Anti-carbamylated protein antibodies in premenopausal rheumatoid arthritis women: relation to disease activity and bone loss

Rheumatology ◽  
2020 ◽  
Author(s):  
Noha A Elsawy ◽  
Rim A Mohamed ◽  
Rasha A Ghazala ◽  
Mennatullah A Abdelshafy ◽  
Rehab Elnemr

Abstract Objectives Anti-carbamylated protein antibodies (anti-CarP Abs) are present in patients with RA, however, their association with bone loss is not confirmed. The purpose of this study was to determine the relation between the serum level of anti-CarP Abs in premenopausal RA women and disease activity and bone loss. Methods This case–control study was conducted on 48 premenopausal women with RA and 48 matched healthy premenopausal women. All RA women were subjected to clinical examination, disease activity assessment using the 28-joint DAS (DAS28) and Clinical Disease Activity Index (CDAI), functional assessment using the HAQ, physical activity assessment using the International Physical Activity Questionnaire (IPAQ), fatigue assessment using the Modified Fatigue Impact Scale (MFIS), serological tests as well as anti-CarP Abs using ELISA. Moreover, the BMD was measured by DXA and plain X-ray of both hands was done to assess juxta-articular osteopenia and erosions. Results The anti-CarP Abs level was significantly higher in RA patients than in healthy controls. The serum level of anti-CarP Abs had a significant positive correlation with the RA DAS28, CDAI, HAQ, MFIS and original Sharp score, while a significant negative correlation was present with the IPAQ. Anti-CarP Abs were negatively correlated with either spine BMD or Z-score and positively correlated with the original Sharp score. Conclusion Anti-CarP Abs were higher in premenopausal RA women compared with older and BMI matched healthy women. Anti-CarP Abs are associated with higher RA disease activity, increased disability and fatigability and decreased physical activity. Moreover, anti-CarP Abs are associated with systemic trabecular bone loss as well as local bone loss.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 947.2-947
Author(s):  
R. Elnemr ◽  
R. Bastawy ◽  
R. Ghazala ◽  
M. Abdelrazek ◽  
N. Elsawy

Background:Anti carbamylated protein anti carP are present in patients with Rheumatoid Arthritis RA and are associated with erosions. However their association with systemic or local bone loss in RA patients is still not confirmed.Objectives:The purpose of this study was to measure the serum level of anti carP in premenopausal women with RA and determine its relation to disease activity and bone loss.Methods:This case control study was conducted on forty eight RA premenopausal female patients diagnosed according to 2010 ACR/EULAR criteria and forty eight ages and body mass index matched healthy premenopausal females. RA patients with other autoimmune diseases, viral hepatitis malignancy or erosive joint disease and systemic diseases that affect bone quality were excluded from the study. All RA women were subjected to history taking, clinical examination, assessment of disease activity using disease activity score-28 DAS28 and clinical disease activity index CDAI functional assessment using health assessment questionnaire HAQ physical activity assessment using international physical activity questionnaire short form IPAQ fatigue assessment using modified fatigue impact scale MFIS, routine laboratory investigations, serological tests as well as Anti carP using ELISA kit. Moreover the bone mineral density was measured by a lunar Prodigy Advanced DEXA scanner system and plain x-ray of both hands and wrists in the anteroposterior view was done to assess the juxta articular osteopenia and erosions.Results:Anti carP level was significantly higher in RA patients than in healthy controls table 1. The serum level of anti carP had a significant positive correlation with RA DAS, CDAI, HAQ, IPAQ, MFIS and erosion and joint space narrowing in original sharp score. Also the anti carP had a significant negative correlation with the bone mineral density BMD of spine. The AUC of anti carP level showed a high level of accuracy AUC 0.857 figure 1 and the calculated cutoff value >65 can precisely discriminate subjects with RA from those without RA with 85.42% sensitivity and 85.11% specificity.Table 1.Comparison between the patient and healthy groups according to anti carp levelAnti-carpRA patientsHealthy controlUpMin – Max15.0 – 90.01.0 – 78.50322.0*<0.001*Mean ± SD71.24 ± 14.7045.99 ± 21.99Median (IQR)72.75 (70.5–78.3)55.0 (32.5–61.5)Figure 1.ROC curve for anti carP to diagnose RA patients from healthy subjectsConclusion:Anti carbamylated antibodies were higher in premenopausal RA women compared to ages and body mass index matched healthy women. Anti carP are associated with higher RA disease activity, increased disability and decreased physical activity. Moreover anti carP are associated with systemic trabecular bone loss manifested by decreased bone mineral density of the spine as well as local bone loss as manifested by increased number of joint erosions in premenopausal RA women.References:[1] Regueiro C, Ortiz AM, Boveda MD, Castañeda S, Gonzalez-Alvaro I, Gonzalez A. Association of high titers of anti-carbamylated protein antibodies with decreased bone mineral density in early arthritis patients. PLoS ONE 2018; 13(8):e0202583.Disclosure of Interests:None declared


2008 ◽  
Vol 28 (10) ◽  
pp. 1001-1007 ◽  
Author(s):  
Tatiana Freitas Tourinho ◽  
Edison Capp ◽  
João Carlos Brenol ◽  
Airton Stein

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 409.1-409
Author(s):  
T. Minier ◽  
V. Lóránd ◽  
Z. Bálint ◽  
D. Komjati ◽  
G. Nagy ◽  
...  

Background:Disease activity assessment is crucial in defining the appropriate therapy and to monitor the efficacy of treatment in systemic sclerosis.Objectives:We aimed to test the performance of the ’old’ European Scleroderma Trials and Research Group (EUSTAR) Activity Index (old-AI) (1), the ’new’ EUSTAR activity index (new-AI) (2), and the scleroderma activity index derived from the old-AI (Pecs-AI) (3). We compared the three indices to the disease activity based on the physician’s global assessment (PGA). We also assessed the correlations with the change in modified Rodnan Skin Score (MRSS), FVC and arthritis after one year follow-up.Methods:We evaluated 77 patients (50 diffuse /dcSSc/ and 27 limited cutaneous SSc /lcSSc/ patients) from a single tertiary clinical center. Cohort enrichment was performed to increase the number of patients with early disease and dcSSc. Seventy-two patients were re-evaluated after one year. Nine patients had overlap syndromes: rheumatoid arthritis (n=3), Sjögren syndrome (n=2), polymyositis (n=2), and mixed connective tissue disease (n=2). The overall disease activity was evaluated using both composite indices (old-AI, Pecs-AI, new-AI) and the PGA of disease activity, based on the blinded evaluation of a single physician (LV). In addition to the minimal essential data from the EUSTAR database we also performed detailed assessment of the musculoskeletal involvement evaluating measures of hand function, DAS28 scores, and the Clinical Disease Activity Index (CDAI) (4).Results:Three times more patients with active disease were identified by the new-AI compared to the old-AI at baseline investigation (n=37, 48.7%, vs. n=11, 14.3%). Two patients (18%) with active disease based on the old-AI were missed by the new-AI. Pecs-AI index identified 15 patients (19.5%) with active disease (cut-off >2.75 points). Active disease was equally frequent in dcSSc and lcSSc patients based on old-AI, but was more frequent in dcSSc patients based on the new-AI in the whole cohort, and also after excluding overlap cases.Patients with active disease based on the old-AI had more frequently rheumatoid factor (6/9, vs. 12/45, p=0.047), and DLCO<70% (11/11, vs. 36/65, p<0.01). Active disease based on the new-Al was associated with current cyclophosphamide treatment (9/37, vs.2/39, p=0.023), and diabetes mellitus (7/30, vs. 0/39, p<0.01). The PGA correlated moderately at both baseline and one year follow-up examination with the old-AI (rho: 0.519, and rho: 0.692, respectively, p<0.001), the new-AI (rho: 0.401, and rho: 0.429, respectively, p<0.001), and the Pecs-AI (rho: 0.425, and rho: 0.593, respectively, p<0.001).CDAI correlated significantly with the old-AI (rho: 0.345, and rho: 0.283, respectively, p<0.05) and the Pecs-AI (rho: 0.363, and rho: 0.324, respectively, p<0.05) at both the baseline and one-year follow-up investigations, but showed no consistent correlation to the new-AI or PGA.Conclusion:The two validated disease activity indices indentify different patient groups. Joint involvement is potentially underrepresented in the new EUSTAR activity index. Active disease is also present in lcSSc and should be assessed regularly in these patients.References:[1]Valentini G, et al. Ann Rheum Dis 2003; 62: 901-3.[2]Valentini G, et al. Ann Rheum Dis 2017;76:270–276.[3]Minier T, et al. Rheumatology (Oxford) 2010;49(6):1133-45.[4]Lorand V, et al. Rheumatology (Oxford). 2016;55(10):1849-58.Acknowledgments:This work was supported by the EU Seventh Framework Program [FP7/2007-2013] under Grant Agreement n° 305495 (DeSScipher), by the Hungarian Scientific Research Fund (contract n°: 112939), and the EU under the Grant Agreement n° PEPSYS GINOP-232-15-2016-00050.Disclosure of Interests:Tünde Minier Speakers bureau: Actelion, Abbvie, MSD, Pfizer, Lilly, Roche, Veronika Lóránd: None declared, Zsófia Bálint: None declared, Dalma Komjati: None declared, Gabriella Nagy Speakers bureau: MSD, Antonietta Kovács: None declared, Orsolya Koncz: None declared, Cecília Varjú Consultant of: Boehringer Ingelheim RCV GmbH & Co KG, Speakers bureau: Lilly, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Gabor Kumanovics Consultant of: Boehringer, Teva, Speakers bureau: Roche, Lilly, Novartis, Balazs Nemeth: None declared


2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Ilse Schilderinck ◽  
Carlijn Lamers ◽  
Nicole de Roos

Abstract Objectives Data on diet and physical activity in ulcerative colitis patients are scarce and frequently mixed with data of patients with Crohn's disease. Therefore, the objective of this study is to investigate habitual diet and physical activity of ulcerative colitis patients and to determine whether there is an association with disease activity. Methods In this cross-sectional study, data of 172 subjects were collected via an online questionnaire that consisted of several validated questionnaires: the Patient Simple Clinical Colitis Activity Index (P-SCCAI) to assess disease activity, a Food Frequency Questionnaire (FFQ) to assess habitual nutrient intake and the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH) to assess habitual physical activity. Nutrient intake was used to calculate the Adjusted Dietary Inflammatory Index (ADII). Physical activity data were used to calculate intensity levels (light, moderate or vigorous intensity) and duration of activity (min/week). These were used combined with age to calculate activity scores. Correlations between the ADII and physical activity with disease activity were investigated. Results The ADII ranged from −5.45 to 3.79 with a mean (±SD) of 0.00 (±1.55). The mean ADII was anti-inflammatory (−0.08) in subjects in remission, while it was pro-inflammatory in subjects with mild and moderately active ulcerative colitis (0.06 and 0.42, respectively), although the correlation between ADII and disease activity was not significant. With regard to physical activity, most minutes per week were spent on light to moderate activity at work or school (median [IQR] of 1375 [825]). The activity with the highest activity score was heavy activity at work or school (median [IQR] of 2160 [6480]). Subjects mostly performed activities of light intensity (median [IQR] of 840 [1575]). No significant differences in intensity levels, duration and activity score between subjects in remission and mild or moderately active ulcerative colitis were found. Also, no correlations were found between intensity levels, duration and activity score with disease activity. Conclusions We found no associations of diet and physical activity with disease activity in patients with ulcerative colitis. Funding Sources N.A.


Doctor Ru ◽  
2020 ◽  
Vol 19 (10) ◽  
pp. 27-32
Author(s):  
А.R. Tahirova ◽  
◽  
I.V. Sichinava ◽  
O.F. Savvateeva ◽  
E.V. Borisova ◽  
...  

Study Objective: To analyse the activity dynamics of Crohn’s disease (CD) and the quality of life (QoL) of children aged 8–17 years. Study Design: Open prospective non-randomized comparative study. Materials and Methods. The quality of life was assessed in 37 healthy children and 28 children with Crohn's disease (17 boys and 11 girls). Disease activity (Paediatric Crohn’s Disease Activity Index, PCDAI) was determined using PedsQL 4.0 Generic Core Scales questionnaire which comprises assessment of health and activity, child’s attitude, problems with interpersonal relations, and progress at school. Observation spanned over 18 months; tests parameters were assessed at the beginning (first visit), after 6, 12 and 18 months. QoL was assessed by both children and their parents, the indicators were assessed over time and compared with the levels of activity, the duration of the disease, and the presence of extraintestinal manifestations of the disease. Study Results. Children with CD aged 8–17 years demonstrated a decrease in the majority of PedsQL 4.0 parameters. The shifts are observed both when QoL is assessed by children and their parents. The therapy in these patients is accompanied by positive QoL dynamics; these changes occur in parallel with a decrease in the values of the CD activity index, suggesting the possibility of using the QoL parameters to predict the course of the disease and the effectiveness of the treatment in this population. PCDAI values in subjects demonstrated moderate statistically significant negative correlations with “Physical activity” (r = –0.412), “Attitude” (r = –0.364), “Psychosocial functioning” (r = –0.306) and “School life” (r = –0.344) and the overall PedsQL 4.0 values (r = –0.406). The duration of the disease has statistically significant negative correlation with “Physical activity” (r = –0.386), “Attitude” (r = –0.423), “Psychosocial functioning” (r = –0.345), and the integral PedsQL 4.0 value (r = –0.397); the presence of extraintestinal manifestations demonstrated moderate negative correlation with “Physical activity” (r = –0.342), “School life” (r = –0.431) and overall value (r = –0.372). Conclusion. Monitoring of the health-related quality of life should become a mandatory component of the examination and management of children with inflammatory bowel diseases, since this category of patients is characterized by a significant decrease relative to the corresponding indicators in healthy peers. Keywords: inflammatory bowel disorder, Crohn’s disease, quality of life, disease activity, extraintestinal manifestations.


2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S8-S8
Author(s):  
Suja Davis ◽  
Carlos Melendez ◽  
Patricia Crane ◽  
Millie Long

Abstract Background Individuals with IBD, comprised of Crohn’s disease (CD) and Ulcerative Colitis (UC), often have ongoing gastrointestinal symptoms that limit their ability to exercise. Importantly, exercise can help to maintain remission in individuals with IBD. Other positive health outcomes of exercise include improvement in quality of life, social and psychological well-being, weight maintenance, bone health, fatigue management and maintaining muscle mass and function. Unfortunately, many of the tools used to measure exercise are burdensome for clinical utility or are not applicable to the IBD population. The purpose of this secondary analysis was to determine if one question related to physical activity would capture exercise in adults with either UC or CD and those with active or inactive disease. Methods This study is a cross-sectional study using the data obtained from IBD Partners, an internet-based longitudinal cohort of adults ≥ 18 year of age living with IBD. This secondary analysis includes only those participants without a current ostomy or pouch, who completed demographic information, disease activity and exercise characteristics. Disease activity was measured via the simple clinical colitis activity index (SCCAI) for UC and the short Crohn’s disease activity index (sCDAI) for CD. Exercise was measured via the Godin Leisure -Time Activity Index (GLTA) questionnaire that assessed type of exercise and intensity for the past seven days. A separate measurement of physical activity included a single question: “How often did you participate in 1 or more physical activities of 20–30 minutes’ duration per session during your leisure time within the past 6 months?” measured via a 6-point ordered category item. Results A total of 8327 patients with IBD were included. Most (63%) of the participants had CD, and 54% were in remission. Majority of the participants were physically active based on GLTA scores (49.7%), and one question physical activity scores (62%; combined scores of 5 & 6). Polychoric correlation coefficient was computed, with a strong correlation between GLTA and the one question (r = 0.74, p &lt; 0.001). Ordinal regression analysis between the one physical activity question and IBD type (UC vs CD) yielded higher odds of physical activity with UC (Odds ratio (OR)=1.2, 95% CI [1.11 -1.31], p &lt; 0.0001). Similar results were noted with ordinal regression analysis between GLTA scores and UC;(OR=1.2, 95% CI [1.09 -1.3], p &lt; 0.0001). Conclusions Both GLTA and the single question of physical activity were highly correlated. The ordinal regression results were comparable for both measures. Adoption of the single physical activity question may adequately reflect exercise status in IBD patients and reduce burden for clinical use. Further longitudinal studies are need to support the use of one question in measuring exercise in those with IBD.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1281.2-1281
Author(s):  
A. Feki ◽  
I. Sellami ◽  
R. Akrout ◽  
S. Ben Jemaa ◽  
Z. Gassara ◽  
...  

Background:Physical activity (PA) is associated with multiple health-related benefits among the general population and adults with chronic diseases like Ankylosing spondylitis (AS) [1]. As known, AS affects primarily enthesis and can lead to loss of function and decreased mobility.Objectives:The aim of this study was to explore the PA levels of adults with AS and to examine associations between PA, sociodemographic characteristics, immunological features, disease activity and treatment type.Methods:Cross-sectional clinical and laboratory data were collected on 68 AS patients. BASDAI (Bath ankylosing spondylarthritis disease activity index) and BASFI (Bath ankylosing spondylarthritis functional index) were calculated. Physical activity was measured using IPAQ-SF (International Physical Activity Questionnaire-Short Form). Its items record the time spent on physical activity of three intensity levels (vigorous, moderate and walking) as well as the time spent on sitting (referred to as sedentary in this study) in the past week. Both continuous (expressed as metabolic equivalent of task (MET)-min /week) and categorical (3 levels proposed: low, moderate and high level of PA) scores of IPAQ-SF were determined. Sedentary time (median) was reported in minutes/week. A p value < 0.05 was considered significant.Results:Cross-sectional clinical and laboratory data were collected on 68 AS patients. BASDAI (Bath ankylosing spondylarthritis disease activity index) and BASFI (Bath ankylosing spondylarthritis functional index) were calculated. Physical activity was measured using IPAQ-SF (International Physical Activity Questionnaire-Short Form). Its items record the time spent on physical activity of three intensity levels (vigorous, moderate and walking) as well as the time spent on sitting (referred to as sedentary in this study) in the past week. Both continuous (expressed as metabolic equivalent of task (MET)-min /week) and categorical (3 levels proposed: low, moderate and high level of PA) scores of IPAQ-SF were determined. Sedentary time (median) was reported in minutes/week. A p value < 0.05 was considered significant.Conclusion:Our study proved that physical activity in people with AS decreased with age and activity disease with a concomitant increase in sedentary activity. Given the risks of developing secondary chronic disease as a result of low levels of physical activity, physical exercise should be recommended as part of comprehensive AS care.References:[1]Conigliaro P, Triggianese P, Ippolito F, Lucchetti R, Chimenti MS, Perricone R. Insights on the Role of Physical Activity in Patients with Rheumatoid Arthritis. Drug Dev Res. 2014;75:S54–6.Disclosure of Interests:None declared.


2018 ◽  
Vol 6 (8) ◽  
pp. 1323-1327 ◽  
Author(s):  
Blondina Marpaung ◽  
Andi Raga Ginting ◽  
OK Moehad Sjah

BACKGROUND: Midkine (MK) induces inflammation and could inhibit inducible regulatory T cell differentiation. These reports suggest that MK may play a role in the pathogenesis of autoimmune disease including SLE, but data about MK in SLE patients was still limited, and the role of Midkine in SLE is largely unknown.AIM: The purpose of this study was to compare serum level MK in SLE patients and control, also analysed the relationship between the serum MK level and disease activity in SLE.METHODS: This cross-sectional study was conducted in Adam Malik Hospital from January-June 2017. Diagnosis of SLE was established according to the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria, and disease activity was assessed using the Mexican Systemic lupus erythematosus disease activity index (MEX-SLEDAI). Subjects with evidence of malignancy and systemic disease (pulmonary, kidney, liver, metabolic disorder, etc.) were excluded. Data analysis was performed using SPSS 22nd version. P < 0.05 was considered statistically significant.RESULTS: There were 90 subjects and divided into 2 groups: SLE patients group (n=40) and healthy control groups (n = 50). Midkine levels were increased in the serum of SLE patients compared by health control. There was a significant difference in the median serum Midkine levels between SLE patients and healthy control (P < 0.001). Elevated Midkine serum levels were a significant difference between active disease and remission (P = 0.018).CONCLUSION: Elevated Midkine serum level could be a marker of SLE disease activity and have a role in the pathogenesis of SLE.


Author(s):  
Kiera Lee-Pii ◽  
Hui Xie ◽  
Yufei Zheng ◽  
Linda Li ◽  
Diane Lacaille

Various studies have demonstrated how rheumatoid arthritis (RA) patients perform less physical activity than the general population, likely due to joint pain and impaired physical function. However, physical activity (PA) may have beneficial effects on reducing inflammation and RA disease activity. The objective of this study was to evaluate the association between baseline PA levels and self-reported changes in measures of RA disease activity.   We conducted a longitudinal study using 2015-2017 data from an annual survey administered to an RA cohort in BC. Subjects were grouped into three levels (Low, Medium and High) of PA at the baseline year (2015) according to the specifications of the International Physical Activity Questionnaire. Subsequently, we examined whether baseline PA was associated with changes in RA disease activity outcomes over 2015 to 2017, using fitted linear mixed models for each measure and adjusting for age, sex and other covariates.   Of the 169 patients who responded to the 2015 survey, 29.6%, 42.0%, and 28.4% were grouped into Low, Medium, and High levels of PA, respectively. Our results demonstrated that the Low PA group experienced significant worsening of disease activity outcomes over the three years, including those of the Rheumatoid Arthritis Disease Activity Index (RADAI) (p=0.007), Fatigue (p=0.007), and Pain (p=0.007). Those in the Medium and High PA groups at baseline experienced either a decrease or no change in their disease activity outcomes over time. These results add to the accumulating evidence that physical activity may reduce disease activity and is essential to RA management.


2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Alexander Oldroyd ◽  
Max A. Little ◽  
William Dixon ◽  
Hector Chinoy

Abstract Background The idiopathic inflammatory myopathies (IIMs) are a group of rare conditions characterised by muscle inflammation (myositis). Accurate disease activity assessment is vital in both clinical and research settings, however, current available methods lack ability to quantify associated variation of physical activity, an important consequence of myositis. This study aims to review studies that have collected accelerometer-derived physical activity data in IIM populations, and to investigate if these studies identified associations between physical and myositis disease activity. Methods A narrative review was conducted to identify original articles that have collected accelerometer-derived physical activity data in IIM populations. The following databases were searched from February 2000 until February 2019: Medline via PubMed, Embase via OVID and Scopus. Results Of the 297 publications screened, eight studies describing accelerometer use in 181 IIM cases were identified. Seven out of the eight studies investigated juvenile dermatomyositis (JDM) populations and only one reported on an adult-onset population. Population sizes, disease duration, accelerometer devices used, body placement sites, and study duration varied between each study. Accelerometer-derived physical activity levels were reduced in IIM cohorts, compared to healthy controls, and studies reported improvement of physical activity levels following exercise programme interventions, thus demonstrating efficacy. Higher levels of accelerometer-derived physical activity measurements were associated with shorter JDM disease duration, current glucocorticoid use and lower serum creatine kinase. However, no clear association between muscle strength and accelerometer-derived physical activity measures was identified. Conclusions The use of accelerometer-derived physical activity in IIM research is in its infancy. Whilst knowledge is currently limited to small studies, the opportunities are promising and future research in this area has the potential to improve disease activity assessment for clinical and research applications.


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