Association of rheumatoid arthritis and its severity with human leukocytic antigen-DRB1 alleles in Kurdish region in North of Iraq

Background Rheumatoid arthritis is a complex multifactorial chronic disease, the importance of human leukocytic antigen (HLA) as a major genetic risk factor for rheumatoid arthritis was studied worldwide. The objective of this study is to identify the association of HLA-DRB1 subtypes with rheumatoid arthritis and its severity in Kurdish region. Methods A case–control study recruited 65 rheumatoid arthritis patients and 100 healthy individuals as control group all over the Kurdistan region/Iraq. Both patient and control groups are genotyped using polymerase chain reaction with sequence specific primer. Anti-CCP antibodies were measured by ELISA test. Rheumatoid factor, C-reactive protein, and disease activity score 28 which measured by DAS-28 values were calculated. The DAS-28 was used to assess the clinical severity of the patients. Results HLA-DRB1-0404 and HLA-DRB1-0405 frequencies showed a strong association with disease susceptibility (P < 0.001). The frequency of HLA-DRB1-0411 and HLA-DRB1-0413 were significantly higher in control group (P < 0.001). The frequency of rheumatoid factor and Anti-CCP were significantly higher among shared epitope-positive patients compared to shared epitope-negative patients (P < 0.001). Regarding the disease activity by DAS-28, rheumatoid arthritis patients didn’t show significant difference between the shared epitope-positive and shared epitope-negative patients. Conclusions HLA-DR0404 and HLA-DR0405 alleles are related to RA, while HLA-DR1-0411 and HLA-DRB1-0413 protect against RA in the Kurdistan region in the North of Iraq.

Rheumatoid Factor, Anti-cyclic Citrullinated Peptide and HLA-B Locus Antigens in Psoriatic Arthritis Patients in Bangladesh

Introduction: Psoriatic arthritis (PsA) is established as a multifactorial disease resulting from a complex interplay between genetic, environmental and immunological factors. It is a seronegative arthritis but rheumatoid factor may be present in up to 15% of PsA patients Antibodies recognizing a cyclic citrullinated peptide are highly speciûc for rheumatoid arthritis (RA) but their role in PsA remains unclear. An increased prevalence of anti-CCP antibody in PsA is also reported. Study shows that HLA-DRB1 shared epitope is signiûcantly associated with the presence of anti-CCP antibody in PsA patients but this type of association is not found with other human leukocyte antigens. Objectives: The aim of this study was to investigate the frequency of anti-CCP and RF in PsA patients and their associations with HLA-B locus antigens. Methods: In this cross sectional study, we selected 50 unrelated consecutive patients with PsA according to CASPAR criteria for PsA. 6 ml of blood was collected from each patient for HLAB locus typing, RA test and test for anti-CCP. Patient’s serum samples were tested for RF by Nephelometric system and tests for anti-CCP were done by ELISA. HLA-B locus typing was done by PCR with sequence specific primer. Results: Among 50 PsA patients, 27 (54%) are female and 23 (46%) are male. RA test is positive in 10 (20%) patients and anti-CCP is positive in 7 (14%) patients. Significant association was found between HLA-B*37 and RF (p value= < 0.001). Conclusion: RF is present in 10 (20%) and anti-CCP is present in 7 (14%) PsA patients. HLAB* 37 was significantly found in RF positive patients. J Shaheed Suhrawardy Med Coll 2020; 12(2): 109-114

Prevalence And Risk Factors of Electrocardiogram Abnormalities In Patients With Rheumatoid Arthritis: A Machine Learning Study With Follow-Up Data

OBJECTIVES: Electrocardiogram (ECG) abnormalities could predict some subsequent cardiovascular events. Cardiac involvement is a major extra-articular manifestation in rheumatoid arthritis (RA). We aimed to determine the prevalence of three major ECG abnormalities in RA patients, discover the associated ECG abnormalities associated with machine learning (ML) approaches, and then examine these preselected factors in the follow-up patients with traditional Cox regression. METHODS: Consecutive RA patients’ records were retrieved from the hospital database; about one-third of patients had follow-up data. Abnormal ECGs with clinical significance were grouped into non-specific ST-segment/T-wave changes, QT interval prolongation, and QRS-T angle increase. Machine learning approaches assessed the associated factors of these abnormalities. The top-important factors selected by the most optimal ML would be used to construct Cox regression models. RESULTS: Two hundred twenty-six patients were enrolled for the first step cross-sectional study. Non-specific ST-T changes (27%) were the most prevalent abnormalities among patients with abnormal ECGs. Random forest models had the best performance in the discovery of associated factors for three outcomes. Cox regression validated that rheumatoid factor and low-density lipoprotein were common risk factors within those three abnormalities. Hypertension, ESR, and serum immunoglobulin G were influential factors for non-specific ST-T changes, prolonged QT interval, and increased QRS-T angle specifically. CONCLUSION: Non-specific ST-T changes were the most common abnormalities seen in ECGs of RA patients. Our finding suggests that rheumatoid factor, LDL, hypertension, and inflammatory indicators are important risk factors for these ECG abnormalities.

A STUDY OF RHEUMATOID FACTOR AND ITS RELATION TO ISCHEMIC HEART DISEASE

INTRODUCTION : Ischemic heart disease (IHD) is a leading cause of death in the world. Most of the subjects with IHD may have traditional risk factors including diabetes,smoking, hypertension,obesity. Rheumatoid Factor (RF) has been associated with an increased likelihood of developing IHD.Presence of RF in general population may identify the subjects with a similar immune pathology to patients with RA, who may also share an increased likelihood of developing IHD and that RF may have special role in the pathogenisis of IHD . MATERIALS AND METHODS: Cross sectional observational study done from September 2020 to August 2021 in Kamineni institute of medical sciences Narketpally, included 100 patients, who were all RF positive.During the study period they were evaluated for IHD by E CG and ECHO.Those who are included in the study were evaluated for traditional risk factors h/o Diabetes, smoking,family h/o IHD and hypertension,BMI for Obesity and features of RA. A resting 12 lead ECG was carried out for features of IHD.The following ch anges in the ECG were taken as marker of ischemia: 1)The combination of ST elevation in a set of leads and reciprocal ST depression in a set of leads.2) Inversion of T with ST still being elevated.3) Presence of pathological Q waves RESULTS : Of the 100 patients with RF positivity, there were 65 females and 35 males. Ischemic changes in ECG in presence of RF with traditional risk factor is n=12 (75%) M 8(50%) F-- 4(25%) and RF without traditional risk factor is n=4 (25%) M-4(25%) F-0.In the present study there were 16 patients who had RF positivity with Ischemic changes in ECG. 12 were males and 4 were females. CONCLUSIONS: RF per se can be considered as one of the risk factor for Ischemic heart disease in males. Ÿ RF associated with traditional risk factors increase the prevalence of IHD. Ÿ Though more female patients have positive RF, they are not vulnerable to IHD.

Predictive role of serum rheumatoid factor in different disease pattern of psoriasis and psoriatic arthritis

Background Psoriasis is a multisystem inflammatory disorder with variable morphology, clinical pattern and multiple comorbidities. Interplay between genetic and environmental factors leading to an aberrant immune response in the skin may contribute to disease development. The assessment for risk factors, signs, and symptoms of potential comorbid diseases is an important component of patient management. The aim of this study is to determine rheumatoid factors (RF) positivity and its levels in psoriasis patients, and describe its relationship with the demographic and clinical characteristics, comorbidities, and disease patterns of psoriasis. Results Rheumatoid factor was positive in psoriatic patients more than control,30% of patients had positive rheumatoid factor while only 10% of control had positive results. Rheumatoid factor level was 63.8 ± 186.7 IU/ml in psoriasis vs. 9.3 ± 12.3 in control. Thirty percent of psoriasis patients have positive rheumatoid factor vs. 10% of control. There was no significant statistical difference between psoriasis patients with or without arthritis as regard rheumatoid factor positivity and titer; rheumatoid factor was positive in 20% in psoriatic patients with arthritis vs. 26% in psoriatic patients without arthritis. In psoriatic patients, the status of rheumatoid factor did not relate to disease severity, onset, course, site of affection, presence of scalp, nail affection, and presence of dactylitis (p value>0.5). Conclusion Psoriasis was associated with higher seropositivity of RF compared to age-matched non-psoriatic healthy controls. Occurrence and level of rheumatoid factor were not associated with severity or clinical pattern of psoriasis.

High-titer rheumatoid factor seropositivity predicts mediastinal lymphadenopathy and mortality in rheumatoid arthritis-related interstitial lung disease

Rheumatoid arthritis-related interstitial lung disease (RA-ILD) is a common connective tissue disease-related ILD (CTD-ILD) associated with high morbidity and mortality. Although rheumatoid factor (RF) seropositivity is a risk factor for developing RA-ILD, the relationship between RF seropositivity, mediastinal lymph node (MLN) features, and disease progression is unknown. We aimed to determine if high-titer RF seropositivity predicted MLN features, lung function impairment, and mortality in RA-ILD. In this retrospective cohort study, we identified patients in the University of Chicago ILD registry with RA-ILD. We compared demographic characteristics, serologic data, MLN size, count and location, and pulmonary function over 36 months among patients who had high-titer RF seropositivity (≥ 60 IU/ml) and those who did not. Survival analysis was performed using Cox regression modeling. Amongst 294 patients with CTD-ILD, available chest computed tomography (CT) imaging and serologic data, we identified 70 patients with RA-ILD. Compared to RA-ILD patients with low-titer RF, RA-ILD patients with high-titer RF had lower baseline forced vital capacity (71% vs. 63%; P = 0.045), elevated anti-cyclic citrullinated peptide titer (122 vs. 201; P = 0.001), CT honeycombing (50% vs. 80%; P = 0.008), and higher number of MLN ≥ 10 mm (36% vs. 76%; P = 0.005). Lung function decline over 36 months did not differ between groups. Primary outcomes of death or lung transplant occurred more frequently in the high-titer RF group (HR 2.8; 95% CI 1.1–6.8; P = 0.028). High-titer RF seropositivity was associated with MLN enlargement, CT honeycombing, and decreased transplant-free survival. RF titer may be a useful prognostic marker for stratifying patients by pulmonary disease activity and mortality risk.

Ultrasonographic characteristics of major salivary glands in anti-centromere antibody-positive primary Sjögren’s syndrome

Purpose To investigate salivary gland ultrasonography (SGUS) findings in primary Sjögren’s syndrome (pSS) patients positive for the anti-centromere antibody (ACA) and compare these with those in ACA-negative pSS patients. Methods We analyzed demographic, clinical, laboratory, and SGUS data of pSS patients who fulfilled the 2002 American-European Consensus Group classification criteria for pSS. SGUS findings of four major salivary glands (bilateral parotid and submandibular glands) were scored in five categories and compared between ACA-positive and ACA-negative pSS patients. Linear regression analysis was performed to elucidate the factors associated with SGUS score. Results In total, 121 pSS patients were enrolled (19, ACA-positive). The ACA-positive patients were older (67.0 vs 58.0 years, P = 0.028), whereas anti-Ro/SSA and anti-La/SSB positivity was more prevalent in the ACA-negative group (89.2% vs 21.1%, P < 0.001, and 47.1% vs 10.5%, P = 0.007, respectively). The total SGUS and hypoechoic area scores were lower in ACA-positive patients (16.0 vs 23.0, P = 0.027, and 4.0 vs 7.0, P = 0.004, respectively). In univariate regression analysis, being positive for unstimulated salivary flow rate (USFR < 1.5 ml/15 min), anti-Ro/SSA, and rheumatoid factor were positively associated whereas ACA positivity was negatively associated with the SGUS score. In multivariate regression analysis, being positive for USFR, anti-Ro/SSA, and rheumatoid factor showed significant association with the SGUS score. Conclusions ACA-positive pSS patients showed a lower SGUS score than ACA-negative patients, which was especially prominent in the hypoechoic area component.