scholarly journals POS0589 PREVALENCE AND SEVERITY OF STRESS AT HOME AMONG PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 527.2-527
Author(s):  
M. Haroon ◽  
F. Hashmi ◽  
S. Ullah ◽  
A. Ashraf ◽  
H. J. Shaheen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Regression Analysis ◽  
Disease Duration ◽  
Female Gender ◽  
Severe Stress ◽  
Das 28 ◽  
Low Education ◽  
Education Status ◽  
Patient Enrolment ◽  
At Home

Background:In chronic inflammatory diseases like rheumatoid arthritis (RA), psychological stress is widely recognised as an important risk factor to negatively affect the disease course. Stress activates the hypothalamic-pituitary adrenal axis and the autonomic nervous system, which associate with the release of neurotransmitters (i.e. norepinephrine), hormones (i.e. cortisol) and activation of immune cells. Perceived stress can potentially induce the disease exacerbation, but on the other hand, the disease itself might produce significant stress to patients thus the vicious circle is formed and maintained.Objectives:We aimed to examine the prevalence of mental/emotional stress at home and its associations among patients with Rheumatoid arthritis. We addressed this question using real-world data from the PRIME registry.Methods:This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts, tender joint counts, deformed joint counts, and DAS-28. All participants were directly inquired at the interview during the time of patient enrolment about the presence or otherwise of mental/emotional stress at home, and to rate it from 1-3 (mild, moderate, severe). For better understanding and ease of statistical analysis, dichotomous variable was made with moderate-to-severe stress patients were categorised into one group and none-to-mild stress patients into second group.Results:The data of consecutive 507 RA patients (mean age 42.3±12.6 years, 73.6% female, disease duration of 80±22 months) was reviewed. Forty-eight percent of patients accepted to have moderate-severe stress at home (moderate stress=29.9%, severe stress=18.3%). On univariate analysis, significant association of moderate-severe stress at home was noted with deformed joint counts (p=0.036), higher DAS-28 scores (p<0.001), and being married (p=0.001). Weak statistical association of age (p=0.11), disease duration (p=0.13), low education status (p=0.14), female gender (p=0.24) was noted. On multiple logistic regression analysis, a significant association of moderate-severe stress at home was observed with higher DAS-28 scores (OR 1.76, CI 1.29-2.41, p<0.001) and deformed joint counts (OR 1.15, CI 1.00-1.31, p=0.040). Following variables were included in multiple stepwise regression analysis: age, disease duration, low education status, married, Das-28 scores, and deformed joint counts. However, when gender was included in the regression analysis, a significant association of moderate-severe stress at home was observed with female gender (OR 3.99, CI 1.47-10.83, p=0.007), higher DAS-28 scores (OR 1.8, CI 1.31-2.51, p<0.001), with marginal association with deformed joint counts (OR 1.13, CI 0.99-1.30, p=0.061).Conclusion:Stress at home is common among patients with RA, and nearly half of the cohort was noted to have moderate-severe level of stress at home. Ongoing stress at home has significant association with higher RA disease activity and deformities suggesting a bidirectional relationship. These findings demonstrate an important need for integration of rheumatologic, social workers and mental health servicesDisclosure of Interests:Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Farzana Hashmi: None declared, Saadat Ullah: None declared, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared, Sadia Asif: None declared, Shabnam Batool: None declared

scholarly journals P138 Developing a digital remote assessment for monitoring rheumatoid arthritis disease activity

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Francesca Donadoni ◽  
Letizia Gionfrida ◽  
Benjamin Clarke ◽  
James Galloway
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Small Sample ◽  
Clinical Team ◽  
Long Term Conditions ◽  
Home Setting ◽  
Face To Face ◽  
Das 28 ◽  
Monitoring Platform ◽  
At Home

Abstract Background/Aims  In an era of increasingly stretched health care resources, accompanied by pressures to deliver more care for people with long term conditions remotely, we need innovative solutions to measure disease activity. In the case of monitoring rheumatoid arthritis (RA), a robust method of capturing reliable Disease Activity Score (DAS-28) information remotely could reduce patient visits to hospitals and free up clinic space. Information would ideally be captured from a home setting by a patient. However, self-reporting of DAS-28 has limited reliability especially at moderate or high levels of disease activity. A mechanism for remotely ascertaining DAS-28 which is both accurate and precise would improve remote management for people living with RA. Methods  We undertook a study to assess patient attitudes regarding a novel remote RA monitoring platform, which uses images and video captured movements to estimate DAS-28. The study involved a semi-structured 30-minutes video interview. Participants were adults with RA living in the UK. The interviews focused on these key areas: i) an overview of their history with the condition, ii) familiarity with DAS-28, iii) relationship with the clinical team, iv) relationship with technology and telemedicine, v) feedback on the RA monitoring platform. Results  Eleven subjects participated in the study. They reported a median disease duration of 11 years (range: 4 to 35), and all had experienced flares, with 10/11 familiar with the DAS-28 prior to the study interview. Since the start of the COVID-19 pandemic, most patients only had contact with clinicians or healthcare facilities over the phone, with only one patient having visited a hospital for a reason not directly related to RA, and one patient having no contact at all. Overall, patients expressed enthusiasm towards the RA monitoring platform and were confident that they would be able to use it at home. Access over the Internet was not perceived as a barrier, and the advantages of tracking disease progression regularly, sharing data with the consultant and saving time travelling to appointments far outweighed the disadvantages. Participants generally reported that they would most benefit from a blended interaction with the clinical team, combining face-to-face appointments with use of the platform at home rather than seeing the platform as a complete alternative to face-to-face assessment. Conclusion  This study provides the first insight into the perception and acceptance of the RA monitoring platform in a small sample of RA patients. Results are positive, and support further evaluation of the platform. Evidence to understand how technology can improve the quality of telemedicine for people with RA is urgently needed as the pandemic continues. Disclosure  F. Donadoni: None. L. Gionfrida: None. B. Clarke: None. J. Galloway: None.

Demodex folliculorum in patients with rheumatoid arthritis

2007 ◽  
Vol 52 (1) ◽  
Author(s):  
Ihsan Ciftci ◽  
Umit Dundar ◽  
Zafer Cetinkaya ◽  
Mustafa Kulac ◽  
Nilay Kiyildi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Disease Duration ◽  
Demodex Folliculorum ◽  
Das 28 ◽  
Immunosuppressed Patients ◽  
The Mean ◽  
Demodex Mites ◽  
Assessment Of Disease Activity

AbstractThe objective of this study was to investigate the incidence and density of Demodex folliculorum in the patients with rheumatoid arthritis (RA). Forty-one patients with RA and twenty-seven age and sex matched healthy controls were enrolled in this study. Disease Activity Score (DAS 28) was used for the assessment of disease activity. Out of 41 patients, 33 were females and 8 males. The mean disease duration was 10.9 ± 8.2 years. The mean DAS 28 was 3.8 ± 1.2. No statistically significant differences in the incidence and density of Demodex mites were found between patients with RA and controls. Although immunosuppression is thought to be a risk factor for the D. folliculorum infestation no such correlations could be found in the 41 immunosuppressed patients with RA, therefore, further studies with larger groups are needed.

scholarly journals Interstitial Lung Disease and its Associations in Rheumatoid Arthritis: Data from a District General Hospital in Sri Lanka

2021 ◽  
Vol 14 ◽  
pp. 117954412110287
Author(s):  
Geetha Wickrematilake
Keyword(s):  
Rheumatoid Arthritis ◽  
Interstitial Lung Disease ◽  
Sri Lanka ◽  
Lung Disease ◽  
General Hospital ◽  
Low Income ◽  
Disease Duration ◽  
District General Hospital ◽  
Simple Method ◽  
Das 28

Context: Interstitial lung disease (ILD) is a frequent pulmonary manifestation of rheumatoid arthritis (RA). No Sri Lankan studies have determined the prevalence of lung disease in RA and its associations. Aims: To find the prevalence of ILD in RA and its association with rheumatoid factor (RF), erosions, Disease activity score in 28 joints (DAS 28), disease duration, Body mass index(BMI), erythrocyte sedimentation rate (ESR), smoking, and also to determine the prevalence of lung disease with demographic factors like age, sex, and income. Settings and Design: Questionnaire based retrospective study at a District General Hospital in Sri Lanka. Materials and Methods: Diagnosed RA patients included through convenient sampling as it was a simple method that could facilitate data collection in a short duration. Since all patients with a diagnosis of RA were eligible, all consecutive patients with a diagnosis of RA at the rheumatology clinics were included in the study. To reduce the bias a large sample of patients were used as well as patients attending different rheumatology clinics were included and also patients who were referred to the hospital from peripheries were included in the study. The calculated sample size was 384 and according to patient numbers attending clinics, a period of 6 months was decided to select the study sample. Statistical Analysis Used: Chi-Square calculation and logistic regression analysis using Minitab 17 software. Results: From 384 patients, the prevalence of ILD was 14.58%, been 5.4% in early RA (<2 years disease duration). Mean age of ILD group was 52.94 years (95% CI 64.66-41.22). Mean RA duration was 7.69 years (95% CI, 2.38-12.99). Male to female sex ratio of RA was 1:7, and that of ILD was 2:9. DAS 28 was 4.58 (95% CI, 3.48-5.68). Statistically significant associations were noted with ILD and DAS 28 ( P = .0006), ESR ( P = .005), RF ( P = .03), erosions ( P < .00001), and smoking ( P < .05). Mean BMI was 22.67 kg and 75.78% had low income (<50 000 rupees/month = 327 US $). Conclusions: ILD significantly associates RA severity indices like DAS 28, ESR, erosions, RF, and also with smoking. No significant association was found with BMI or gender difference. Therefore, disease severity indices could be used to predict progression to ILD in RA.

The influence of coping styles on long-term employment in multiple sclerosis: A prospective study

2016 ◽  
Vol 23 (7) ◽  
pp. 1008-1017 ◽  
Author(s):  
Nina Grytten ◽  
Anne BR Skår ◽  
Jan Harald Aarseth ◽  
Jorg Assmus ◽  
Elisabeth Farbu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Regression Analysis ◽  
Disease Duration ◽  
Coping Styles ◽  
Female Gender ◽  
Avoidant Coping ◽  
Predictive Values ◽  
Cox Regression Analysis

Background: The aim was to investigate predictive values of coping styles, clinical and demographic factors on time to unemployment in patients diagnosed with multiple sclerosis (MS) during 1998–2002 in Norway. Method: All patients ( N = 108) diagnosed with MS 1998–2002 in Hordaland and Rogaland counties, Western Norway, were invited to participate in the long-term follow-up study in 2002. Baseline recordings included disability scoring (Expanded Disability Status Scale (EDSS)), fatigue (Fatigue Severity Scale (FSS)), depression (Beck Depression Inventory (BDI)), and questionnaire assessing coping (the Dispositional Coping Styles Scale (COPE)). Logistic regression analysis was used to identify factors associated with unemployed at baseline, and Cox regression analysis to identify factors at baseline associated with time to unemployment during follow-up. Results: In all, 41 (44%) were employed at baseline. After 13 years follow-up in 2015, mean disease duration of 22 years, 16 (17%) were still employed. Median time from baseline to unemployment was 6 years (±5). Older age at diagnosis, female gender, and depression were associated with patients being unemployed at baseline. Female gender, long disease duration, and denial as avoidant coping strategy at baseline predicted shorter time to unemployment. Conclusion: Avoidant coping style, female gender, and longer disease duration were associated with shorter time to unemployment. These factors should be considered when advising patients on MS and future employment.

scholarly journals POS0667 TOFACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-WORLD SETTINGS: A NATIONAL MULTICENTER STUDY OF 167 PATIENTS FROM ARGENTINA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 576-577
Author(s):  
M. D. R. Maliandi ◽  
Y. S. Malvano ◽  
A. Cusa ◽  
M. J. Gamba ◽  
R. Gomez ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Clinical Remission ◽  
Disease Duration ◽  
Biological Therapy ◽  
Treatment Persistence ◽  
Medical Centers ◽  
Radiological Damage

Background:Tofacitinib (TOF), an oral JAK inhibitor, is approved for the treatment of rheumatoid arthritis (RA) either as monotherapy or in combination with background methotrexate (MTX). Despite the current evidence of efficacy from randomized controlled trials and open-label long-term extension studies, evidence of effectiveness and safety in real-world settings is limited, not only in Argentina but also in Latin America.Objectives:To describe effectiveness, safety and persistence of TOF therapy in RA patients from public and private medical centers from Argentina. In addition, establish prognostic factors for clinical remission at 3 months and TOF monotherapy at 12 months.Methods:A retrospective, observational and multicentre study was performed from an analysis of medical records of 10 medical centers. RA patients (ACR/EULAR, 2010) and age ≥ 18 years who had received or are under treatment with TOF until June 2020 were included. The data collection was done on a standard database that included baseline data and at 3, 6 and 12 months. Clinical remission was defined as DAS28-ESR < 2,6. Adverse events, treatment duration, TOF treatment persistence at last visit and discontinuation cause were assessed. Comparison to baseline values was performed using Wilcoxon sign for numerical variables and McNemar´s test for categorical variables. Treatment persistence was analyzed using Kaplan Meier´s technique. Multivariate analysis was performed using R software and its library packages (Lme4, Tidyverse and ggpubr). A p value < 0.05 was considered significant.Results:A total of 167 patients were included (78.4% were female). At baseline, the median age was 53 years (IQR 43-63 years), median disease duration was 4 years (IQR 2-13 years). RF was positive in 85.6% of patients, ACPA in 80.8% and structural radiological damage was present in 71.8%. Previous use of MTX was 97%, leflunomide 74.8% and biologic therapy 42.5% (28.74% 1 biologic, 11.98% 2 biologics and 1.8% ≥ 3 biologics). TOF dose: 48% 11 mg/day and 52% 5 mg BID. A statistically significant difference was observed not only in disease activity (p<0.0001) but also in the requirement of MTX and PDN (p<0.0001) in the 12 months evaluated. Remission significantly increased from baseline to month 3 and to a much lesser extent to month 6 (p < 0.001). The mean duration of treatment with TOF was 20.10 ± 15.25 months. Treatment persistence was 93.84% at 3 months and 91.24% at 6 months. In those patient who achieved REM at month 3, a statistically significant differences in duration of RA (p 0.0002), structural radiological damage (p 0.011), basal disease activity (p 0.018) and prior treatment with biological therapy (p 0.017) was found when compared with patients who remained active. Furthermore, in univariate logistic regression analysis, 5 years or more of disease duration was associated with a 3 times higher risk of not achieving clinical remission at 3 months (odds ratio = 0.35, 95% CI = 0.15-0.83). In the multivariate logistic regression analysis, previous biological therapy was the only predictor associated with a decrease in the probability of clinical remission (p < 0.008). Adverse events were registered in 26 patients (herpes zoster, n = 9).Conclusion:The effectiveness of TOF was observed not only in the clinical response achieved but also in the dose titration or withdrawal of MTX and PDN. The safety profile did not show any difference from long-term extension studies. At 12 months, 86.81% of the patients persisted with TOF therapy. We found prognostic factors associated with clinical remission at 3 months but those associated with monotherapy at 12 months could not be defined due to small number of patients analyzed that could have generated lack of statistical power, although more studies are required to confirm these assumptions.Disclosure of Interests:Maria Del Rosario Maliandi: None declared, Yanina Silvia Malvano: None declared, Alejandra Cusa: None declared, María Julieta Gamba: None declared, Ramiro Gomez Speakers bureau: Abbvie, Novartis, Julio Got: None declared, Oscar Gut: None declared, Ursula Vanesa Paris: None declared, Maria Andrea Spinetto: None declared, Carolina Mariach: None declared, Alejandra Ines Abalo: None declared, Adrián Estevez Speakers bureau: Bristol-Meyer-Squibb, Jose Luis Velazco Zamora: None declared, Juan Pablo Vinicki: None declared

scholarly journals POS0310 EXPOSURE TO MAJOR PSYCHOLOGICAL TRAUMA OR STRESS IN THE PRECEDING ONE YEAR SIGNIFICANTLY CONTRIBUTES TO POOR DISEASE CONTROL IN PATIENTS WITH RHEUMATOID ARTHRITIS: SINGLE CENTRE RESULTS FROM THE PRIME REGISTRY COHORT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 381.2-381
Author(s):  
M. Haroon ◽  
S. Asif ◽  
S. Batool ◽  
F. Hashmi ◽  
S. Ullah ◽  
...  
Keyword(s):  
Disease Activity ◽  
Marital Status ◽  
Psychological Stress ◽  
Rheumatic Diseases ◽  
Disease Duration ◽  
Psychological Trauma ◽  
Stressful Events ◽  
Das 28 ◽  
Education Status ◽  
One Year

Background:Stress response is considered to involve the activation of both the hypothalamus-pituitary-adrenal axis and the autonomic nervous system, along with its communication with the immune system. Because many rheumatic diseases are characterized by immune-mediated joint inflammation, stressful events might contribute to the aetiology, maintenance and exacerbation of rheumatic diseases.Objectives:We aimed to examine whether real-life major stressful events lead to poor disease control among patients with Rheumatoid arthritis (RA). We addressed this question using real-world data from the PRIME registry.Methods:This was a cross-sectional study conducted using data collected at the time of patient enrolment in the PRIME registry. The PRIME Registry is a large, independent, prospective, observational cohort initiated in October 2019 that comprises patients diagnosed with RA, SLE, PsA or AS by a rheumatologist, and is being actively followed up. IRB approval and informed consent was obtained. We assessed the registry data for RA patients. The clinical variables studied were gender, age, smoking habits, body mass index, education status, marital status, disease duration, comorbidities (using Charlson Comorbidity Index). Education status was stratified by whether participants completed secondary (high) school education. Evaluation of disease activity and severity was made as per internationally agreed definitions, such as: swollen joint counts (SJC), tender joint counts (TJC), deformed joint counts, and DAS-28. Major psychological trauma or stress was defined if the patient has experienced any of the following in the past year: a) major personal injury or illness; b) death/major illness of a close relative; c) marital separation/divorce; d) loss of job; e) major financial loss; f) mass casualty incident loss.Results:The data of consecutive 507 RA patients (mean age 42.3±12.6 years, 73.6% female, disease duration of 80±22 months) was reviewed. Thirty-six percent of the cohort reported to have major psychological stress and trauma in the preceding one year. No statistical association of age, gender, and marital status was noted, but statistical association of low education status (p=0.042), longer disease duration (p=0.044), higher DAS-28 values (p<0.001) and other markers of RA disease activity (SJC, TJC, ESR, patient global health) was found. On multiple logistic regression analysis, a significant association of major psychological stress and trauma in the preceding one year was noted with active disease (DAS-28; OR 1.67, CI 1.17-2.4, p=0.005). Following variables were included in the full regression model, disease duration, gender, age, marital status, education status, and DAS-28 value (also used models with SJC, TJC, deformed joint counts, ESR, patient global health, but the results remained unchanged).Conclusion:Major psychological stress and trauma in the preceding one year is associated with high disease activity among patients with RA. Therapies that focus on stress management may be important adjuncts to traditional pharmacotherapy in the treatment of inflammatory rheumatic diseases.Disclosure of Interests:Muhammad Haroon Speakers bureau: Roche, Novartis, Grant/research support from: Abbvie, Pfizer, Sadia Asif: None declared, Shabnam Batool: None declared, Farzana Hashmi: None declared, Saadat Ullah: None declared, Arfa Ashraf: None declared, Hafiza Javeria Shaheen: None declared

scholarly journals SAT0153 GENDER DOES NOT INFLUENCE CLINICAL RESPONSE TO JAK INHIBITORS IN RHEUMATOID ARTHRITIS: AN ITALIAN MULTICENTRE ANALYSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1016.2-1017
Author(s):  
F. R. Spinelli ◽  
M. S. Chimenti ◽  
M. Vadacca ◽  
C. Iannuccelli ◽  
P. Conigliaro ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Clinical Response ◽  
Social Impact ◽  
Disease Duration ◽  
Female Gender ◽  
Clinical Feature ◽  
Jak Inhibitors ◽  
Low Disease Activity ◽  
Men And Women

Background:Gender medicine aims at describing how diseases differ between men and women in terms of epidemiology, clinical feature, therapeutic approach, treatment response and prognosis, psychological and social impact. Rheumatoid Arthritis (RA) affects women 2-3 times more than men. Female gender seems to be independently associated to a more refractory disease and a worst response to conventional synthetic Disease Modifying Anti-Rheumatic Drugs (csDMARDs) and biological DMARDs. Male patients achieve remission more often than females probably due to the higher number of tender joints reported by the latter.Objectives:In the light of the effect of Janus kinases inhibitors (JAKi) on pain, the objective of the study was to investigate whether gender might affect the achievement of remission or low disease activity in RA patients treated with baricitinib and tofacitinib.Methods:We performed a multicentric, prospective study on consecutive patients starting one of the two available JAKi: baricitinib and tofacitinib. Demographic and clinical data were recorded in a dedicate database and included: gender, age, disease duration, serological status (Rheumatoid Factor – RF; anti-citrullinated peptide antibodies, ACPA) number of previous csDMARDs and bDMARDs, number of tender joints (TJ) and swollen joints (SJ), C reactive protein (CRP); patient global assessment (PGA) and pain were recorded on a 0-100 mm visual-analogue scale (VAS). Disease activity score (DAS) 28 was calculated at baseline and at two follow-up visits (after 3-4 months and after 6-8 months). Data were expressed as mean±standard deviation or median (interquartile range) according to variables’ distribution. Continuous variables were compared by Mann Whitney test while dichotomous ones by Chi-squared test; p value < 0.05 were considered statistically significant.Results:We enrolled 182 RA patients (149 F:33 M) with similar age (F 58±12 vs M 60±10) and disease duration (F 143±101 vs M 147±105 months). Females and males were previously treated with the same number of csDMARDs [2(2)] but female have previously received numerically more bDMARDs [2(3) vs 1(2)]. At the 3 timepoints females and males showed similar number of TJ, SJ, similar values of CRP, PGA and pain. We did not observe any difference in percentage of males and females achieving remission or low disease activity according to gender (figure 1A) nor in terms of reduction of TJ, SJ and PGA; only pain decreased significantly more in male than in female patients at both timepoints (figure 1B).Conclusion:In RA patients treated with JAK inhibitors, even if the effect of JAKi on pain seems to be more relevant in male than in female, gender seems not to influence the overall clinical response, allowing men and women the same probability of reaching the therapeutic targetReferences:Disclosure of Interests:Francesca Romana Spinelli Grant/research support from: Pfizer, Speakers bureau: Lilly, BMS, Celgene, Maria Sole Chimenti: None declared, Marta Vadacca: None declared, Cristina Iannuccelli: None declared, Paola Conigliaro: None declared, Silvia Laura Bosello: None declared, Fulvia Ceccarelli: None declared, Cristina Garufi: None declared, Giulia Raffone: None declared, Paola Di Noi: None declared, Dario Bruno: None declared, Antonella Afeltra: None declared, Roberto Perricone: None declared, fabrizio conti Speakers bureau: BMS, Lilly, Abbvie, Pfizer, Sanofi, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB

Body Mass Index Impact on Disease Activity, Clinical and Sonographic Remission Rates in Patients with Rheumatoid Arthritis

2019 ◽  
Vol 15 (3) ◽  
pp. 215-223
Author(s):  
Tanya Sapundzhieva ◽  
Rositsa Karalilova ◽  
Anastas Batalov
Keyword(s):  
Rheumatoid Arthritis ◽  
Body Mass Index ◽  
Disease Activity ◽  
Body Mass ◽  
Normal Weight ◽  
Clinical Disease ◽  
Clinical Disease Activity ◽  
Das 28 ◽  
Remission Rates ◽  
Activity Indices

Aim: To investigate the impact of body mass index (BMI) on clinical disease activity indices and clinical and sonographic remission rates in patients with rheumatoid arthritis (RA). Patients and Methods: Sixty-three patients with RA were categorized according to BMI score into three groups: normal (BMI<25), overweight (BMI 25-30) and obese (BMI≥30). Thirty-three of them were treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), and 30 with biologic DMARDs (bDMARDs). Patients underwent clinical and laboratory assessment and musculoskeletal ultrasound examination (MSUS) at baseline and at 6 months after initiation of therapy. We evaluated the rate of clinical and sonographic remission (defined as Power Doppler score (PD) = 0) and its correlation with BMI score. Results: In the csDMARDs group, 60% of the normal weight patients reached DAS28 remission; 33.3% of the overweight; and 0% of the obese patients. In the bDMARDs group, the percentage of remission was as follows: 60% in the normal weight subgroup, 33.3% in the overweight; and 15.8% in the obese. Within the csDMARDs treatment group, two significant correlations were found: BMI score–DAS 28 at 6th month, rs = .372, p = .033; BMI score–DAS 28 categories, rs = .447, p = .014. Within the bDMARDs group, three significant correlations were identified: BMI score–PDUS at sixth month, rs = .506, p =.004; BMI score–DAS 28, rs = .511, p = .004; BMI score–DAS 28 categories, rs = .592, p = .001. Sonographic remission rates at 6 months were significantly higher in the normal BMI category in both treatment groups. Conclusion: BMI influences the treatment response, clinical disease activity indices and the rates of clinical and sonographic remission in patients with RA. Obesity and overweight are associated with lower remission rates regardless of the type of treatment.

Can Cytokines be used as an Activation Marker in Rheumatoid Arthritis?

2020 ◽  
Vol 20 ◽  
Author(s):  
Fatih Öner Kaya ◽  
Yeşim Ceylaner ◽  
Belkız Öngen İpek ◽  
Zeynep Güneş Özünal ◽  
Gülbüz Sezgin ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Healthy Volunteers ◽  
Venous Blood ◽  
Cross Sectional Study ◽  
Joint Disease ◽  
Control Group ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Das 28 ◽  
Tnf Α

Aims: The etiopathogenesis of Rheumatoid Arthritis (RA) is not clearly understood. However, the role of the cytokines takes an important part in this mechanism. We aimed to bring a new approach to the concept of 'remission' in patients with RA. Background: RA is a chronic, autoimmune, inflammatory disease that involves small joints in the form of symmetrical polyarthritis and progresses with exacerbations and remissions. Pain, swelling, tenderness and morning stiffness are typical of the joints involved. Although it is approached as a primary joint disease, a wide variety of extra-articular involvements may also occur. It is an interesting pathophysiological process, the exact cause of which is still unknown, with many environmental, genetic and potentially undiscovered possible factors in a chaotic manner. Objective: In this cross-sectional study, sedimentation rate (ESR), C- Reactive protein (CRP), Tumor necrosis factor (TNF)-α, soluble-TNF-α receptor (TNF-R), Interleukin (IL)-1B and IL-10 were measured in three groups which were healthy volunteers, patients with RA in the active period, and patients with RA in remission. Disease activity score-28 (DAS-28) was calculated in active RA and RA in remission. Methods: This study included 20 healthy volunteers, 20 remission patients with RA and 20 active RA patients. Venous blood samples were collected from patients in both healthy and RA groups. Results: RA group consisted 43 (71.6%) female and 17 (28.4%) male. Control group consisted 11 (55%) female and 9 (45%) male. TNF-R was significantly high only in the active group according to the healthy group (p=0.002). IL-10 was significantly high in active RA according to RA in remission (p=0.03). DAS-28 was significantly high in active RA according to RA in remission (p=0.001). In the active RA group, ESR and TNF-R had a positive correlation (r:0.442; p=0.048). In the active RA group, there was also a positive correlation between TNF-R and CRP (r:0.621; p=0,003). Both healthy and active RA group had significant positive correlation between ESR and CRP (r: 0.481; p=0.032 and r: 0,697; p=0,001 respectively). Conclusion: TNF-R can be the main pathophysiological factor and a marker showing activation. TNF-R can be very important in revealing the effect of TNF on the disease and the value of this effect in the treatment and ensuring the follow-up of the disease with CRP instead of ESR in activation.

Anti-carbamylated Protein Antibodies and Serum Level of 14-3-3 Protein for Early Detection of Rheumatoid Arthritis Patient in Correlation with Rheumatoid Factor, Anti-CCP Antibodies, Disease Activity and Joint Damage using High Frequency Musculoskeletal Ultrasound

2020 ◽  
Vol 7 (2) ◽  
pp. 141-153
Author(s):  
Sahar A. Ahmed ◽  
Enas M. Darwish ◽  
Walaa A. Attya ◽  
Mai Samir ◽  
Mennatallah Elsayed ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Rheumatoid Factor ◽  
Disease Activity Score ◽  
Joint Damage ◽  
Musculoskeletal Ultrasound ◽  
Activity Score ◽  
Das 28 ◽  
Significant Difference ◽  
Hands And Feet

Background: Rheumatoid arthritis (RA) is a common progressive chronic inflammatory autoimmune disease which affects mostly small joints, causing pain, swelling, deformity, and disability. Although progress has been made in exploring RA nature, still there is a lot to know about the disease pathogenesis, diagnosis, and treatment. Aim of the Work: To investigate the role of serum anti-carbamylated protein antibodies and 14-3-3η in the diagnosis of RA compared to rheumatoid factor (RF), anti-CCP antibodies, and highfrequency musculoskeletal ultrasound used to assess the disease activity and joint damage. Methods: Serum anti-carbamylated protein antibodies and 14-3-3η were measured using ELISA in 61 RA patients and 26 normal controls. RA Disease Activity Score (DAS 28), X-ray and musculoskeletal ultrasound (hands and feet), carotid ultrasound (Intima-Media Thickness IMT) were used in assessing the RA disease. Results: Anti-carbamylated protein antibodies were significantly elevated in RA patients 4.5 (4.1- 8.9 U⁄ml) compared to the control 3.2(1.9- 4.3 U⁄ml) (p< 0.001) but 14-3-3η showed no significant difference. There was a significant positive correlation between anti-carbamylated protein antibodies, 14-3-3η levels and disease activity score assessed by DAS 28, increased IMT measured by carotid duplex, total synovitis and total erosion score were assessed by musculoskeletal ultrasound. There was no correlation between RF and anti-CCP antibodies. Anti-carbamylated protein antibodies were found to have 66.7% sensitivity and 85.2% specificity in RA diagnosis, while 14- 3-3η had 51.9% sensitivity and 72.1% specificity. Conclusion: Anti-carbamylated protein antibodies and 14-3-3η have a high sensitivity and specificity in RA diagnosis and had a correlation with the disease activity and joint damage.

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