Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

Abstract Background Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA). Methods We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2-C7 angle, were measured before and after surgery. Results The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p = 0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (> 7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.66; 95% confidence interval, 1.37–15.84; p = 0.014). Conclusion We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (> 7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

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Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

BMC Surgery ◽

10.1186/s12893-020-00900-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Byeong Jin Ha ◽

Yu Deok Won ◽

Je Il Ryu ◽

Myung-Hoon Han ◽

Jin Hwan Cheong ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Sagittal Alignment ◽

Multivariate Logistic Regression Analysis ◽

Atlantoaxial Instability ◽

Atlantoaxial Fusion ◽

T1 Slope ◽

Significant Difference ◽

Cervical Sagittal Alignment ◽

Before And After ◽

Atlantodental Interval

Abstract Background Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA). Methods We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2–C7 angle, were measured before and after surgery. Results The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p = 0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (> 7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.59; 95% confidence interval, 1.34–15.73; p = 0.015). Conclusion We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (> 7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

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Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

10.21203/rs.3.rs-35674/v2 ◽

2020 ◽

Author(s):

Byeong Jin Ha ◽

Yu Deok Won ◽

Jeil Ryu ◽

Myung-Hoon Han ◽

Jin Hwan Cheong ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Sagittal Alignment ◽

Multivariate Logistic Regression Analysis ◽

Atlantoaxial Instability ◽

Atlantoaxial Fusion ◽

T1 Slope ◽

Significant Difference ◽

Cervical Sagittal Alignment ◽

Before And After ◽

Atlantodental Interval

Abstract Background: Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA).Methods: We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2-C7 angle, were measured before and after surgery.Results: The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p=0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (>7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.59; 95% confidence interval, 1.34-15.73; p=0.015).Conclusion: We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (>7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

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Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

10.21203/rs.3.rs-35674/v3 ◽

2020 ◽

Author(s):

Byeong Jin Ha ◽

Yu Deok Won ◽

Jeil Ryu ◽

Myung-Hoon Han ◽

Jin Hwan Cheong ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Sagittal Alignment ◽

Multivariate Logistic Regression Analysis ◽

Atlantoaxial Instability ◽

Atlantoaxial Fusion ◽

T1 Slope ◽

Significant Difference ◽

Cervical Sagittal Alignment ◽

Before And After ◽

Atlantodental Interval

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AB0655 RHEUMATOID ARTHRITIS ACTIVITY BEFORE AND AFTER COVID-19 LOCKDOWN PERIOD

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.576 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1360.1-1360

Author(s):

M. Jordhani ◽

D. Ruci ◽

F. Skana ◽

E. Memlika

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Musculoskeletal Diseases ◽

Statistical Tests ◽

Laboratory Data ◽

World Population ◽

Chronic Patients ◽

Das 28 ◽

Significant Difference ◽

Before And After

Background:The COVID-19 global pandemic has had a great impact on world population due to morbidity, mortality and restriction measures in order to stop the progression of COVID-19.Patients with rheumatic and musculoskeletic diseases, and especially rheumatoid arthritis (RA) patients, being one of the vulnerable classes of chronic patients, were recommended to follow the government’s rules1.Objectives:The aim of this study was to evaluate DAS-28-ESR in patients with rheumatoid arthritis before and after lockdown period.Methods:This is a multi-center observational study including 85 patients which were evaluated before and after lockdown for their disease activity score according to DAS-28-ESR score. They had been diagnosed with rheumatoid arthritis more than 5 years ago. A thorough physical examination was performed before and after the lockdown period. It included examination of tender and swollen joints and patient’s global health. They were completed with all required laboratory data, including erythrosedimentation rate. For a more accurate calculation, DAS-28-ESR was used in an electronic version. Patients with other inflammatory or infective diseases were excluded from the study. All data were statistically evaluated using statistical tests such as t-student test.Results:The first group (the one before lockdown) had an average DAS-28-ESR of 4.7 while after the lockdown period, the average DAS-28-ESR was 5.16.After statistically evaluating all data, it was found that there exists a significant difference between DAS-28-ESR score before and after COVID-19 lockdown (p=0.0011).Conclusion:Our study showed that lockdown period due to COVID-19 pandemic, has aggravated disease activity in patients with Rheumatoid Arthritis. This may be consequence of various causes such as physical inactivity and difficulty to follow-up or to take the medication properly.References:[1]Landewé RB, Machado PM, Kroon F, et al, EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2, Annals of the Rheumatic Diseases 2020;79:851-858.Disclosure of Interests:None declared.

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The impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

10.21203/rs.3.rs-18000/v1 ◽

2020 ◽

Author(s):

Jia Li ◽

Di Zhang ◽

Yong Shen

Keyword(s):

Risk Factors ◽

Neck Pain ◽

Sagittal Alignment ◽

Multivariate Logistic Regression Analysis ◽

Cervical Disc ◽

Multivariate Logistic Regression ◽

Cervical Kyphosis ◽

T1 Slope ◽

Sagittal Parameters ◽

Axial Neck Pain

Abstract Background:Cervical sagittal alignment is closely related with cervical disc degeneration and impacts the spinal function and quality of life, especially for cervical kyphosis (CK). The purpose of this study was to evaluate the influence of cervical sagittal parameters on the axial neck pain (ANP) in patients with CK.Methods: A retrospective analysis was performed of data from 263 patients who underwent to the authors’ department of this institution between January 2012 and December 2018. Radiographic evaluations were performed at authors’ department, including CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt and cervical tilt. Sagittal alignment of the cervical spine was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to evaluate these parameters as the risk factors for ANP.Results: Patients in this study were divided into 2 groups according to ANP. There were 92 patients in ANP group and 171 patients in Non-ANP group. There was no significant difference in age (P=0.196), gender (P=0.516), TIA(P=0.139), NT (P=0.676), CK types (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585) and cervical disc degeneration (P=0.695) between the two groups. T1 slope, C2-7 SVA in the ANP group was significantly higher than in the Non-ANP group (P < 0.05). After multivariate logistic regression analysis, C2-7 SVA (P=0.003, OR 2.318, 95% CI 1.373-4.651) and T1 slope (P=0.028, OR 2.563, 95% CI 1.186-4.669) were the two risk factors for the ANP.Conclusions: Based on this study, cervical sagittal parameters have a significant effect on the happening of axial neck pain in patients with CK. A higher T1 slope and larger C2-7 SVA are closely lead to the development of neck pain.

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FRI0105 EVALUATION OF CXCL13 AND ICAM1 SERUM LEVELS AS PREDICTORS OF CLINICAL RESPONSE TO ABATACEPT IN RHEUMATOID ARTHRITIS.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3761 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 632.2-632

Author(s):

S. Piantoni ◽

S. Masneri ◽

F. Regola ◽

C. Nalli ◽

A. Tincani ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Response ◽

Synovial Fibroblasts ◽

Serum Levels ◽

Response To Treatment ◽

Intercellular Adhesion Molecule ◽

Intercellular Adhesion Molecule 1 ◽

Entire Cohort ◽

Significant Difference ◽

Before And After

Background:Soluble intercellular adhesion molecule 1 (ICAM1) and C-X-C motif chemokine 13 (CXCL13) were described as differentially associated with two major subtypes of synovitis in rheumatoid arthritis (RA). Raised serum levels of ICAM1 (which is upregulated in synovial fibroblasts in response to TNFα), and of CXCL13 (which is expressed by synovial follicular dendritic cells and activated mature antigen-experienced T-helper cells), are associated with a myeloid or lymphoid synovial phenotype, respectively (1). It has been suggested that a preferential clinical response to anti-TNFα, as compared to anti-IL-6R monotherapy, can be predicted by measuring these two biomarkers (2). No information is available on the possible utility of these biomarkers in RA patients treated with abatacept (ABA), a T-cell co-stimulation blocker.Objectives:To analyze the effect of ABA on ICAM1 and CXCL13 serum levels in RA and to verify whether they predict the response to the drug.Methods:63 RA patients [F/M=51/12; median (10th-90thpercentile) age=60 (41-72) years; CRP-DAS28=4.6 (3.3-5.8); ACPA positive: 86%], before and after 6 months of treatment with ABA + methotrexate and 22 sex and age-matched healthy controls (HC) were evaluated. Serum ICAM1 and CXCL13 levels were dosed by commercial ELISA (Life Technologies and R&D). Response to treatment was defined with the EULAR criteria.Results:CXCL13 serum levels were higher in RA at baseline than in HC [136 (42-325) vs 32 (19-57) pg/ml, p<0.01], while no difference was observed in ICAM1 [186 (125-276) vs 184 (153-246) ng/ml, p=0.9]; positive correlations between ICAM1 and CRP (r:0.28; p=0.03) and CXCL13 levels and CRP (r:0.40; p<0.01) and CRP-DAS28 values (r:0.27, p=0.05) were found. After therapy with ABA, a reduction of CXCL13 was observed [136 (42-325) vs 94 (29-319) pg/ml, p<0.01], both in responders [n: 37: 151 (57-462) vs 97 (26-329) pg/ml; p<0.01] and non-responders (n: 14: 142 (68-293) vs 89 (42-198) pg/ml; p=0.01]. Not significant variation of ICAM1 serum levels was found in the entire cohort [186 (125-276) vs 190 (113-252) ng/ml, p=0.06]. However, a significant decrease was observed in non-responders [222 (169-302) vs 186 (110-233) ng/ml, p=0.02]. At baseline, no significant difference was found among patients seropositive for ACPA if compared with the negative ones [ACPA+ vs ACPA- for ICAM1 [187 (123-280) vs 177 (134-258) ng/ml; p=0.7] and for CXCL13 [143 (42-368) vs 113 (56-270) pg/ml; p=0.4]].Conclusion:Our results confirmed that CXCL13 serum levels are directly correlated with disease activity and demonstrated that ABA therapy induces their reduction. These findings suggest that the co-stimulation blockade at central level and/or in the synovium lead to a reduced production of CXCL13. We could not demonstrate that CXCL13 levels predict the clinical response to ABA in this cohort of patients.References:[1]Rosengren S, Rheumatology 2011;2.Dennis G, Arthritis Res Ther 2014Acknowledgments:Bristol-Myers-Squibb Italy provided an unrestricted research grant for the study conduction.Disclosure of Interests:None declared

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Correlation between lumbar sagittal alignment, Modic changes, and endplate erosion in patients with degenerative disease

10.21203/rs.3.rs-18890/v1 ◽

2020 ◽

Author(s):

Bin Lv ◽

Haosheng Wang

Keyword(s):

Lumbar Lordosis ◽

Sagittal Alignment ◽

Modic Changes ◽

Degenerative Disease ◽

Defect Group ◽

Sacral Slope ◽

Precise Understanding ◽

Significant Difference ◽

Before And After ◽

Operation Results

Abstract Purpose To explore the role of lumbar sagittal alignment in the occurrence of Modicchanges and endplate defects (MC&ED) development in patients with a spinal degenerative disease, and the relationship between lumbar sagittal alignment and patient-report outcomes. Background Increasing attention has been focused on MC&ED as playing a potential role in the etiopathogenesis of lumbar degeneration. The precise understanding of the mechanisms leading to progression of MC&ED is lacking. Hence, we investigated how lumbar sagittal alignment influences the MC&ED. Patients and methods Ninety-six consecutive asymptomatic or symptomatic patients with Modic changes or endplate defect were retrospectively recruited in this study from August 2016 to December 2018. MC&ED were observed in 76 patients and not observed in 20 patients, representing two groups for comparison. The lumbar sagittal parameters were measured, including lumbar lordosis (LL),pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT). The lumbar lordosis index (LLI) and idea LL were then calculated. Clinical outcomes were assessed using a visual analog scale(VAS) and a Oswestry Disability Index (ODI) before and after operation. Results There were no significant differences in the distribution of demographics and baseline clinical variables between both groups. Mean age and BMI showed a significant difference between both groups (P<0.05). There were significant correlations between LL, LLI, Lossof LL, and Level 1 (r=0.281, 0.230, and 0.284, P<0.05) Also, PI, PT were significantly correlated with Level 4 (r=0.249, 0.202, P<0.05).Compared with presurgery scores, an improvement was seen in postoperative VAS and ODI scores (P<0.05). Further, the postoperative scores at 24 months in the without Modicor end plate defect group showed greater improvements compared with the with Modic or endplate defect group (P<0.05). Conclusion This analysis indicated that maintaining lumbar sagittal alignment was related to a lower risk of Modic changes in patients with the spinal degenerative disease. The lumbar sagittal alignment might be a factor that influenced the posterior inclination of the pelvis in symptomatic lumbar disease.

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Why the patients with Hirayama disease have abnormal cervical sagittal alignment? A radiological measurement analysis of posterior cervical extensors

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02905-5 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Ye Tian ◽

Lin Xie ◽

Jianyuan Jiang ◽

Hongli Wang

Keyword(s):

Cobb Angle ◽

Sagittal Alignment ◽

Spearman Correlation ◽

Kyphosis Angle ◽

Hirayama Disease ◽

Cutoff Value ◽

T1 Slope ◽

Cervical Sagittal Alignment ◽

Local Kyphosis ◽

The Relationship

Abstract Purpose To explore the relationship between the strength of posterior cervical extensors (PCEs) and cervical sagittal alignment in Hirayama disease (HD) patients. Methods We analyzed the (magnetic resonance imaging) MRI T2WI and X-rays of 60 HD patients who visited Huashan Hospital from June 2017 to February 2020. Symptoms of these patients include adolescent onset, manifestation of unilateral upper limb muscle weakness and muscle atrophy of the forearm and hand. MRI images were used to measure (the cross-sectional area) CSA of cervical PCEs. The ratio of muscle CSA to vertebral body areas at the same level is defined as R-CSA. Cervical sagittal alignment includes the C2–7 Cobb angle, T1 slope and C2–7 sagittal vertical axis (SVA). The geometric center of the C3–6 vertebral body was determined using the line connecting the C2 inferior endplate and the C7 upper endplate. When located behind the line, it is defined as a “local kyphotic deformity.” The number of vertebral bodies involved in kyphotic deformity was determined by measuring the local kyphosis angle (LKA). Spearman correlation analysis (α = 0.05) was used to determine the relationship between R-CSA and sagittal parameters. ROC curves were used to analyze the sensitivity and specificity of relevant variables. Results Spearman correlation test revealed that R-CSA negatively correlated with T1S (S = 0.34, r = 0.34, p = 0.01) and LKA (S = 0.44, r = 0.5, p = 0.01), but did not correlate with the C2-C7 Cobb angle (S = 0.20, p = 0.12) or C2-C7 SVA (S = − 0.17, p = 0.46). (p < 0.05). ROC curve analysis showed that the areas under the curve (AUCs) of the T1 slope and LKA was 0.6696 and 0.7646, respectively. T1 slope, cutoff value: 17.2°; sensitivity: 0.5806; specificity: 0.7241; p < 0.05. LKA: cutoff value: − 14°; sensitivity: 1; specificity: 0.5333; p < 0.05. Conclusions In patients with Hirayama disease, the strength of posterior cervical extensors and cervical sagittal alignment are closely related. The local kyphosis angle can be used as a reference for the strength of posterior cervical extensors. These results indicate the weakness of PCEs, which may predispose the cervical spine of HD patients to a less stable situation. Therefore, patients with Hirayama disease should strengthen the exercise of the PCEs.

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The Change of Cervical Spine Alignment Along with BMI in Asymptomatic Population: A Preliminary Analysis

10.21203/rs.3.rs-66913/v1 ◽

2020 ◽

Author(s):

Zhenxuan Shao ◽

Gaole Dai ◽

Qingqian Zhao ◽

Ben Wang ◽

Rui Wen ◽

...

Keyword(s):

Sagittal Alignment ◽

Demographic Data ◽

Sagittal Imbalance ◽

Sagittal Vertical Axis ◽

Forward Head Posture ◽

Thoracic Inlet ◽

Head Posture ◽

Significant Difference ◽

Cervical Sagittal Alignment ◽

Asymptomatic Volunteers

Abstract Study design: A cross-sectional studyObjective:Describe the difference in the cervical sagittal alignment between various BMI people.Summary of Background Data:Cervical sagittal imbalance is implicated in the development of various spinal disorders, and obesity was recognized as a global epidemic. But there were few studies focusing on the correlation between cervical sagittal alignment and body mass index (BMI). Methods: This study enrolled 140 asymptomatic volunteers from July 2016 to July 2019. Demographic data included gender, age and BMI, and radiographic parameters included chin–brow vertical angle (CBVA), occipital slope (OS), orbital tilt (OrT), orbital index (OI), occiput-C2 lordosis (O-C2), cervical lordosis (CL), C2-C7 sagittal vertical axis (C2-C7SVA) , cranial tilting (CrT), cervical tilting (CeT), T1 slope (TS), neck tilt (NT), and thoracic inlet angle (TIA). The data were analyzed by ANOVA statistical analyses.Results: In terms of the occipitocervical parameters, we found that there was no significant difference (OS, P=0.970; OrT, P=0.970; OI, P=0.798); In terms of cervical parameters, we found significant correlations between BMI and parameters (C2-C7SVA, P=0.005; TZC2-C7, P=0.030; CrT, P= 0.050; CeT, P=0.013), which reflected that forward head posture increases as BMI rises; In terms of thoracic parameters, we also found significant correlations between BMI and parameters (NT, P=0.014; TIA, P=0.050), which reflected that thoracic inlet lifts as BMI rises.Conclusions: We found that there are the correlations between cervical sagittal alignment (C2-C7SVA, TZC2-C7, CL, CrT, and CeT) and BMI, and forward head posture increases and thoracic inlet lifts in the obese, which can provide clinical advice and remind surgeons of BMI effect in reconstructive surgery for better prognoses.

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AB0114 INVESTIGATION OF THE EFFECTS OF EXERCISE ON MIRNA EXPRESSIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1369 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1086.1-1086

Author(s):

Z. B. Özcan ◽

F. S. Karaahmetoğlu ◽

M. Z. Çiraci ◽

H. H. Pençe ◽

M. Vural ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Peripheral Blood ◽

Mononuclear Cells ◽

Control Group ◽

Peripheral Blood Mononuclear ◽

Sf 36 ◽

Significant Difference ◽

Before And After

Background:The goal of treatment for patients with RA is achieve to remission, or at least a state of low disease activity. Exercise is recommended for patients with RA in addition to drug therapy. It has been found to be effective in greatly improving functionality and reducing cardiovascular risk without exacerbating disease activity. Therefore, it is recommended that all RA patients should be encouraged to include aerobic and resistant exercise training as part of their routine treatment (1).miRNAs(miRNA) are known to protect the pathophysiological process specific to RA. miRNA-146a is one of the miRNAs extensively studied in RA, its expression was found to be higher in the synovial fluid and synovial tissue of RA patients compared to healthy individuals (2).Many studies have found that miRNA-146a, along with miRNA-16 and miRNA155 may be related to disease pathology. It has also been found that high levels of miRNA-16 expression correlate with active disease and low levels of expression with inactive disease. It has been found that the increased level of miRNA-155 causes a problem in the modulation of arthritis It has been found that the expression level of miRNA-145 is increased in peripheral blood mononuclear cells of RA patients and synovium supporting osteoclastogenesis (3,4,5).Objectives:It is aimed to investigate the effect of exercise on microRNA expressions in patients with rheumatoid arthritis (RA).Methods:30 patients and 30 healthy controls aged 18-60 years who met the 2010 ACR / EULAR RA criteria were included in the study. A program consisting of strengthening and stretching exercises 2 days a week was applied to the study group for 8 weeks. One day a week, 30 minutes of mild moderate walking was requested. Of the cases at the beginning and at the end of the treatment; 5-10 cc peripheral blood samples were taken into one EDTA tube. Then Numeric Rating Scale (NRS) was used for pain, 28-joint Disease Activity Score (DAS28) was used to calculate disease activity, Health Assessment Questionnaire (HAQ) was used to assess general health and Short Form-36 (SF-36) was used to evaluate quality of life. 5-10 cc peripheral blood samples were taken to only 1 EDTA tube of the control group. In the samples taken, gene expressions of miRNA-146a, miRNA-155, miRNA-16, miRNA-145 were determined by real-time PZR method.Results:There was a significant difference in DAS28, SF-36, NRS, HAQ scales before and after treatment in the RA group of patients (p 0.05). The expression level of MiRNA-146a does not differ significantly before and after treatment (p> 0.05). However, these two groups differ significantly with the control group (p 0.05). No significant difference was observed in the miRNA-155 and miRNA-16 expression levels in the pretreatment, posttreatment, and control groups (p> 0.05).Conclusion:Exercise therapy has a good effect on pain, disease activity, quality of life and general health in patients with RA. It has been found that exercise can affect vii some of the miRNAs involved in disease pathogenesis. However, more comprehensive studies are needed.References:[1]Cooney JK, Law RJ, Matschke V, Lemmey AB, Moore JP, Ahmad Y, et al. Benefits of exercise in rheumatoid arthritis. Journal of Aging Research. 2011. p. 14.[2]Abou-Zeid A, Saad M, Soliman E. MicroRNA 146a expression in rheumatoid arthritis: Association with tumor necrosis factor-alpha and disease activity. Genet Test Mol Biomarkers. 2011;15(11):807–12.[3]Murata K, Yoshitomi H, Tanida S, Ishikawa M, Nishitani K, Ito H, et al. Plasma and synovial fluid microRNAs as potential biomarkers of rheumatoid arthritis and osteoarthritis. Arthritis Res Ther. 2010;12(3):86.[4]Pauley KM, Satoh M, Chan AL, Bubb MR, Reeves WH, Chan EKL. Upregulated miR-146a expression in peripheral blood mononuclear cells from rheumatoid arthritis patients. Arthritis Res Ther. 2008;10(4):101.[5]Evangelatos G, Fragoulis GE, Koulouri V, Lambrou GI. Micrornas in rheumatoid arthritis: From pathogenesis to clinical impact. Autoimmun Rev. 2019;18(11):102391.Disclosure of Interests:None declared

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