POS1355 THE REMITTING SERONEGATIVE SYMMETRICAL SYNOVITIS WITH PITTING EDEMA SYNDROME (RS3PE): REVIEW OF TEN YEARS AT A REFERENCE HOSPITAL

Background:The Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome (RS3PE) is a rare rheumatological disease, considered a benign process.Objectives:This study aims to describe its clinical features and serological markers, and also to analyze its possible association with neoplasms.Methods:An observational retrospective study was performed to assess demographic and clinical characteristics of patients diagnosed from RS3PE at a reference hospital amongst the Rheumatology and Internal Medicine departments, from 2010 to 2021.Results:Twenty-seven patients were included, with a mean age of 82.74 y.o. (IC95% 80.45-85.04; range 66 to 93), and a 51.85% proportion of males. Only 22.22% were from rural areas.All patients presented bilateral hand edema although some associated feet edema (40.74%) or morning stiffness (70.37%). Blood tests demonstrated anemia in 44.44% of patients. Inflammatory markers were elevated, such as C-Reactive Protein (29.23 mg/L, IC95% 18.17-40.29), erythrocyte-sedimentation rate (33.74 mm/hour, IC95% 24.22-43.26) and fibrinogen (531.6 mg/dL, IC95% 482.91-580.30). Only a few patients presented any autoimmune serological marker such as antinuclear antibodies (18.18%) or rheumatoid factor (8.70%).X-ray screening was realized to 22 patients. 14 showed of osteoarthritis radiologic presentation, 4 had radiological findings of chondrocalcinosis and one of them presented both. Only one patient had bone erosion.Malignancy screening was performed at diagnosis in only 29.63% of patients (all negative). During follow-up only two tumors were detected (mean accumulated follow-up: 40.37 months, IC95% 26.70-54.04; range 1 to 122) and there were adenocarcinoma primary neoplasms.All but one patient received low-dose corticosteroids, with a good and rapid response in all cases. Three patients received treatment with methotrexate (2) or leflunomide (1).Conclusion:RS3PE must be contemplated in elderly patients presenting with bilateral hand pitting edema and articular symptoms. No specific biomarkers have been described, but inflammatory reaction is often found in the absence of rheumatoid arthritis biomarkers. Rapid response to corticosteroids is prevalent. Only two neoplasms were detected during follow-up.References:[1]Paira S, Graf C, Roverano S, Rossini J. Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases. Clin Rheumatol. 2002 May;21(2):146-9. doi: 10.1007/pl00011218. PMID: 12086166.[2]Cobeta García JC, Martínez Burgui J. RS3PE syndrome or benign edematous polysynovitis in the elderly. Study of 8 cases. Rev Clin Esp. 1999 Dec;199(12):785-9. Spanish. PMID: 10687410.[3]Moreno Obregón F, Del Castillo Madrigal M, Díaz Narváez F, Pérez Delgado FJ. RS3PE syndrome with positive rheumatoid factor. Reumatol Clin. 2019 Nov-Dec;15(6):e168-e169. English, Spanish. doi: 10.1016/j.reuma.2017.11.009. Epub 2017 Dec 15. PMID: 29254743Disclosure of Interests:None declared

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Immunological and Biochemical Peculiarities of the Rheumatoid Arthritis

Bulletin of Science and Practice ◽

10.33619/2414-2948/67/29 ◽

2021 ◽

Vol 7 (6) ◽

Author(s):

A. Chaldanbaeva ◽

A. Chargynova

Keyword(s):

Rheumatoid Arthritis ◽

Rheumatoid Factor ◽

Scientific Literature ◽

The Elderly ◽

Men And Women ◽

Cyclic Citrullinated Peptide ◽

Reactive Protein ◽

Men 2 ◽

Rheumatoid Arthritis Disease ◽

Citrullinated Peptide

The article presents the results of studies of immunological and biochemical characteristics of diseases of the osteoarticular system among residents of Bishkek. The studies were carried out on residents of Bishkek, men and women aged 21–74, in the spring of 2019, in the fall of 2019 and in the fall of 2020. A total of 1358 people were examined for ACCP, of which 282 residents of Bishkek were found to have an ACCP content higher than the norm, among which 238 were women and 44 were men. The level of antibodies to cyclic citrullinated peptide (ACCP) was determined in blood serum by immunochemiluminescence analysis. Biochemical studies aimed at identifying the activity of the process and immune inflammation consisted of determining the levels of rheumatoid factor (RF), C-reactive protein (CRP), Antistreptolysin-O (ASL-O) and uric acid (MC) according to generally accepted methods. Out of the selected 282 Bishkek residents, 17 men and 82 women belong to the confirmation group, while 27 men and 156 women are in the group of people with increased levels of ACCP were first established. ACCPs mainly belong to the IgG class and are found in the blood at the earliest stages of rheumatoid arthritis disease (1–2 years before the onset of the first symptoms) and their specificity in rheumatoid arthritis is about 97%. They are detected at very early stages of the disease, which explains the distribution of the surveyed residents of Bishkek by groups. Analysis by sex distribution showed that in all groups women prevail than men, since it is known from scientific literature source that diseases of the osteoarticular system, in particular rheumatoid arthritis, are more susceptible to women than men. Women get sick more often than men 2–5 times more, which was found in our studies, the ratio of men and women is on average 1:3.4–5.6. It has been proven that damage to the osteoarticular system can occur at any age. According to our data, 47.7% of the total number of surveyed men were aged 35–60 years, 45.5% were men aged 61–74 years. At the same time, among women, 37% were aged 35–60 years, 36.3% were women aged 61–74 years. According to scientific literature sources, the incidence of rheumatoid arthritis increases with age, over 60 years old reaches its maximum value (more than 2%), the population is aging when RA grows. Gender differences are also lost, the ratio of women to men is 2:1 or less. At the same time, rheumatoid arthritis can develop at any age, most often from 35 to 50 years, but it can also be in childhood and in the elderly. According to our results, among women under 35 years of age in the confirmation group, the prevalence of RA was 28.3%, at the age of 36-60 years 58.8%, and at the age of over 61 years — 43.6%. And in the group of primary confirmation, women under 35 years old accounted for 16.7%, at the age of 36-60 they make up 20.4% and over 60 years old — 28.5%. As you know, ACCP can be detected in 30% of cases of seronegative rheumatoid arthritis (negative for rheumatoid factor), which is advisable in the diagnosis of early seronegative RA, in differential diagnosis with other rheumatic diseases. Elevated ACCP levels in healthy individuals indicate a significant increase in the risk of developing RA. Rheumatoid factor is an autoimmune antibody, an immunoglobulin protein (IgM) produced by the body's immune system. Autoantibodies attack their own tissues, mistaking them for foreign ones. Although the nature of rheumatoid factor is still poorly understood, its presence is an indicator of inflammatory and autoimmune processes. With rheumatoid arthritis symptoms, high rheumatoid factor levels are likely to indicate seropositive rheumatoid arthritis. However, even a negative test result does not exclude that the patient has these diseases. Antibodies to cyclic citrullinated peptide and RF are currently recognized as an informative serological marker of rheumatoid arthritis. Based on studies carried out at different times of the year (spring, autumn 2019, autumn 2020), it was found that the season does not have a significant effect on the content of the ACCP level, although residents of Bishkek (men and women) often complain of pain in the joints in the fall. than in the spring. This is confirmed by the highest content of ACCP among women, as well as men over 35 years old to 74 years old.

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bFGF could be a biomarker of malignancy in RS3PE syndrome: an ambispective single-center cohort analysis of 51 patients

Arthritis Research & Therapy ◽

10.1186/s13075-021-02638-0 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Yuzhou Gan ◽

Yi Sun ◽

Jiayang Jin ◽

Yifan Wang ◽

Jiali Chen ◽

...

Keyword(s):

Inflammatory Arthritis ◽

Cohort Analysis ◽

Serum Levels ◽

Fibroblast Growth ◽

Rs3pe Syndrome ◽

Elderly Onset ◽

Hematological Tumor ◽

Pitting Edema ◽

Elderly Onset Rheumatoid Arthritis

Abstract Objectives Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare inflammatory arthritis, with a higher incidence of malignancy. The aim of this study is to identify biomarkers for predicting malignancy in RS3PE. Methods A total of 51 patients with RS3PE from September 2007 to May 2019 were retrospectively reviewed and followed for up to 5 years, with 15 patients with osteoarthritis (OA) and 14 patients with elderly-onset rheumatoid arthritis (EORA) as disease controls. Serum levels of angiogenesis cytokines were measured by electrochemiluminescent immunoassay and Luminex Human Magnetic Assay. Clinical data and laboratory parameters were analyzed to identify risk factors for malignancy. Results A total of forty-eight RS3PE patients (94.1%) were available with follow-up data; 8 patients (16.7%) were diagnosed with malignancy, of which 6 patients were hematological tumor; and 2 patients were solid tumors. Serum levels of basic fibroblast growth factor (bFGF) were exclusively higher in RS3PE patients with malignancy [14.21 (7.52, 23.18) ng/mL] than RS3PE patients without malignancy [4.32 (2.88, 7.42) ng/mL], OA [3.20 (2.20, 5.30) ng/mL], and EORA [3.20 (2.20, 5.30) ng/mL]. The optimal cut-off value of bFGF for malignancy was 10ng/mL in RS3PE. Logistic regression analysis indicated that elevation of bFGF was a risk factor for malignancy in RS3PE. Conclusions This study indicated that bFGF was elevated in RS3PE patients with malignancy and could serve as a biomarker for predicting paraneoplastic RS3PE.

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bFGF could be a Biomarker of Malignancy in RS3PE Syndrome: an Ambispective Single Center Cohort Analysis of 51 Patients

10.21203/rs.3.rs-696714/v1 ◽

2021 ◽

Author(s):

Yuzhou Gan ◽

Yi Sun ◽

Jiayang Jin ◽

Yifan Wang ◽

Jiali Chen ◽

...

Keyword(s):

Inflammatory Arthritis ◽

Cohort Analysis ◽

Serum Levels ◽

Fibroblast Growth ◽

Rs3pe Syndrome ◽

Elderly Onset ◽

Hematological Tumor ◽

Pitting Edema ◽

Elderly Onset Rheumatoid Arthritis

Abstract ObjectivesRemitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare inflammatory arthritis, with a higher incidence of malignancy. The aim of this study is to identify biomarkers for predicting malignancy in RS3PE.MethodsA total of 51 patients with RS3PE from September 2007 to May 2019 were retrospectively reviewed and followed for up to 5 years, with 15 patients with osteoarthritis (OA) and 14 patients with elderly-onset rheumatoid arthritis (EORA) as disease controls. Serum levels of angiogenesis cytokines were measured by electrochemiluminescent immunoassay and Luminex Human Magnetic Assay. Clinical data and laboratory parameters were analyzed to identify risk factors for malignancy.ResultsA total of forty-eight RS3PE patients (94.1%) were available with follow-up data, 8 patients (16.7%) were diagnosed with malignancy, of which 6 patients were hematological tumor, and 2 patients were solid tumor. Serum levels of basic fibroblast growth factor (bFGF) were exclusively higher in RS3PE patients with malignancy [14.21 (7.52, 23.18) ng/mL] than RS3PE patients without malignancy [4.32 (2.88, 7.42) ng/mL], OA [3.20 (2.20, 5.30) ng/mL] and EORA [3.20 (2.20, 5.30) ng/mL]. The optimal cut-off value of bFGF for malignancy was 10ng/mL in RS3PE. Logistic regression analysis indicated that elevation of bFGF was a risk factor for malignancy in RS3PE.ConclusionsThis study indicated that bFGF was elevated in RS3PE patients with malignancy and could serve as a biomarker for predicting paraneoplastic RS3PE.

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Prevalence of deep vein thrombosis (DVT) in non-surgical patients at hospital admission

Thrombosis and Haemostasis ◽

10.1160/th07-02-0107 ◽

2007 ◽

Vol 98 (10) ◽

pp. 765-770 ◽

Cited By ~ 12

Author(s):

Wibke Hoffmanns ◽

Phillip Hoffmanns ◽

Uli Rapp ◽

Michael Ames ◽

Alessandro Pira ◽

...

Keyword(s):

Internal Medicine ◽

Risk Factors ◽

The Elderly ◽

Acute Illness ◽

Surgical Patients ◽

Vein Thrombosis ◽

Reactive Protein ◽

Deep Vein ◽

D Dimer

SummaryVenous thromboembolism (VTE) is known as a common complication in surgical and non-surgical patients. We hypothesized that according to the underlying risk factors and the acute illness, the prevalence of VTE in non-surgical patients admitted to hospital is widely underestimated. For three months each patient admitted to the department of internal medicine with an acute illness, but without known deep venous thrombosis (DVT) was investigated by ultrasound compression sonography. Patients’ history, risk factors and extent of immobilisation were documented. In patients with newly detected DVT D-dimer and fibrinogen were measured as well as computer tomography scans performed. Follow-up investigations of the DVT population were performed at four weeks and three months. Six hundred seventeen patients (49.3% men) were included. In 16 patients (men=7) a previously unknown thrombosis (2.6%) was detected, mainly in patients with acute cardio-pulmonary disease (56%) and the elderly (mean age 75.6 years). Eight patients had femoro-popliteal (50.0%), four a femoral (25.0%), and four a popliteal vein thrombosis (25.0%). Five had pulmonary embolism (31.3%). In patients with DVT D-dimer was 875 ± 1,228 mg/l, fibrinogen 568 ± 215 mg/dl and C-reactive-protein 58.54 ± 73.65 mg/dl. One patient died from sepsis during hospitalisation, one died from sudden cardiac death at home. None of the other 14 surviving patients relapsed. The study shows a 2.6% risk for DVT in outpatients with acute illness admitted to the department of internal medicine. These data demonstrate the high risk of DVT is in non-surgical patients. Early prophylaxis has to be considered in internal medicine patients especially in the elderly.

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Complementary Effects of Multivitamin and Omega-3 Fatty Acid Supplementation on Indices of Cardiovascular Health in Individuals with Elevated Homocysteine

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000093 ◽

2012 ◽

Vol 82 (1) ◽

pp. 41-52 ◽

Cited By ~ 5

Author(s):

P. Earnest ◽

S. Kupper ◽

M. Thompson ◽

Guo ◽

S. Church

Keyword(s):

Risk Factors ◽

Cardiovascular Health ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

C Reactive Protein ◽

Fatty Acid Supplementation ◽

Omega 3 Fatty Acid ◽

Reactive Protein ◽

Daily Ingestion

Homocysteine (HCY), C-reactive protein (hsCRP), and triglycerides (TG) are risk factors for cardiovascular disease (CVD). While multivitamins (MVit) may reduce HCY and hsCRP, omega-3 fatty acids (N3) reduce TG; yet, they are seldom studied simultaneously. We randomly assigned 100 participants with baseline HCY (> 8.0 umol/L) to the daily ingestion of: (1) placebo, (2) MVit (VitC: 200 mg; VitE: 400 IU; VitB6: 25 mg; Folic Acid: 400 ug; VitB12: 400 ug) + placebo, (3) N3 (2 g N3, 760 mg EPA, 440 mg DHA)+placebo, or (4) MVit + N3 for 12 weeks. At follow-up, we observed significant reductions in HCY (umol/L) for the MVit (- 1.43, 95 %CI, - 2.39, - 0.47) and MVit + N3 groups (- 1.01, 95 %CI, - 1.98, - 0.04) groups, both being significant (p < 0.05) vs. placebo (- 0.57, 95 %CI, - 1.49, 0.35) and N3 (1.11, 95 % CI, 0.07, 2.17). hsCRP (nmol/L) was significantly reduced in the MVit (- 6.00, 95 %CI, - 1.04, - 0.15) and MVit + N3 (- 0.98, 95 %CI, - 1.51, - 0.46) groups, but not vs. placebo (- 0.15, 95 %CI, - 0.74, 0.43) or N3 (- 0.53, 95 %CI, - 1.18, 0.12). Lastly, we observed significant reductions in TG for the N3 (- 0.41, 95 %CI, - 0.69, - 0.13) and MVit + N3 (- 0.71, 95 %CI, - 0.93, - 0.46) groups, both significant vs. placebo (- 0.10, 95 %CI, - 0.36, 0.17) and MVit groups (0.15, 95 %CI, - 12, 0.42). The co-ingestion of MVit + N3 provides synergistic affects on HCY, hsCRP, and plasma TG.

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No relation between biomarkers at age 47–49 and aortic diameter after 14–19 years of follow-up – a population-based study

VASA ◽

10.1024/0301-1526/a000632 ◽

2017 ◽

Vol 46 (4) ◽

pp. 291-295 ◽

Cited By ~ 2

Author(s):

Soumia Taimour ◽

Moncef Zarrouk ◽

Jan Holst ◽

Olle Melander ◽

Gunar Engström ◽

...

Keyword(s):

Population Based ◽

Aortic Diameter ◽

Aortic Dilatation ◽

Population Based Study ◽

Reactive Protein ◽

Abdominal Aortic ◽

Long Term Follow Up ◽

Old Men

Abstract. Background: Biomarkers reflecting diverse pathophysiological pathways may play an important role in the pathogenesis of abdominal aortic aneurysm (aortic diameter ≥30 mm, AAA), levels of many biomarkers are elevated and correlated to aortic diameter among 65-year-old men undergoing ultrasound (US) screening for AAA. Probands and methods: To evaluate potential relationships between biomarkers and aortic dilatation after long-term follow-up, levels of C-reactive protein (CRP), proneurotensin (PNT), copeptin (CPT), lipoprotein-associated phospholipase 2 (Lp-PLA2), cystatin C (Cyst C), midregional proatrial natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM) were measured in 117 subjects (114 [97 %] men) aged 47–49 in a prospective population-based cohort study, and related to aortic diameter at US examination of the aorta after 14–19 years of follow-up. Results: Biomarker levels at baseline did not correlate with aortic diameter after 14–19 years of follow up (CRP [r = 0.153], PNT [r = 0.070], CPT [r = –.156], Lp-PLA2 [r = .024], Cyst C [r = –.015], MR-proANP [r = 0.014], MR-proADM [r = –.117]). Adjusting for age and smoking at baseline in a linear regression model did not reveal any significant correlations. Conclusions: Tested biomarker levels at age 47–49 were not associated with aortic diameter at ultrasound examination after 14–19 years of follow-up. If there are relationships between these biomarkers and aortic dilatation, they are not relevant until closer to AAA diagnosis.

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C-reactive protein as a marker of progression of carotid atherosclerosis in subjects with type 2 diabetes mellitus

VASA ◽

10.1024/0301-1526/a000614 ◽

2017 ◽

Vol 46 (3) ◽

pp. 187-192 ◽

Cited By ~ 7

Author(s):

Aleš Pleskovič ◽

Marija Šantl Letonja ◽

Andreja Cokan Vujkovac ◽

Jovana Nikolajević Starčević ◽

Katarina Gazdikova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Carotid Atherosclerosis ◽

Inflammatory Marker ◽

Progression Rate ◽

C Reactive Protein ◽

Reactive Protein ◽

Hs Crp ◽

Unstable Plaques

Abstract. Background: This prospective study was designed to evaluate the effect of inflammatory markers on the presence and progression of subclinical markers of carotid atherosclerosis in a 3.8-year follow-up period in patients with type 2 diabetes mellitus (T2DM). Patients and methods: A total of 595 subjects with T2DM were enrolled. Subclinical markers of carotid atherosclerosis (carotid intima media thickness (CIMT), plaque thickness, and plaques presence) were assessed with ultrasound at the time of recruitment and again after 3.8 years. Subjects with T2DM were divided into 2 groups according to the plasma high sensitive C-reactive protein (hs-CRP) levels (subjects with hs-CRP ≥ 2 mg/L and subjects with hs-CRP below 2 mg/L). Results: Subjects with T2DM and hs-CRP levels ≥ 2 mg/L had higher CIMT in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L, and higher incidence of plaques/unstable plaques in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L. Multivariate logistic regression analysis found the association between the HDL cholesterol level and presence of plaques, whereas the inflammatory marker hs-CRP was not associated with subclinical markers of progression of carotid atherosclerosis. Multiple linear regression analysis found the association between the hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up. Conclusions: We demonstrated an association between the inflammatory marker hs-CRP and either CIMT or incidence of plaques/unstable plaques at the time of recruitment in Caucasians with T2DM. Moreover, we found the association between hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up in subjects with T2DM.

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Evaluation of R-CHOP and R-CVP in the treatment of elderly patient with non-Hodgkin lymphoma

MedPharmRes ◽

10.32895/ump.mpr.3.3.1 ◽

2019 ◽

Vol 3 (3) ◽

pp. 1-6

Author(s):

Truc Phan ◽

Tram Huynh ◽

Tuan Q. Tran ◽

Dung Co ◽

Khoi M. Tran

Keyword(s):

Elderly Patients ◽

Hodgkin Lymphoma ◽

B Cell Lymphoma ◽

Complete Response ◽

The Elderly ◽

Free Survival ◽

Non Hodgkin Lymphoma ◽

Common Sign ◽

Related Mortality

Introduction: Little information is available on the outcomes of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) in treatment of the elderly patients with non-Hodgkin lymphoma (NHL), especially in Vietnam. Material and methods: All patients were newly diagnosed with CD20-positive non-Hodgkin lymphoma (NHL) at Blood Transfusion and Hematology Hospital, Ho Chi Minh city (BTH) between 01/2013 and 01/2018 who were age 60 years or older at diagnosis. A retrospective analysis of these patients was perfomed. Results: Twenty-one Vietnamese patients (6 males and 15 females) were identified and the median age was 68.9 (range 60-80). Most of patients have comorbidities and intermediate-risk. The most common sign was lymphadenopathy (over 95%). The proportion of diffuse large B cell lymphoma (DLBCL) was highest (71%). The percentage of patients reaching complete response (CR) after six cycle of chemotherapy was 76.2%. The median follow-up was 26 months, event-free survival (EFS) was 60% and overall survival (OS) was 75%. Adverse effects of rituximab were unremarkable, treatment-related mortality accounted for less than 10%. There was no difference in drug toxicity between two regimens. Conclusions: R-CHOP, R-CVP yielded a good result and acceptable toxicity in treatment of elderly patients with non-Hodgkin lymphoma. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive complete response rate.

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