequency of KIR2DL2 genes than the seronegative group (73.6% vs. 46.2%, p = 0.044) which, in turn, presented a higher KIR2DL2-/KIR2DL3+ genotype frequency than the first ones (46.2% vs. 17.2%, p = 0.043). These results suggest different KIR genetic backgrounds for each subset of the disease according to anti-CCP serodiagnosis.


Assuntos
Artrite Reumatoide/diagnóstico , Autoanticorpos/sangue , Receptores KIR2DL2/genética , Adulto , Idoso , Artrite Reumatoide/sangue , Artrite Reumatoide/genética , Autoanticorpos/genética , Feminino , Genótipo , Humanos , Masculino , México , Pessoa de Meia-Idade , Fator Reumatoide/sangue
8.
Z Rheumatol ; 78(8): 713-721, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31273459

RESUMO

BACKGROUND: The objective of the research consortium PROCLAIR was to gain population level knowledge on the treatment of patients with rheumatoid arthritis (RA), axial spondylarthritis (axSpA) and osteoarthritis (OA) in Germany. AIMS: A main question of the consortium was whether it is possible to identify groups of people who were exposed to a particular risk of undersupply or oversupply of treatment. In addition, the study investigated the validity of claims data for these diseases as a basis for further studies. PATIENTS AND METHODS: Cross-sectional surveys were carried out among insurees of the BARMER statutory health insurance fund whose claims data included RA, axSpA and OA diagnoses. The questionnaire data were linked with the claims data of the insured persons if they agreed. RESULTS: In all three diseases risk groups for care deficits could be identified. Persons with RA who are not treated by a specialist have less access to drug treatment. Physical therapy is prescribed for all three diagnoses at a low level, even for people undergoing joint replacement surgery. A connection between depressive symptoms and disease activity or function in axSpA was shown. In addition to the results relevant to care, the PROCLAIR network has also made contributions to critically assess the quality of health insurance data. DISCUSSION: The combination of billing data with survey data enables a comprehensive description of the treatment of musculoskeletal diseases. Particularly relevant factors are the specialization of the physician, sociodemographic parameters of the patients and the region of residence. In particular, access to treatment cannot be investigated in randomized clinical trials.


Assuntos
Artrite Reumatoide , Osteoartrite , Espondilartrite , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Produtos Biológicos/uso terapêutico , Estudos Transversais , Alemanha , Humanos , Osteoartrite/diagnóstico , Osteoartrite/terapia , Modalidades de Fisioterapia , Espondilartrite/diagnóstico , Espondilartrite/terapia , Inquéritos e Questionários
9.
Z Rheumatol ; 78(7): 660-669, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31165251

RESUMO

BACKGROUND/OBJECTIVE: The majority of patients in Germany miss out on the necessity of early diagnosis and initiation of therapy for rheumatoid arthritis (RA) caused by considerable structural deficits in the health care system. The challenge is to reconcile the individual demand for the best possible therapy result with a sustainable expenditure of resources. METHODS: The cross-sectoral regional care network ADAPTHERA aims to improve early RA diagnosis and treatment in Rhineland-Palatinate. The retrospective triage analyses of suspected early onset RA patients was performed by tracing the selection process of all available enquiries (n = 1045). For analysis of the clinical course of the disease, a subset comprising 143 patients with a minimum observation time of 12 months (5 consecutive visits) was available. Clinical and laboratory parameters were collected quarter yearly, self-administered questionnaires were filled out and the treatment was adapted if necessary. RESULTS: A total of 454 patients were included. The mean waiting time was 23.9 (SD = 18) days. The mean observation period in the subcohort was 29.2 (SD = 12.7) months, with about 50% of the patients presenting within 3 months. Almost 75% of the patients were in remission after 2 years. A sustained remission could be described for 74.8% (6 months) and 53.5% (12 months), respectively. Especially patients with rapid remission induction benefited in terms of longer remissions (p = 0.03). A very early stage of the disease (VERA) was associated with a rarely necessary biologic therapy (p = 0.022). DISCUSSION: The approach of a supply network is not a panacea, but it might improve healthcare for patients with early onset RA. In order to minimize resource utilization, a pinpoint referral and accurate triage of potential cases are crucial.


Assuntos
Antirreumáticos , Artrite Reumatoide , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Prestação Integrada de Cuidados de Saúde , Alemanha , Humanos , Indução de Remissão , Estudos Retrospectivos , Resultado do Tratamento
10.
Analyst ; 144(11): 3613-3619, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31070614

RESUMO

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic joint inflammation and one of the main causes of chronic disability worldwide with high prevalence in the ageing population. RA is characterized by autoantibody production, synovial inflammation and bone destruction, and the most accepted biomarker is rheumatoid factor (RF) autoantibodies. In this work, we developed a low-cost approach for the detection and quantification of the RF marker. This colorimetric immunosensor is based on gold nanoprobe crosslinking that results in extensive aggregation in the presence of the pentameric IgM RF. Aggregation of the nanoconjugates yields a color change from red to purple that can be easily observed by the naked eye. The interaction between nanoconjugates and the specific target was confirmed via dynamic light scattering (DLS), Raman spectroscopy and atomic force microscopy (AFM) imaging. This conceptual system shows a LOD of 4.15 UA mL-1 IgM RF (clinical threshold is set for 20 IU mL-1). The one-step biosensor strategy herein proposed is much faster than conventional detection techniques, without the need for secondary antibodies, additional complex washing or signal amplification protocols. To the best of our knowledge this is the first report on target induced aggregation of gold nanoprobes for quantitative colorimetric autoantibody detection.


Assuntos
Artrite Reumatoide/diagnóstico , Ouro/química , Imunoglobulina M/sangue , Nanopartículas Metálicas/química , Fator Reumatoide/sangue , Artrite Reumatoide/imunologia , Biomarcadores , Técnicas Biossensoriais/métodos , Colorimetria/métodos , Humanos , Fragmentos Fc das Imunoglobulinas/imunologia , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Limite de Detecção , Tamanho da Partícula , Fator Reumatoide/imunologia
11.
Immunol Med ; 42(1): 29-38, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31067155

RESUMO

The aim of this study was to assess abatacept in rheumatoid arthritis (RA) patient. Patients (20 men, 89 women, aged 61.9 ± 10.4 y) who responded inadequately to conventional synthetic disease-modifying anti-rheumatic drug were treated with abatacept for 24-months. Disease activity score in 28 joints (DAS28-CRP) was evaluated. Of 109 patients, 82 (75.2%) were on methotrexate (MTX; mean dosage 9.0 ± 2.7 mg/week); 48 (44.0%) were naive to biologics and 61 (56.0%) had failed biologics. The 1- and 2-year retention rates were 77% and 53%, respectively. At 24-months, the DAS28-CRP remission rates were 54.5% in the biologic-naïve patients, and 28.2% in the biologic-failure patients (p < .01), while the structural remission rates were 83.9% and 73.1%, respectively (p = .461). Abatacept was equally effective in RA patients who were and were not on concomitant MTX. Biologic-naïve was associated with better clinical outcome. Abatacept was effective in patients who showed decreasing anti-CCP antibody titers or serum MMP-3 levels during treatment. Infection was the most frequent adverse effect of abatacept therapy. In conclusion, abatacept is more effective in biologic-naïve than in biologic-failure RA patients with or without concomitant use of MTX. Abatacept is more effective in RA patients with than without decreasing serum MMP-3 or anti-CCP antibody titers during treatment.


Assuntos
Abatacepte/administração & dosagem , Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Imunossupressores/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/diagnóstico , Grupo com Ancestrais do Continente Asiático , Biomarcadores/sangue , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Metaloproteinase 3 da Matriz , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Indução de Remissão , Resultado do Tratamento
12.
Drug Discov Ther ; 13(2): 96-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080209

RESUMO

Oligoarticular arthritis (inflammation of upto 4 joints) has a wide range of infectious and non-infectious etiologies. The aim of our study was to identify the features which could help in the differentiation of infectious from non-infectious arthritis. The study was prospective and observational, and included 100 patients with oligoarticular inflammatory arthritis. The final diagnosis was made using standard diagnostic criteria and the patients were categorized into infectious and non-infectious groups. Among the 100 patients who were recruited, the following final diagnosis were made: peripheral spondyloarthritis (n = 37), axial spondyloarthritis (n = 11), tuberculosis (n = 19), brucellosis (n = 6), septic arthritis (n = 6), gouty arthritis (n = 5), early rheumatoid arthritis (n = 5), non-tubercular mycobacteria (n = 2), SLE (n = 2), post-chikungunya arthritis (n = 2), acute lymphocytic leukaemia (n = 1), pachydermoperiostosis (n = 1), sarcoidosis (n = 1) and juvenile idiopathoic arthritis (n = 1). The patients were categorized into two groups: infectious (33) and non-infectious (60). The presence of monoarthritis, clinically-significant weight loss, hepatomegaly, splenomegaly and erosive arthritis were significantly more common in the infectious group as compared to the non-infectious group.


Assuntos
Artrite Infecciosa/epidemiologia , Artrite/classificação , Doenças não Transmissíveis/epidemiologia , Adolescente , Adulto , Artrite/diagnóstico , Artrite Gotosa/diagnóstico , Artrite Gotosa/epidemiologia , Artrite Infecciosa/diagnóstico , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Brucelose/diagnóstico , Brucelose/epidemiologia , Feminino , Humanos , Índia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sarcoidose/epidemiologia , Espondilartrite/diagnóstico , Espondilartrite/epidemiologia , Centros de Atenção Terciária , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto Jovem
13.
Scand J Rheumatol ; 48(4): 271-278, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31135239

RESUMO

Objective: To identify predictors of sick leave and improved worker productivity in patients with early rheumatoid arthritis (RA) treated for 52 weeks with intensive combination strategies. Methods: Patients with early RA were included in the COmbinatietherapie Bij Reumatoïde Artritis (COBRA)-light trial and followed for 52 weeks. As the COBRA-light strategy proved to be non-inferior to the COBRA strategy, all patients were pooled. Predictors for sick leave and improved worker productivity were assessed through a 3 month time-lag multivariable logistic generalized estimating equations model. Results: At baseline, 97 patients had a paid job, 59 had no job, and for six patients the work status was unknown. During the trial, 13 patients stopped working (8%) and six started working (4%). Only sick leave in the past 3 months predicted sick leave. By excluding this variable, patient global assessment and actual hours of sick leave became predictors. Increased worker productivity was predicted by higher patient global assessment levels, Sharp van der Heijde score ≥ 1, actual hours on sick leave, and higher worker productivity in the past 3 months. Conclusion: Sick leave and improved worker productivity were mainly predicted by non-disease-specific variables. Both outcomes can be predicted on a 3 month basis, using the outcome over the past 3 months for the next 3 months. By applying this model in daily practice, decisions for therapy change could be based not solely on disease activity but also taking into account a possible high risk for sick leave in the upcoming 3 months.


Assuntos
Antirreumáticos , Artrite Reumatoide , Licença Médica/estatística & dados numéricos , Adulto , Antirreumáticos/classificação , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/fisiopatologia , Avaliação da Deficiência , Quimioterapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Prognóstico , Desempenho Profissional/estatística & dados numéricos
14.
ScientificWorldJournal ; 2019: 6940401, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31015823

RESUMO

Objective: The aim of this study is to demonstrate if routine assessment of patient index data 3 has a correlation with disease's activity as much as disease activity score 28, clinical disease activity index, and simplified disease activity index in Ecuadorian patients with rheumatoid arthritis seen in Unidad de Enfermedades Reumáticas y Autoinmunes [UNERA] from December 2016 to December 2017. Methods: This is a retrospective study in 200 patients that fulfill the American College of Rheumatology 2010 criteria for diagnosis of rheumatoid arthritis. The patients were evaluated from December 2016 to December 2017. Descriptive analyses were carried out, also Pearson correlation was used, and, to give a better clinical significance, a chi-square test was conducted. Whenever assumptions of chi-square test were violated, a Fisher's exact test was reported. Results: RAPID3 correlated best with DAS28 (r.83, p < 0.001), followed by CDAI (r.80, p < 0.001) and then SDAI (r.77, p < 0.001). Conclusion: RAPID3 is a questionnaire that only takes 10 seconds to calculate and correlates in a significant way with traditional clinical measures that require more time to perform, saving time in busy health facilities.


Assuntos
Artrite Reumatoide/epidemiologia , Índice de Gravidade de Doença , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão
15.
EBioMedicine ; 42: 76-85, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30952617

RESUMO

BACKGROUND: Autoimmune disease prevention requires tools to assess an individual's risk of developing a specific disease. One tool is disease-associated autoantibodies, which accumulate in an asymptomatic preclinical period. However, patients sometimes exhibit autoantibodies associated with a different disease classification. When and how these alternative autoantibodies first appear remain unknown. This cross-sectional study characterizes alternative autoimmunity, and associated genetic and environmental factors, in unaffected first-degree relatives (FDRs) of patients, who exhibit increased future risk for the same disease. METHODS: Samples (n = 1321) from disease-specific autoantibody-positive (aAb+) systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and type 1 diabetes (T1D) patients; and unaffected aAb+ and autoantibody-negative (aAb-) SLE and RA FDRs were tested for SLE, RA, and T1D aAbs, as well as anti-tissue transglutaminase, anti-cardiolipin and anti-thyroperoxidase. FDR SLE and RA genetic risk scores (GRS) were calculated. FINDINGS: Alternative autoimmunity occurred in SLE patients (56%) and FDRs (57·4%), RA patients (32·6%) and FDRs (34·8%), and T1D patients (43%). Expanded autoimmunity, defined as autoantibodies spanning at least two other diseases, occurred in 18·5% of SLE patients, 16·4% of SLE FDRs, 7·8% of RA patients, 5·3% of RA FDRs, and 10·8% of T1D patients. SLE FDRs were more likely to have alternative (odds ratio [OR] 2·44) and expanded (OR 3·27) autoimmunity than RA FDRs. Alternative and expanded autoimmunity were associated with several environmental exposures. Alternative autoimmunity was associated with a higher RA GRS in RA FDRs (OR 1·41), and a higher SLE GRS in aAb+ RA FDRs (OR 1·87), but not in SLE FDRs. INTERPRETATION: Autoimmunity commonly crosses disease-specific boundaries in systemic (RA, SLE) and organ-specific (T1D) autoimmune diseases. Alternative autoimmunity is more common in SLE FDRs than RA FDRs, and is influenced by genetic and environmental factors. These findings have substantial implications for preclinical disease pathogenesis and autoimmune disease prevention studies. FUND: NIH U01AI101981, R01AR051394, U19AI082714, P30AR053483, P30GM103510, U54GM104938, U01AI101934, R01AI024717, U01AI130830, I01BX001834, & U01HG008666.


Assuntos
Artrite Reumatoide/etiologia , Autoimunidade/genética , Predisposição Genética para Doença , Lúpus Eritematoso Sistêmico/etiologia , Núcleo Familiar , Adulto , Idoso , Alelos , Artrite Reumatoide/diagnóstico , Autoanticorpos/imunologia , Meio Ambiente , Feminino , Frequência do Gene , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Pessoa de Meia-Idade , Especificidade de Órgãos/imunologia , Polimorfismo de Nucleotídeo Único , Fatores de Risco
16.
Intern Med ; 58(7): 979-984, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30930349

RESUMO

Chronic pulmonary aspergillosis, which features nodular lesions known as Aspergillus nodules, is a relatively uncommon disorder. We herein report a case of slowly progressing chronic multiple nodular pulmonary aspergillosis in a 59-year-old man with rheumatoid arthritis, dyspnea, and fatigue. One nodule was surgically resected. The surgical specimen featured central necrosis and was located adjacent to a respiratory bronchiole and pulmonary artery, without parenchymal invasion. Branching septate hyphae, compatible with Aspergillus, were seen inside this necrotic nodule. Chronic pulmonary aspergillosis should therefore be considered in the differential diagnosis of patients who present with slowly progressing pulmonary multiple nodules.


Assuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico , Antifúngicos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Aspergillus , Aspergillus fumigatus , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Aspergilose Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X
17.
Nat Commun ; 10(1): 1776, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992449

RESUMO

Polygenic risk scores (PRS) have shown promise in predicting human complex traits and diseases. Here, we present PRS-CS, a polygenic prediction method that infers posterior effect sizes of single nucleotide polymorphisms (SNPs) using genome-wide association summary statistics and an external linkage disequilibrium (LD) reference panel. PRS-CS utilizes a high-dimensional Bayesian regression framework, and is distinct from previous work by placing a continuous shrinkage (CS) prior on SNP effect sizes, which is robust to varying genetic architectures, provides substantial computational advantages, and enables multivariate modeling of local LD patterns. Simulation studies using data from the UK Biobank show that PRS-CS outperforms existing methods across a wide range of genetic architectures, especially when the training sample size is large. We apply PRS-CS to predict six common complex diseases and six quantitative traits in the Partners HealthCare Biobank, and further demonstrate the improvement of PRS-CS in prediction accuracy over alternative methods.


Assuntos
Predisposição Genética para Doença , Modelos Genéticos , Herança Multifatorial/genética , Característica Quantitativa Herdável , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/genética , Teorema de Bayes , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Simulação por Computador , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/genética , Bases de Dados Genéticas/estatística & dados numéricos , Depressão/diagnóstico , Depressão/genética , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/genética , Feminino , Estudo de Associação Genômica Ampla , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/genética , Desequilíbrio de Ligação/genética , Masculino , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco
18.
Medicine (Baltimore) ; 98(17): e14997, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027052

RESUMO

RATIONALE: Rheumatoid arthritis (RA) shows a variable clinical expression in patients. Articular disease is common manifestation, but patients may rarely present with extra-articular manifestation such as cranial neuropathy. Also, primary hepatic lymphoma (PHL) has rarely been reported in patient treated with immunosuppressive drug such as methotrexate (MTX) for RA. We herein describe a case of cranial neuropathy and MTX-related PHL in a woman receiving MTX for RA. PATIENT CONCERNS: A 73-year-old women received MTX treatment for more than 5 years, presented with recurrent cranial neuropathies. During therapy of cranial neuropathies, liver enzyme levels were elevated. DIAGNOSES: The patient was diagnosed as RA by laboratory examination. A series of examinations had been launched to evaluate any possible cause of the extra-articular manifestation of the patient including ultrasound, computed tomography, magnetic resonance image (MRI) and positron emission tomography of the liver and MRI of the brain. Finally, the patient diagnosed as MTX-associated PHL and cranial neuropathy. INTERVENTIONS: The patient underwent 4-year MTX therapy for RA at first with prednisolone. After that, she had been treated with cyclophosphamide therapy for cranial neuropathy. The liver biopsy was performed for hepatic lesion. OUTCOMES: MTX was discontinued, but no improvement of PHL and elevated liver enzyme was observed during the 3 weeks. The patient received 6 cycles of chemotherapy for 3 months and achieved complete remission including PHL and cranial neuronal lesion with symptom. No instances of relapse have occurred in 2 years of follow-up. LESSONS: The present case is the extremely rare case in which MTX-related PHL and cranial neuropathy were involved together in the RA patient. It is necessary to examine long-term follow up hepatic and neurologic examinations that patient had a long history of receiving MTX therapy for RA.


Assuntos
Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Doenças dos Nervos Cranianos/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Linfoma/tratamento farmacológico , Metotrexato/efeitos adversos , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Linfoma/complicações , Linfoma/diagnóstico , Linfoma/patologia , Metotrexato/uso terapêutico , Recidiva
19.
Bone Joint J ; 101-B(4): 454-460, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30929496

RESUMO

AIMS: Few studies have compared survivorship of total shoulder arthroplasty (TSA) with hemiarthroplasty (HA). This observational study compared survivorship of TSA with HA while controlling for important covariables and accounting for death as a competing risk. PATIENTS AND METHODS: All patients who underwent shoulder arthroplasty in Ontario, Canada between April 2002 and March 2012 were identified using population-based health administrative data. We used the Fine-Gray sub-distribution hazard model to measure the association of arthroplasty type with time to revision surgery (accounting for death as a competing risk) controlling for age, gender, Charlson Comorbidity Index, income quintile, diagnosis, and surgeon factors. RESULTS: During the study period, 5777 patients underwent shoulder arthroplasty (4079 TSA, 70.6%; 1698 HA, 29.4%), 321 (5.6%) underwent revision, and 1090 (18.9%) died. TSA patients were older (TSA mean age 68.4 years (sd 10.2) vs HA mean age 66.5 years (sd 12.7); p = 0.001). The proportion of female patients was slightly lower in the TSA group (58.0% vs 58.4%). The adjusted association between surgery type and time to shoulder revision interacted significantly with patient age. Compared with TSA patients, revision was more common in the HA group (adjusted-health ratio (HR) 1.214, 95% confidence interval (CI) 0.96 to 1.53) but this did not reach statistical significance. CONCLUSION: Although there was a trend towards higher revision risk in patients undergoing HA, we found no statistically significant difference in survivorship between patients undergoing TSA or HA. Cite this article: Bone Joint J 2019;101-B:454-460.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia do Ombro/métodos , Hemiartroplastia/métodos , Osteoartrite/cirurgia , Vigilância da População , Amplitude de Movimento Articular/fisiologia , Articulação do Ombro/cirurgia , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Osteoartrite/diagnóstico , Osteoartrite/fisiopatologia , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Resultado do Tratamento
20.
Amino Acids ; 51(5): 773-782, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30830311

RESUMO

Rheumatoid arthritis (RA) patients have increased risk of cardiovascular disease (CVD) death. Elevated asymmetric dimethylarginine (ADMA) levels have been reported to be an independent predictor of CVD morbidity and mortality, however, the role of ADMA in RA remains undetermined. To derive a more accurate estimation on circulating ADMA levels in RA patients, a meta-analysis was performed. Embase, PubMed, and The Cochrane Library database (up to October 7 2018) were used to acquire published literatures. Heterogeneity test was performed by the Q statistic and quantified using I2. Publication bias was evaluated using a funnel plot and Egger's linear regression test. A total of 174 articles were identified, 16 studies with 1365 subjects (666 RA patients and 699 healthy individuals) were ultimately included. Plasma/serum ADMA levels appeared to be higher in RA patients than healthy controls (SMD = 0.84, 95% CI 0.32, 1.35). By assessing the BMI, age, disease duration and disease activity as subgroups, BMI ≥ 24 and BMI < 24 groups both showed elevated ADMA levels than controls, disease duration ≥ 8, age < 50 and disease activity ≥ 3.2 and < 5.1 group had a higher ADMA level than control groups. However, disease duration < 8, disease activity ≥ 5.1 and age ≥ 50 groups showed no difference between two groups. Circulating ADMA levels are higher in RA patients compared with healthy controls. In addition, ADMA levels are influenced by age, disease duration and disease activity.


Assuntos
Arginina/análogos & derivados , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico , Biomarcadores/sangue , Arginina/sangue , Estudos de Casos e Controles , Humanos , Fatores de Risco
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