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1.
Isr Med Assoc J ; 21(7): 480-486, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31507125

RESUMO

BACKGROUND: Serum rheumatoid factors are autoantibodies of different isotypes directed against the Fc fraction of immunoglobulin G (IgG) and represent paradigmatic autoantibodies that have been largely used in clinical practice for decades. Traditionally IgG has been associated with rheumatoid arthritis and more recently included also in the classification criteria for SjÓ§gren's syndrome. Researchers have established that rheumatoid factors are positive in a variety of infectious, autoimmune, and neoplastic disorders, thus requiring a comprehensive evaluation of seropositive patients. Of note, hepatitis B and C viruses represent a crossroad that includes the high rheumatoid factor seroprevalence and chronic inflammatory disease, as well as progression to non-Hodgkin's lymphomas. Chronic antigen stimulation is the likely common ground of these processes and rheumatoid factors may represent mere bystanders or drivers of pathology. Mixed cryoglobulinemia and lymphoproliferative disease are prime examples of the deleterious effects of rheumatoid factor-B cell activity, possibly associated with hepatitis B and C. More importantly, they show a clear association in a physiological host response to infection, chronic inflammation, and the slide toward autoimmunity and malignancy. The association between hepatitis B and C infections and the appearance of serum rheumatoid factors is further supported by prevalence data, which support a coexistence of these markers in a significant proportion of cases, with viral infections being frequent causes of rheumatoid factors in patients without a rheumatic condition. We provide a comprehensive overview of the known connections between hepatitis B and C infections and rheumatoid factors.


Assuntos
Hepatite B/imunologia , Hepatite C/imunologia , Fator Reumatoide/imunologia , Autoanticorpos/imunologia , Doenças Autoimunes/imunologia , Autoimunidade/imunologia , Crioglobulinemia/imunologia , Humanos , Transtornos Linfoproliferativos/imunologia , Neoplasias/imunologia , Fator Reumatoide/sangue
2.
Medicine (Baltimore) ; 98(30): e16413, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348241

RESUMO

BACKGROUND: Pain is the main symptom of patients with rheumatoid arthritis (RA). Reports of the effects of moxibustion on patients with rheumatoid arthritis have reached various conclusions. The aim of this meta-analysis was to evaluate the effect of moxibustion on pain in patients with RA. METHODS: A systematic search of MEDLINE, EMBASE, the Cochrane Library, and the Chinese databases Wan Fang Med Database, CNKI, and VIP (until November, 2018) was used to identify studies reporting pain (on a visual analogue scale (VAS)), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factor (RF) levels, response rate, and the ACR50 rate in patients with RA. Results were expressed as mean difference (MD) and 95% confidence intervals (CI). RESULTS: Six studies involving 281 participants were included. Moxibustion had significant effects on pain (VAS: MD = -0.53, 95% CI [-0.94, -0.12], P =.01). Moreover, moxibustion had effects on CRP (MD = -2.84, 95% CI [-5.13, -0.55], P =.01), ESR (MD = -8.44, 95% CI ([-13.19, -3.68], P =.0005), and RF (MD = -6.39, 95% CI [-18.57, 5.79], P =.30). Additionally, it had effects on response rate (n = 249, RR = 1.26, 95% CI [1.11, 1.43], P =.0004) and ACR50 rate (n = 140, RR = 1.44, 95% CI [1.11, 1.88], P =.007). CONCLUSION: We found that moxibustion with Western medicine therapy is superior to Western medicine therapy alone for pain in patients with RA. Moxibustion had significant effects on pain in patients with RA, but the effects of moxibustion on inflammatory factors in RA were unclear.


Assuntos
Artrite Reumatoide/terapia , Moxibustão/métodos , Manejo da Dor/métodos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Sedimentação Sanguínea , Proteína C-Reativa/análise , Terapia Combinada , Humanos , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Fator Reumatoide/sangue
3.
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
4.
Medicine (Baltimore) ; 98(23): e15899, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169700

RESUMO

BACKGROUND: Rheumatoid Arthritis (RA) is a serious chronic disease which will result in serious syndrome such as joints stiffness, disability, and death. The major medications treating RA usually make sense and side effects, while moxibustion is known as a safe and effective treatment for RA. This review aims to systematically evaluate the effect and safety of moxibustion for treating RA. METHODS: The following databases will be searched from their inception to March 2019: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Wan-Fang Databases, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Citation Information by National Institute of Informatics, Chinese Scientific Journal Database (VIP Database). Two reviewers will search these databases, select data and measure the quality of studies independently. The methodological quality will be assessed by the Cochrane risk of bias tool. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The primary outcome is symptom evaluation including morning stiffness, pain and joint swelling. The number of joints affected by RA, adverse effects, quality of life, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and Rheumatoid factor (RF) will be evaluated as secondary outcomes. Risk ratio for dichotomous data and mean differences with a 95% confidence interval for continuous data will be adopted to express the effect and safety of acupuncture for RA. RESULTS: This study will provide a high-quality synthesis of current evidence of moxibustion for asthma from several aspects including morning stiffness, pain and joint swelling. The number of joints affected by RA, adverse effects, quality of life, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and Rheumatoid factor (RF). CONCLUSION: The conclusion of our study will provide updated evidence to judge whether moxibustion is an effective and safe intervention for patients with RA. ETHICS AND DISSEMINATION: As individuals will not be involved, the ethical approval will not be required. This review will be published in a peer-reviewed journal or at a relevant conference. PROSPERO REGISTRATION NUMBER: CRD42019126685.


Assuntos
Artrite Reumatoide/terapia , Moxibustão/métodos , Sedimentação Sanguínea , Proteína C-Reativa/análise , Doença Crônica , Humanos , Moxibustão/efeitos adversos , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Fator Reumatoide/sangue , Índice de Gravidade de Doença
5.
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
6.
Ann Clin Lab Sci ; 49(2): 224-231, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31028068

RESUMO

BACKGROUND: Sialic acids are a diverse family of sugar units attached to the outermost ends of sugar chains, which were demonstrated to be related to many diseases. We hypothesized sialic acids could be used as biomarkers for diagnosis of rheumatoid arthritis (RA). METHODS: The serum level of the main sialic acids, N-acetyl-D-neuraminic acid (Neu5Ac) in 163 RA patients and 50 healthy individuals were detected by pre-column derivatization-high performance liquid chromatography method. And three biomarkers to diagnose RA in clinic, C-reactive protein (CRP), rheumatoid factor (RF), and cyclic citrullinated peptides (CCP) in serum of these subjects were analyzed using enzyme-linked immunosorbent assay (ELISA). The data was analyzed using the receiver operating characteristic (ROC) curve and the Youden index. RESULTS: We found the concentration of Neu5Ac in RA group was significantly higher than healthy group. There was a positive correlation between the concentration of Neu5Ac and the RA disease activity score (DAS). The sensitivity and specificity of Neu5Ac were significantly greater than CRP, RF, CCP. CONCLUSIONS: Higher serum levels of Neu5Ac were significantly associated with the presence as well as severity of RA. Neu5Ac may be a potential biomarker for prediction and severity of RA in clinical practice.


Assuntos
Artrite Reumatoide/sangue , Ácido N-Acetilneuramínico/sangue , Adulto , Área Sob a Curva , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Cromatografia Líquida de Alta Pressão , Feminino , Fluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Ácido N-Acetilneuramínico/química , Peptídeos Cíclicos/sangue , Quinoxalinas/química , Curva ROC , Fator Reumatoide/sangue , Sensibilidade e Especificidade
7.
Clin Chim Acta ; 495: 40-42, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30890397

RESUMO

The association between Down syndrome (DS), a genetic disorder resulting from trisomy of the 21st chromosome, and the autoantibodies of rheumatoid arthritis (RA) has been proposed but not unequivocally proven. The aim of this study was to determine whether adult patients with DS present higher levels of anti-cyclic citrullinated peptide (anti-CCP) antibodies and/or rheumatoid factor (RF) than the general population. Our results showed that none of the 68 patients with DS had anti-CCP antibodies, whereas among 204 age- and sex-matched controls these autoantibodies were present in one person. However, DS patients presented a higher number of RF positive cases than controls (11.7% to 3.2% respectively; Fisher's exact test, p = .027). The higher number of RF positive cases in the DS group without increase of anti-CCP antibodies may be indicative of immune disturbances in general rather than RA in these patients. Our study supports the view that RA does not occur with higher frequency in patients with DS than in the general population.


Assuntos
Síndrome de Down/sangue , Síndrome de Down/imunologia , Peptídeos Cíclicos/imunologia , Fator Reumatoide/sangue , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Adulto Jovem
8.
Medicine (Baltimore) ; 98(12): e14945, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30896663

RESUMO

Rheumatoid arthritis (RA) is a chronic debilitating inflammatory disease affecting mainly the joint, surrounding tissue and other extra-articular structures in the body. RA can lead to destruction of bone and cartilage which may cause severe disability and it is characterized by the presence of serum rheumatoid factor (RF). The anti-cyclic citrullinate peptide (anti-CCP) antibody is another serum biomarker used in RA diagnosis with higher sensitivity and specificity.In this cross-sectional study with retrospective record review, 159 established RA patients from Hospital Universiti Sains Malaysia (HUSM) were recruited. Enzyme-linked immunosorbent assays (ELISAs) for serum RF and anti-CCP were performed. Our goal was to evaluate the significance of anti-CCP antibody in predicting the disease activity and progression in terms of radiological and extra-articular manifestations upon diagnosis.Of the 159 RA patients included in this study, mean age was 48.3 years old and majority (n = 134; 84.3%) were female. A total of 83 (52.2%) and 99 (62.3%) patients had anti-CCP antibody and RF, respectively. Mean Disease Activity Score-28 for Rheumatoid Arthritis with erythrocyte sedimentation rate (ESR) (DAS28-ESR) score for all patients was 4.74 (medium and high disease activity). Fifty-eight (36.5%) patients had radiological defects and 49 (30.8%) patients had extra-articular involvement manifested by rheumatoid nodule, pulmonary involvement, and anemia.In terms of anti-CCP antibody association with clinical and laboratory parameters, a significant co-occurrence of RF and anti-CCP antibody (P = .002) was observed. Anti-CCP antibody was significantly associated with radiological defects in which majority of patients with such defects (n = 40/58; 68.9%) were positive for anti-CCP antibody (P = .001). However, there was no significant difference between mean and classes of disease activity score and extra-articular manifestations between different anti-CCP antibody groups. In addition, extra-articular manifestations were not associated with high disease activity upon RA diagnosisThere was a significant association between anti-CCP antibody positivity and positive RF. Radiological defects were the sole clinical parameter significantly associated with anti-CCP antibody positivity, indicating that patients positive for anti-CCP antibody should be routinely monitored for radiological defects and their onset.


Assuntos
Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/sangue , Fator Reumatoide/sangue , Adulto , Fatores Etários , Idade de Início , Anticorpos Anti-Proteína Citrulinada/imunologia , Artrite Reumatoide/imunologia , Biomarcadores , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fator Reumatoide/imunologia , Índice de Gravidade de Doença , Fatores Sexuais
9.
Clin Rheumatol ; 38(5): 1413-1424, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30790095

RESUMO

OBJECTIVES: Evaluate abatacept retention over 2 years in the AbataCepT In rOutiNe clinical practice (ACTION) study. METHOD: ACTION was an international, observational study of patients with moderate-to-severe rheumatoid arthritis (RA) who initiated intravenous abatacept. Crude abatacept retention rates over 2 years were estimated using Kaplan-Meier analyses in biologic-naive and -failure patients. Clinically relevant risk factors and significant prognostic factors for retention were evaluated using a Cox proportional hazards multivariable model. RESULTS: Overall, 2350/2364 enrolled patients were evaluable; 673 (28.6%) were biologic naive and 1677 (71.4%) had prior biologic failure (1 biologic, 728/1677 [43.4%]; ≥ 2 biologics, 949/1677 [56.6%]). Abatacept retention rate (95% confidence interval [CI]) at 2 years was 47.9% (45.7, 50.0): 54.5% (50.4, 58.3) for biologic-naive vs 45.2% (42.7, 47.7) for biologic-failure patients (log-rank P < 0.001). For patients with 1 and ≥ 2 prior biologic failures, respectively, retention rates (95% CI) were 50.2% (46.3, 53.9) vs 41.3% (38.0, 44.6; log-rank P < 0.001). Main reasons for discontinuation (biologic-naive vs biologic-failure, respectively) were lack of efficacy (61.4 vs 67.7%) and safety (21.3 vs 21.2%). Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) double positivity versus negativity were predictive of higher retention in both biologic-naive (hazard ratio [HR] [95% CI] 0.71 [0.53, 0.96]; P = 0.019) and biologic-failure patients (HR [95% CI] 0.76 [0.62, 0.94]; P = 0.035). CONCLUSIONS: Abatacept initiation as earlier vs later line of therapy in RA may achieve higher 2-year retention rates. RF and anti-CCP seropositivity could predict increased abatacept retention, irrespective of treatment line. TRIAL REGISTRATION: NCT02109666.


Assuntos
Abatacepte/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Corticosteroides/uso terapêutico , Idoso , Estudos de Coortes , Quimioterapia Combinada , Feminino , Humanos , Internacionalidade , Estimativa de Kaplan-Meier , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Fator Reumatoide/sangue , Resultado do Tratamento
10.
Clin Rheumatol ; 38(5): 1301-1307, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30810912

RESUMO

INTRODUCTION: The rheumatoid factor (RF) is present in numerous autoimmune disorders, although its role in many of them remains a subject of research. The study assesses the role of RF as an immunological and prognostic factor in the primary Sjögren's syndrome (pSS). METHODS: Seventy-five pSS patients (mean age 50.03 ± 15.1), 65 (87%) females, and 10 (13%) males. WBC, CRP, RF, ESR, gammaglobulins, C4, C3 component of complement, cryoglobulins, ANA, anti-SS-A, and anti-SS-B antibodies were determined. The disease activity assessed with ESSDAI. Minor salivary gland biopsy (focus score and immunochemistry) was conducted. Results were analyzed with U Mann-Whitney (continuous variables) tests, correlations between quantitative variables assessed with the Spearman correlation coefficient with statistical significance set at p < 0.05. The approval of the Bioethics Committee was obtained. RESULTS: Two subgroups I-RF(+) (61%) and II-RF(-) (39%) were established, with lower WBC (p = 0.012) and higher ESR (p = 0.016), gammaglobulin concentration (p = 0.007) in group I. Conjunctivitis sicca was more severe in group I. There was positive correlation between RF and lnANA (rho = 0.496), anti-SS-A, anti-SS-B antibodies (rho = 0.448; rho = 0.397 respectively). There was higher disease activity ESSDAI in group I than in group II (Me, 3.0 vs 2.0; p < 0.003). RF correlated negatively with WBC (rho = - 0.374). RF did not correlate with serum concentrations of BAFF, APRIL, CRP, and C3, C4 and with CD19+, CD3+, CD4+, CD 21+, and CD35+. CONCLUSIONS: RF should be considered as a prognostic, but not diagnostic, factor in patients with pSS, as it is associated with more severe disease course (sicca eye symptoms, ESSDAI) and parameters (production of gammaglobulins, ANA, anti SS-A, anti-SS-B autoantibodies) indicating increased B cell activity.


Assuntos
Fator Reumatoide/sangue , Síndrome de Sjogren/diagnóstico , Adulto , Idoso , Anticorpos Antinucleares/sangue , Biomarcadores/sangue , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Glândulas Salivares Menores/patologia , Síndrome de Sjogren/patologia
11.
Medicine (Baltimore) ; 98(5): e14181, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702571

RESUMO

We determined whether rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) can predict remission or severe disability in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor (TNF) alpha drugs.We performed a cohort study based on the clinical data from a referral center for the treatment of RA in Bogotá, Colombia, were included patients aged ≥18 years with diagnosis of RA with an active disease and for whom a treatment scheme was begun with anti-TNF alpha medication, with a minimum follow-up time of 12 months. Disease activity of Rheumatoid Arthritis was assessed through measurement of RF, ACPA, disease activity score (DAS28), and health assessment questionnaire (HAQ). We calculated the incidence rates (IRs) for remission and severe disability. We also calculated the incidence rate ratio (IRR) for each outcome by adjusting for possible confounders using the Poisson regression method. The hypothesis was tested with a P value of <.05. Statistical analysis was performed in Stata 15.We included 400 patients receiving an anti-TNF alpha agent. Median age was 60 years, and 322 patients were women (80.5%). RF was positive in 357 patients (89%), ACPA in 348 patients (87%), and co-positivity in 324 patients (81%). Median follow-up was 41 months (range, 12-79 months). The IR for remission was 23 per 100 person-years in RF-negative patients and 16 per 100 person-years in RF-positive patients. The adjusted IRR (age sex, treatment, and ACPA) was 1.51 (95%CI, 1.05-2.18). The IR for severe disability was 10.8 per 100 person-years in the RF-positive cohort and 2.3 per 100 person-years in the RF-negative cohort. The IRR adjusted for these factors was 4.37 (95%CI, 1.6-12). Co-positivity had a similar behavior to RF. No differences were recorded in the rates of remission or disability in ACPA-positive and ACPA-negative patients.Our findings suggest that remission is less frequent and severe disability more frequent in RF-positive patients treated with anti-TNF alpha agents than in RF-negative patients.


Assuntos
Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/sangue , Artrite Reumatoide/tratamento farmacológico , Fator Reumatoide/sangue , Fator de Necrose Tumoral alfa/uso terapêutico , Idoso , Anticorpos Anti-Proteína Citrulinada/biossíntese , Artrite Reumatoide/fisiopatologia , Biomarcadores , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Fator Reumatoide/biossíntese , Índice de Gravidade de Doença
12.
Medicine (Baltimore) ; 98(6): e14083, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732128

RESUMO

OBJECTIVES: To study the correlation between high-frequency ultrasonography of patients with early rheumatoid arthritis (RA) and anti-cyclic citrullinated peptide (CCP) antibody. METHODS: Two wrists, 1st to 5th metacarpal phalangeal (MCP) and 1st to 5th proximal interphalangeal (PIP) joints of 53 early RA patients treated from October 2015 to October 2017 and 30 healthy subjects were examined by high-frequency ultrasonography. The thicknesses of synovial membrane, sheaths of 1st to 5th extensor tendons, flexor tendons and ulnar wrist extensor tendons were measured. Related pathological changes were observed. RESULTS: RA and control groups had significantly different thicknesses of synovium, extensor and flexor tendon sheaths (P <.001). In RA group, 14.15% of joints had cavity fluid, 5.23% had cartilage destruction, and 2.32% of bone cortices had tendon sheath effusion. The detection rates of tendon sheath effusion and tendon adhesion were 19.81% and 16.30% respectively. Anti-CCP antibody positive group had significantly different DAS28, Health Assessment Questionnaire score and rheumatoid factor positive rate from those of negative group (P <.05). Synovitis, cartilage destruction, bone erosion, tendon sheath effusion, and joint effusion were significantly positively correlated with these values (P <.05). Besides, 8.92% of joints had blood flow signals of thickening synovium, of which joints with signals in the active phase accounted for 4.37%. The resistance index (RI) of synovial artery was (0.58 ±â€Š0.07). However, 0.94% of joints had synovial blood flow signals in the inactive phase, and RI of synovial artery was (0.67 ±â€Š0.03). Anti-CCP antibody positive group was significantly more prone to bone erosion than negative group (P <.05). CONCLUSIONS: For patients with early RA, high-frequency ultrasonography was more likely to detect articular cartilage destruction and bone erosion changes when anti-CCP antibody was positive. Combining anti-CCP antibody with ultrasonography can provide valuable evidence for the development of clinical treatment regimens.


Assuntos
Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/patologia , Articulação Metacarpofalângica/patologia , Ultrassonografia/métodos , Articulação do Punho/patologia , Adulto , Artrite Reumatoide/diagnóstico por imagem , Cartilagem/patologia , Feminino , Humanos , Masculino , Articulação Metacarpofalângica/diagnóstico por imagem , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Fator Reumatoide/sangue , Índice de Gravidade de Doença , Membrana Sinovial/patologia , Sinovite/patologia , Tendões/patologia , Articulação do Punho/diagnóstico por imagem , Adulto Jovem
13.
Ethiop J Health Sci ; 29(1): 957-958, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30700964

RESUMO

The diagnosis of rheumatologic problem can be difficult, especially if not all the diagnostic criteria or typical clinical features are seen. This includes conditions such as rheumatoid arthritis which needs early diagnosis to start disease modifying drugs (DMARDs) which can improve the prognosis and prevent further joint erosion and organ damage. This case report focused on a similar scenario in an elderly woman initially thought to have osteoarthritis but was diagnosed later with rheumatoid arthritis which brought much relief to her current predicament.


Assuntos
Artrite Reumatoide/diagnóstico , Idoso , Anti-Inflamatórios/uso terapêutico , Anticorpos Anticitoplasma de Neutrófilos/sangue , Antirreumáticos/uso terapêutico , Artrite Reumatoide/sangue , Artrite Reumatoide/tratamento farmacológico , Sedimentação Sanguínea , Proteína C-Reativa , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Metotrexato/uso terapêutico , Prednisolona/uso terapêutico , Radiografia , Fator Reumatoide/sangue
14.
BMJ Case Rep ; 12(1)2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30635304

RESUMO

Rheumatoid meningitis (RM) is a rare extra-articular manifestation of rheumatoid arthritis (RA). A 59-year-old man presented with a 10-day history of right-sided frontal headache and a 7-day history of subacute left-sided weakness. He had no history of RA. He was febrile (38.2°C). Left ankle dorsiflexion and plantarflexion were graded at 4+/5. He developed focal onset motor seizures. He was intermittently febrile with minimal improvement despite intravenous antivirals and antimicrobials. Serology revealed elevated rheumatoid factor 88.2 IU/mL and anti-cyclic citrullinated peptide (anti-CCP) IgG >340 AU/mL. Initial cerebrospinal fluid (CSF) was predominantly lymphocytic 96%, with elevated protein 672 mg/L and normal glucose 3.4 mmol/L. Interval CSF revealed newly low glucose 2.6 mmol/L. Extensive CSF microbiology tests were negative. CSF cytology confirmed reactive lymphocytes. MRI brain revealed right frontoparietal leptomeningeal enhancement. Brain and leptomeningeal biopsy demonstrated florid leptomeningeal mixed inflammatory infiltrate without granulomas. The combination of elevated anti-CCP IgG, erosive arthropathy, CSF lymphocytosis, asymmetrical leptomeningeal enhancement and biopsy findings confirmed RM.


Assuntos
Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico , Meningite/sangue , Meningite/líquido cefalorraquidiano , Administração Intravenosa , Administração Oral , Assistência ao Convalescente , Anticorpos Anti-Proteína Citrulinada/sangue , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Biópsia , Encéfalo/diagnóstico por imagem , Glucocorticoides/uso terapêutico , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Artropatias/diagnóstico , Artropatias/etiologia , Linfocitose/líquido cefalorraquidiano , Imagem por Ressonância Magnética/métodos , Masculino , Meningite/diagnóstico , Meningite/diagnóstico por imagem , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Doenças Raras , Fator Reumatoide/sangue , Convulsões/diagnóstico , Convulsões/etiologia , Resultado do Tratamento
15.
J Stroke Cerebrovasc Dis ; 28(4): 1133-1140, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30661971

RESUMO

BACKGROUND: The effect of serum rheumatoid factor (RF) on poststroke cognitive impairment remains unknown. We aimed to investigate the association of serum RF in the acute phase with cognitive impairment at 3 months after ischemic stroke onset. METHODS: Our study was based on a random sample from the China Antihypertensive Trial in Acute Ischemic Stroke, a total of 582 patients from 7 of 26 participating sites of the trial with serum RF levels were included in this analysis. Cognitive impairment was defined as Mini-Mental State Examination less than 27 or Montreal Cognitive Assessment less than 25. RESULTS: According to Mini-Mental State Examination score, the multivariate-adjusted odds ratio and 95% confidence interval of cognitive impairment for the highest tertile of serum RF was 1.79 (1.08-2.99) compared with the lowest tertile. Each standard deviation increase of log-transformed RF was associated with 33% (95% confidence interval: 7%-66%) increased risk of cognitive impairment, and a linear association between serum RF and risk of poststroke cognitive impairment was observed (P for linearity < .01). Adding log-transformed RF to a model containing conventional risk factors improved the predictive power for poststroke cognitive impairment (net reclassification improvement: 26.21%, P < .01; integrated discrimination index: 1.24%, P = .02). Similar significant findings were observed when cognitive function was defined by Montreal Cognitive Assessment score. CONCLUSIONS: Elevated serum RF levels in the acute phase were independently associated with 3-month cognitive impairment among ischemic stroke patients. Further studies are needed to replicate our findings and to clarify the potential mechanisms.


Assuntos
Isquemia Encefálica/sangue , Transtornos Cognitivos/etiologia , Cognição , Fator Reumatoide/sangue , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/psicologia , China , Transtornos Cognitivos/sangue , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Regulação para Cima
16.
Beijing Da Xue Xue Bao Yi Xue Ban ; 50(6): 986-990, 2018 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-30562769

RESUMO

OBJECTIVE: To investigate the clinical characteristics of rheumatoid arthritis (RA) patients with malignant tumor. METHODS: Retrospective summary was made of 1 562 in patients of RA from January 2011 to June 2017. In the study, 74 RA patients with malignant tumor were reviewed and analyzed, and the general conditions, tumor types, RA and tumor onset sequence, and the medication situation were analyzed. RESULTS: The incidence of malignant tumor in the patients with rheumatoid arthritis in our center was 4.16%. The 74 patients were complicated with malignant tumor, of whom 53 were female, and 21 male. The age of RA at presentation was (52.6±17.8) years. The average disease duration of malignant tumor was (63.4 ± 12.7) years. The onset time of rheumatoid arthritis was earlier than that of malignant tumors in 51 cases (51/74), with an average of (17.2±14.2) years between 2 and 60 years. The incidence of malignant tumor was earlier than that of rheumatoid arthritis in 16 cases (16/74), with an average of (6.2±5.9) years between 1 and 21 years, of which 10 cases were sex hormone related tumors. Seven cases (7/74) were diagnosed with RA at the same time, and the time interval between the two diseases was within 1 year. All the patients were over 60 years old with digestive tract tumors. All the 7 patients showed polyarthritis, significantly increased erythrocyte sedimentation rate and C-reactive protein, including 4 rheumatoid factor positive cases and 2 anti-CCP antibody positive cases. The effect of non-steroidal anti-inflammatory drugs and traditional drugs to improve the condition of the disease was poor in the 7 patients, and the condition was relieved after using low-dose glucocorticoids. Gastrointestinal tumors, breast and reproductive system tumors were the most common, followed by respiratory, urological and blood system tumors. CONCLUSION: The risk in patients of rheumatoid arthritis complicated with malignant tumor is higher than that of the general population. A variety of factors play an important role in cancer risk of RA, including disease activity, some estrogen metabolites, the use of drugs and so on. Therefore, all RA patients should be screened for malignant tumor during diagnosis, and malignant tumor surveillance is mandatory for all rheumatoid arthritis patients after diagnosis.


Assuntos
Artrite Reumatoide , Neoplasias , Adulto , Idoso , Artrite Reumatoide/sangue , Artrite Reumatoide/complicações , Autoanticorpos , Proteína C-Reativa/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/imunologia , Peptídeos Cíclicos , Estudos Retrospectivos , Fator Reumatoide/sangue
17.
Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi ; 34(10): 924-930, 2018 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-30554586

RESUMO

Objective To develope a chemiluminescence immunoassay based on microarray protein chip technology for detecting the anti-carbamylated protein (CarP) antibody. We aimed to evaluate the detection performance of this method and to explore its preliminary clinical application value of this index in patients with rheumatoid arthritis (RA). Methods A quantitative detection method for anti-CarP antibody was established to evaluate the precision, minimum detection limit, linear range and specificity of the method. The 95th position of anti-CarP antibody level in serum of 120 healthy controls was defined as the cutoff value. The anti-CarP antibody level and positive rate in RA group and non-RA group were analyzed. And the correlation between anti-CarP antibody and disease activity index in RA group was analyzed. Results The precision of this method for detecting high-level sample and low-level sample was less than 15%; The linear range could reach (3.31~1448.18) AU/mL, and there was almost no cross-reaction between anti-CarP antibody and anti-CCP antibody. Compared with healthy control group, the level of anti-CarP antibody in RA group, anti-CCP antibody positive RA group and joint pain group was significantly higher, and that in undifferentiated connective tissue disease group was also higher. Compared with the 5% positive rate of anti-CarP antibody in healthy control group, the positive rate of RA patients was 28.21%, anti-CCP antibody positive RA patients was 32.2%, joint pain group was 38.89%, which were significantly higher. There was no statistical difference between other disease groups. The level of anti-CarP antibody was weakly correlated with level of rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR) in RA patients, but it was moderately correlated with CRP and IgG level. Conclusion The protein chip chemiluminescence method for quantitative detection of anti-CarP antibody has good detection precision and wide linear range, and has good sensitivity and specificity. Anti-CarP antibody detection is valuable for RA diagnosis and disease activity evaluation.


Assuntos
Artrite Reumatoide/sangue , Autoanticorpos/sangue , Medições Luminescentes , Anticorpos Anti-Proteína Citrulinada/sangue , Sedimentação Sanguínea , Estudos de Casos e Controles , Humanos , Imunoensaio , Fator Reumatoide/sangue
18.
Clin Exp Rheumatol ; 36 Suppl 112(3): 102-112, 2018 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30156539

RESUMO

OBJECTIVES: To evaluate the influence of the main immunological markers on the disease phenotype at diagnosis in a large international cohort of patients with primary Sjögren's syndrome (SjS). METHODS: The Big Data Sjögren Project Consortium is an international, multicentre registry created in 2014. As a first step, baseline clinical information from leading centres on clinical research in SjS of the 5 continents was collected. The centres shared a harmonised data architecture and conducted cooperative online efforts in order to refine collected data under the coordination of a big data statistical team. Inclusion criteria were the fulfillment of the 2002 classification criteria. Immunological tests were carried out using standard commercial assays. RESULTS: By January 2018, the participant centres had included 10,500 valid patients from 22 countries. The cohort included 9,806 (93%) women and 694 (7%) men, with a mean age at diagnosis of primary SjS of 53 years, mainly White (78%) and included from European countries (71%). The frequency of positive immunological markers at diagnosis was 79.3% for ANA, 73.2% for anti-Ro, 48.6% for RF, 45.1% for anti- La, 13.4% for low C3 levels, 14.5% for low C4 levels and 7.3% for cryoglobulins. Positive autoantibodies (ANA, Ro, La) correlated with a positive result in salivary gland biopsy, while hypocomplementaemia and especially cryoglo-bulinaemia correlated with systemic activity (mean ESSDAI score of 17.7 for cryoglobulins, 11.3 for low C3 and 9.2 for low C4, in comparison with 3.8 for negative markers). The immunological markers with a great number of statistically-significant associations (p<0.001) in the organ-by-organ ESS- DAI evaluation were cryoglobulins (9 domains), low C3 (8 domains), anti-La (7 domains) and low C4 (6 domains). CONCLUSIONS: We confirm the strong influence of immunological markers on the phenotype of primary SjS at diagnosis in the largest multi-ethnic international cohort ever analysed, with a greater influence for cryoglobulinaemic-related markers in comparison with Ro/La autoantibodies and ANA. Immunological patterns play a central role in the phenotypic expression of the disease already at the time of diagnosis, and may guide physicians to design a specific personalised management during the follow-up of patients with primary SjS.


Assuntos
Autoanticorpos/sangue , Complemento C3/análise , Complemento C4/análise , Crioglobulinas/análise , Síndrome de Sjogren/imunologia , Adulto , Idoso , Anticorpos Antinucleares/sangue , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Prognóstico , Sistema de Registros , Fator Reumatoide/sangue , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/epidemiologia
19.
Int J Rheum Dis ; 21(7): 1430-1435, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29968328

RESUMO

BACKGROUND: Systemic sclerosis (SSc) can present as an overlap syndrome with rheumatoid arthritis (SSc-RA overlap). OBJECTIVE: To evaluate the frequency of rheumatoid factor (RF) and anticyclic citrullinated peptide antibodies (anti-CCP) in our SSc cohort and their association with clinical features. METHODS: Data were gathered prospectively from the Waikato Hospital Systemic Sclerosis Clinics. Patients with SSc and SOS (systemic sclerosis overlap syndrome) underwent baseline auto-antibody profiling including RF and anti-CCP along with annual clinical review. RESULTS: Our cohort comprised of 132 patients (two had incomplete data); 115 (87.1%) were female. Out of 89 limited cutaneous SSc (lcSSc) patients, arthralgia, synovitis, contractures, tendon crepitus and erosions on imaging were found in three, 10, 31, five and nine patients, respectively. Within the 33 diffuse cutaneous SSc (dcSSc) patients, arthralgia, synovitis, contractures, tendon crepitus and erosion were found in 15, five, 27, five and one patient, respectively. In the 10 SOS patients, arthralgia, synovitis and contractures were found in six, three and two patients; none had tendon crepitus or erosions. RF positivity was found in 15.7%, 9% and 20% of patients with lcSSc, dcSSc and SOS, and anti-CCP positivity was found in 13.5%, 6.1% and 0% in lcSSc, dcSSc and SOS patients. A statistically significant relationship of double antibody positivity with arthralgia (P = 0.03) and erosions (P < 0.001) was found. Anti-CCP positivity association with erosions was significant at P = 0.007. CONCLUSION: Our study confirms that articular manifestations are common in SSc. Statistically significant associations of double antibody positivity with arthralgia and erosions were demonstrated. Significant association between anti-CCP antibody and erosions was also confirmed.


Assuntos
Anticorpos Anti-Proteína Citrulinada/sangue , Artropatias/sangue , Peptídeos Cíclicos/imunologia , Fator Reumatoide/sangue , Escleroderma Sistêmico/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Biomarcadores/sangue , Feminino , Humanos , Artropatias/diagnóstico , Artropatias/tratamento farmacológico , Artropatias/imunologia , Articulações/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Prognóstico , Estudos Prospectivos , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/tratamento farmacológico , Escleroderma Sistêmico/imunologia , Fatores de Tempo , Adulto Jovem
20.
Int J Rheum Dis ; 21(7): 1423-1429, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29968329

RESUMO

AIM: This study investigated the common initial clinical presentations of primary Sjögren's syndrome (pSS) with interstitial lung disease (ILD) and explored differences between sicca and non-sicca onset pSS-ILD patients. METHOD: A total of 1341 SS patients hospitalized between 2003 and 2012 were retrospectively reviewed. Of them, 102 were analyzed and recruited to examine the differences between non-sicca and sicca onset. RESULTS: Fifty-one percent of pSS-ILD patients presented with non-sicca onset. Although the mean diagnosis time was equal, only 4% of non-sicca onset patients were diagnosed with pSS at onset versus 34% with sicca onset (P = 0.000). Hyperglobulinemia, elevated rheumatoid factor (RF) titer, and anti-SSA and/or anti-SSB presence were less predominant in patients with non-sicca onset (immunoglobulin G, 16 [12-21] vs. 21 [15-28] g/L, P = 0.032; RF, 22 [20-171] vs. 104 [20-237] IU/mL, P = 0.048; anti-SSA and/or anti-SSB presence, 33% vs. 72%, P = 0.000). The usual interstitial pneumonia pattern was more commonly seen in non-sicca onset patients (20.0% vs. 14.3%). The high-resolution computed tomography score was higher (12 [88-15] vs. 8 [5-13], P = 0.070) and predicted total lung capacity and forced vital capacity were lower (87 ± 23% vs. 97 ± 20%, P = 0.050; 88 ± 28% vs. 100 ± 27%, P = 0.089) in non-sicca patients. CONCLUSION: Non-sicca is a common initial manifestation in pSS-ILD. Anti-SSA presence, elevated RF titer and hyperglobulinemia were less predominant, and pulmonary complications were more progressive and severe in non-sicca onset patients than sicca onset patients.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico , Síndrome de Sjogren/diagnóstico , Idoso , Anticorpos Antinucleares/sangue , China/epidemiologia , Progressão da Doença , Feminino , Hospitalização , Humanos , Imunoglobulinas/sangue , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fator Reumatoide/sangue , Fatores de Risco , Índice de Gravidade de Doença , Síndrome de Sjogren/sangue , Síndrome de Sjogren/epidemiologia , Tomografia Computadorizada por Raios X , Capacidade Pulmonar Total , Capacidade Vital
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