scholarly journals Tofacitinib Citrate for Ulcerative Keratitis in a Patient with Rheumatoid Arthritis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Philip B. Meadow ◽  
Jacqueline Nguyen ◽  
Keerthana Kesavarapu
Keyword(s):  
Rheumatoid Arthritis ◽  
Reactive Protein ◽  
Laboratory Values ◽  
Body Sensation ◽  
History Of ◽  
Blurry Vision ◽  
Citrullinated Peptide ◽  
Preservative Free ◽  
Ulcerative Keratitis ◽  
Normal Laboratory

Purpose.To report a case of a patient with rheumatoid arthritis (RA) treated with tofacitinib citrate.Methods.Observational case report.Results.A 59-year-old patient, with a history of rheumatoid arthritis, on methotrexate 10 mg PO qwk and IV abatacept 750 mg/month, presented with photosensitivity, foreign body sensation, pain, redness, and blurry vision of her right eye (RE). Visual acuity of the RE was 20/200 and 20/20 of the left eye (LE). The slit lamp examination of the RE revealed dryness, 2+ injection of the conjunctiva, and pericentral ulceration of the cornea with 20–30% stromal thinning, pannus, and diffuse punctate epithelial erosions. The anterior chamber appeared normal. Laboratory values revealed elevated levels of rheumatoid factor, anticyclic citrullinated peptide antibodies, and C-reactive protein. The patient was switched to tofacitinib citrate 5 mg PO b.i.d, underwent corneal gluing, and was given prednisone acetate 1% gt TID, polytrim gt TID, neomycin-polymyxin-dexameth gt QD, FreshKote lubricant 1.8% gt QID, moxifloxacin 0.5% gt QID, and preservative free artificial tears Q1H. Within one week, laboratory values normalized, symptoms diminished, and the cornea reepithelialized.Conclusion.RA can present with ulcerative keratitis. Tofacitinib citrate, steroids, and corneal gluing were found to halt the progression of keratolysis and promote reepithelialization.

Quantifying anti-cyclic citrullinated peptide titres: clinical utility and association with tobacco exposure in patients with rheumatoid arthritis

2008 ◽  
Vol 68 (2) ◽  
pp. 201-208 ◽  
Author(s):  
D M Lee ◽  
R Phillips ◽  
E M Hagan ◽  
L B Chibnik ◽  
K H Costenbader ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Smoking History ◽  
Demographic Information ◽  
Tobacco Exposure ◽  
C Reactive Protein ◽  
Rheumatology Clinic ◽  
Reactive Protein ◽  
Antibody Titres ◽  
History Of ◽  
Citrullinated Peptide

Objective:To determine the significance of quantitative levels of antibodies to cyclic citrullinated peptides (anti-CCP) in a population of patients with rheumatoid arthritis (RA).Methods:A total of 241 consecutive sera from patients with RA sent from a large rheumatology clinic for laboratory testing were selected for precisely quantifying anti-CCP antibody titres with the anti-CCP2 assay. Patient charts were reviewed for demographic information, smoking history, clinical diagnosis, rheumatoid factor (RF) titre, radiographic information and other laboratory information (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level). Correlations with anti-CCP titre and RF titre, disease parameters and smoking history were assessed.Results:We confirm previous findings that anti-CCP seropositivity is associated with a higher incidence of erosions in patients with RA (56% vs 20% CCP+ vs CCP−, κ = 0.297, p<0.001). We also found a moderate correlation between anti-CCP titre and RF titre. However, we failed to find an association between anti-CCP titre and presence of erosions, between anti-CCP titre and CRP or ESR level, or between anti-CCP titre and age or disease duration. Interestingly, we did find significantly higher anti-CCP titres in patients with a history of smoking (452 units/ml vs 229 units/ml, smokers vs non-smokers, respectively; p = 0.02).Conclusions:Although anti-CCP titres were not associated with clinical parameters of disease, they are increased in patients with RA with exposure to tobacco. By contrast, no elevation in RF was noted in patients with a history of smoking. These observations are consistent with a pathogenic contribution of smoking to RA and suggest the immune stimulus for anti-CCP is distinct from that for RF.

scholarly journals Serum Levels of Anticyclic Citrullinated Peptide Antibodies, Interleukin-6, Tumor Necrosis Factor-α, and C-Reactive Protein Are Associated with Increased Carotid Intima-Media Thickness: A Cross-Sectional Analysis of a Cohort of Rheumatoid Arthritis Patients without Cardiovascular Risk Factors

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Mónica Vázquez-Del Mercado ◽  
Lourdes Nuñez-Atahualpa ◽  
Mauricio Figueroa-Sánchez ◽  
Eduardo Gómez-Bañuelos ◽  
Alberto Daniel Rocha-Muñoz ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Tumor Necrosis ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Citrullinated Peptide ◽  
Necrosis Factor

The main cause of death in rheumatoid arthritis (RA) is cardiovascular events. We evaluated the relationship of anticyclic citrullinated peptide (anti-CCP) antibody levels with increased carotid intima-media thickness (cIMT) in RA patients.Methods. Forty-five anti-CCP positive and 37 anti-CCP negative RA patients, and 62 healthy controls (HC) were studied. All groups were assessed for atherogenic index of plasma (AIP) and cIMT. Anti-CCP, C-reactive protein (CRP), and levels of tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA).Results. The anti-CCP positive RA patients showed increased cIMT compared to HC and anti-CCP negative (P<0.001). Anti-CCP positive versus anti-CCP negative RA patients, had increased AIP, TNFαand IL-6 (P<0.01), and lower levels of high density lipoprotein cholesterol (HDL-c) (P=0.02). The cIMT correlated with levels of anti-CCP (r=0.513,P=0.001), CRP (r=0.799,P<0.001), TNFα(r=0.642,P=0.001), and IL-6 (r=0.751,P<0.001). In multiple regression analysis, cIMT was associated with CRP (P<0.001) and anti-CCP levels (P=0.03).Conclusions. Levels of anti-CCP and CRP are associated with increased cIMT and cardiovascular risk supporting a clinical role of the measurement of cIMT in RA in predicting and preventing cardiovascular events.

scholarly journals Heart Rate–corrected QT Interval Duration in Rheumatoid Arthritis and Its Reduction with Treatment with the Interleukin 6 Inhibitor Tocilizumab

2018 ◽  
Vol 45 (12) ◽  
pp. 1620-1627 ◽  
Author(s):  
Hitomi Kobayashi ◽  
Yasuyuki Kobayashi ◽  
Isamu Yokoe ◽  
Noboru Kitamura ◽  
Atsuma Nishiwaki ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interleukin 6 ◽  
Qt Interval ◽  
Cardiac Repolarization ◽  
Matrix Metalloproteinase 3 ◽  
Reactive Protein ◽  
Response Measures ◽  
Qt Interval Duration ◽  
Citrullinated Peptide ◽  
Repolarization Abnormalities

Objective.Individuals with rheumatoid arthritis (RA) are at a heightened risk of sudden cardiac death, an outcome increased in those with prolongation of the corrected electrocardiographic QT interval (QTc). We compared QTc between patients with RA and demographically matched controls and studied the change in QTc after treatment with the interleukin 6 inhibitor tocilizumab (TCZ).Methods.Standard 12-lead electrocardiograms were obtained and QTc was measured in patients with RA at baseline and after 24 weeks of TCZ treatment, then compared with non-RA controls who were frequency-matched on age and sex. Indicators of the baseline QTc and predictors of change in QTc were studied using multivariable linear regression.Results.A total of 94 RA and 42 non-RA controls were studied. The average baseline QTc was 10 ms longer in the RA group vs controls (422 vs 412 ms, respectively; p < 0.001) and decreased to an average of 406 ms with treatment (p < 0.001). Baseline QTc was significantly and independently higher among those with anticyclic citrullinated peptide antibodies seropositivity, higher swollen joint counts, and higher levels of C-reactive protein (CRP) and matrix metalloproteinase 3. Each log unit decrease in CRP with treatment was associated with an average reduction in QTc of 2.9 ms (p = 0.002) after adjusting for age and baseline QTc. Clinical response measures were not associated with the change in QTc.Conclusion.The marked normalization of QTc observed with TCZ treatment, and its close parallel with CRP reduction, support the premise that systemic inflammation contributes to cardiac repolarization abnormalities in RA that may be amenable to treatment.

scholarly journals Stabilization of Bilateral Progressive Rheumatoid Corneal Melt with Infliximab

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Sheelah F. Antao ◽  
Tariq Ayoub ◽  
Hasan Tahir ◽  
Dipak N. Parmar
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Amniotic Membrane ◽  
Conventional Treatment ◽  
Penetrating Keratoplasty ◽  
Amniotic Membrane Transplantation ◽  
Cyanoacrylate Glue ◽  
Ocular Discomfort ◽  
History Of ◽  
Ulcerative Keratitis

Purpose. To report the use of infliximab in the rapid stabilization of a case of progressive, bilateral rheumatoid peripheral ulcerative keratitis (PUK) that failed to respond to conventional immunosuppressive therapy.Methods. A single interventional case report.Results. A patient with rheumatoid arthritis presented with bilateral PUK following a 2-month history of ocular discomfort and redness. His systemic prednisolone (PDN) and methotrexate (MTX) were increased and, despite an initial favorable response, bilateral recurrent corneal perforations ensued. Both eyes underwent cyanoacrylate glue repair, amniotic membrane transplantation (AMT), and penetrating keratoplasty (PKP). Recurrence of the disease and bilateral perforations of the second PKP in both eyes prompted administration of intravenous infliximab immediately after the fourth PKP. The disease activity rapidly settled in both eyes, and at eighteen-month followup, after 12 infliximab infusions, the PUK remains quiescent with no further graft thinning or perforation.Conclusion. Infliximab can be used to arrest the progression of severe bilateral rheumatoid PUK in cases that are refractory to conventional treatment.

Evaluation of Selected Rheumatoid Arthritis Activity Scores for Office-based Assessment

2010 ◽  
Vol 37 (12) ◽  
pp. 2466-2468 ◽  
Author(s):  
MARY BETH SULLIVAN ◽  
CHRISTINE IANNACCONE ◽  
JING CUI ◽  
BING LU ◽  
KERRI BATRA ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Duration ◽  
Office Setting ◽  
Reactive Protein ◽  
Patient Reported ◽  
Pairwise Correlations ◽  
Patient Reported Measures ◽  
Rheumatoid Arthritis Activity ◽  
Citrullinated Peptide

Objective.Patient-reported measures can quickly provide assessments of rheumatoid arthritis (RA) disease activity in the office setting and do not require a laboratory test or physician examination. The goal of our study was to establish the validity of patient-reported indices compared to the C-reactive protein-based Disease Activity Score (DAS28-CRP4).Methods.Baseline and 1-year followup DAS28-CRP4 data were obtained from 740 RA subjects and were compared to indices (MDHAQ, CDAI, RAPID, RADAI, GAS) according to cyclic citrullinated peptide (CCP) status and change at 1 year. Pairwise correlations were calculated for each index.Results.Among 740 subjects, mean age 57 years, disease duration 14 years, the CDAI (r = 0.84, Δ r = 0.80) and RAPID (r = 0.71, Δ r = 0.70) had the highest correlation with the DAS28-CRP4 scores at baseline and 1 year. These correlations were not influenced by CCP status, disease-modifying antirheumatic drug use, biologic use, or by disease duration.Conclusion.In RA, the CDAI and RAPID correlated well with the DAS28-CRP4. They may both be practical and informative in the care of patients in the office setting.

scholarly journals Rheumatoid arthritis in a sickle cell patient: a dangerous association?

2021 ◽  
Vol 2 ◽  
pp. 29-31
Author(s):  
Fatoumata Diakité ◽  
Youssouf Traoré ◽  
Boubacari Ali Touré ◽  
Boureima Kodio ◽  
Mohomedine Touré ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Normocytic Anemia ◽  
Cell Disease ◽  
Ulnar Deviation ◽  
Reactive Protein ◽  
The Right ◽  
Inflammatory Syndrome ◽  
Citrullinated Peptide

Introduction - The diagnosis of rheumatoid arthritis remains a challenge because sickle cell disease can result in various rheumatological manifestations, including joint and bone pain. The concomitant presence of rheumatoid arthritis and sickle cell disease makes the therapeutic management of both conditions problematic. Observation - A 24-year-old man, a nurse by profession, has been followed for 10 years for homozygous sickle cell disease at the Sickle Cell Disease Research Center (CRLD) of Bamako, Mali. He has presented for 8 months symmetrical polyarthritis with morning stiffness of 3 hours, distinct from the usual vaso-occlusive crisis. The Analog Visual Scale was estimated at 80/100. He reported unquantified weight loss and asthenia. The physical examination showed a deformity in bilateral ulnar deviation, flexion of the right elbow, twelve painful joints, and five swollen joints. Normochromic normocytic anemia (hemoglobin 8.3g/dl), inflammatory syndrome with C - Reactive Protein (CRP) 130.91 mg, and Sedimentation Rate (ESR) 72mm at the first hour were noted. Rheumatoid Factor was weakly positive at 21.3 IU and Anti Citrullinated Peptide Antibodies at 385.2 IU. The radiography discovered bilateral erosive carpets without associated tarsitis and osteonecrosis of both femoral heads. The diagnosis of a very active immunopositive erosive rheumatoid arthritis meeting the criteria of ACR / EULAR 2010 was retained. A treatment based on prednisone 10 mg per day was initiated, associated with methotrexate at a dosage of 15 mg weekly in single-dose, folic acid, calcium, and vitamin D. Conclusion - The coexistence of rheumatoid arthritis in sickle cell patients makes the diagnosis of polyarthritis difficult.

scholarly journals The impact of therapies as monotherapy with combined therapy on novel and traditional biomarkers in patients with rheumatoid arthritis

2020 ◽  
Vol 24 (3) ◽  
pp. 325-332
Author(s):  
Asmaa Haydar ◽  
Ijlal Abdullah
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Markers ◽  
Combined Therapy ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Group I ◽  
Group Ii ◽  
Citrullinated Protein ◽  
Citrullinated Peptide

Background and objectives: Rheumatoid arthritis is an autoimmune and inflammatory disease that influences many tissues and organs. Inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate, anti-cyclic citrullinated protein, rheumatoid factor, and 14-3-3η protein have been found to play an important role in both the diagnosis and progression of rheumatoid arthritis. This study aimed to elucidate the effect of anti-rheumatoid medication, as mono- and combined therapy, on these inflammatory mediators. Methods: A cross-sectional study was performed at Hawler Medical University, College of Pharmacy, Erbil, Iraq. Forty-two patients of both genders with rheumatoid arthritis participated in the study as group I. Forty-four age–gender matched adults (with no rheumatoid arthritis) were included as a comparison group or group II. Serum levels of biomarkers were determined by enzyme linked immune sorbent assay. Results: There was a statistically significant (P <0.05) increased level of serum anti-cyclic citrullinated peptide, 14-3-3η protein, erythrocyte sedimentation rate, C-reactive protein, and rheumatic factor levels in group I compared with group II. The serum level of the anti-cyclic citrullinated peptide significantly decreased in rheumatoid patients treated with combined therapy compared with mono remedy. However, the mean of body mass index, age, and gender of group I was non-significantly different from group II (P >0.05). Conclusion: Therapeutic regimen of mono or combined therapy played a role in changing levels of inflammatory markers. Anti-cyclic citrullinated protein significantly decreased with the combined therapy in comparison with the monotherapy regimen. Keywords: Rheumatic arthritis; Monotherapy; Combined therapy; Anti-rheumatoid; Inflammatory markers.

scholarly journals Rheumatoid Arthritis and CLOVES Syndrome: A Tricky Diagnosis

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 467
Author(s):  
Laura Damian ◽  
Andrei Lebovici ◽  
Cristina Pamfil ◽  
Cristina Belizna ◽  
Romana Vulturar
Keyword(s):  
Rheumatoid Arthritis ◽  
Venous Malformation ◽  
Pik3ca Mutation ◽  
Young Female ◽  
Leg Length ◽  
Clinical Criteria ◽  
Activating Mutations ◽  
Dysmorphic Features ◽  
History Of ◽  
Citrullinated Peptide

The PI3K/AKT/mTOR signaling pathway is significantly activated in rheumatoid arthritis. In addition, somatic activating mutations of the PI3K/AKT/mTOR pathway may result in PIK3CA-related overgrowth spectrum diseases, including CLOVES (Congenital Lipomatous Overgrowth, Vascular malformation, Epidermal nevi, Skeletal abnormalities/Scoliosis) syndrome. We describe the case of a young female patient, with anti-citrullinated peptide antibodies-positive rheumatoid arthritis, referred for persistent finger pain and stiffness. Examination revealed discrete macrodactyly involving two fingers, scoliosis, asymmetrical calves, venectasias, a shoulder nevus and triangular feet with a “sandal gap” between two toes. These mild dysmorphic features with early-onset and the history of surgeries for thoracic lipoma and venous malformation were strongly suggestive of CLOVES syndrome. Confirmatory mutation analysis was not performed, as blood or saliva testing is not contributive for tissue-specific localized effects in the PIK3CA-related overgrowth spectrum. Nevertheless, lack of detection of a PIK3CA mutation does not exclude the diagnosis in patients fulfilling clinical criteria. Due to the patient’s wish to plan a pregnancy, therapy consisted in sulfasalazine and hydroxychloroquine, along with orthotic correction of leg length discrepancy. Overgrowth syndromes and arthritis may share common pathways. Mild macrodactyly should be differentiated from dactylitis. Diagnosing patients with minimal dysmorphic features within the PI3K-related overgrowth spectrum may help design better care strategies, in the quest for personalized medicine.

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