Multimorbidity Accrual After Incident Rheumatoid Arthritis: A Wolf at the Door

Rheumatoid arthritis (RA) has long been recognized to have serious extraarticular manifestations such as interstitial lung disease (ILD).1 Consequences of immunosuppressive medications used to treat RA include serious infections, liver toxicity, and osteoporosis leading to fracture.2,3

Successful Use of Adalimumab in Children with Uveitis-Associated Juvenile Idiopathic Arthritis

Objective of the Paper: To describe clinical cases of successful use of adalimumab in children with uveitis-associated juvenile idiopathic arthritis (JIA). Key Points. One of the extraarticular manifestations of JIA is uveitis, i. e. inflammation of the vascular tract of the eye. JIA-associated uveitis is diagnosed primarily in small girls with oligoarthritis, early seronegative polyarthritis; in patients with arthritis associated with enthesitis and psoriatic arthritis. The article describes clinical cases of the use of adalimumab in JIA and uveitis where the therapy with methotrexate and topical glucocorticosteroids fails. Conclusion. Uveitis-associated JIA is one of the most disabling forms of JIA, since, despite timely and adequate management, very often it results in severe ocular complications: cataract, glaucoma and even blindness. Adalimumab, a human anti-TNFα monoclonal antibody, is available and it helps in achieving uveitis remission where methotrexate and topical glucocorticosteroids fail, as well as in delaying ocular complications. Keywords: juvenile idiopathic arthritis, uveitis, adalimumab, children.

AB0103 THE AMBIGUOUS ROLE OF TISSUE CYTOKINES IN THE PATHOGENESIS OF RHEUMATOID ARTHRITIS

Background:Cytokines stimulate the inflammatory response in the synovial membrane with rheumatoid arthritis (RA), initiate apoptosis of chondrocytes, activation of osteoclasts. The progression of comorbid diseases is also associated with the influence of cytokines. At the same time, anti-inflammatory cytokines are produced in various tissues. Their role in the pathogenesis of RA and its complications is ambiguous.Adiponectin (A) and Fetuin A (FA) are classified as negative acute phase proteins. Their concentration decreases with an increase in the level of pro-inflammatory cytokines: TNF-α, IL-1 and IL-6. Molecules A and FA, regardless of various factors and from each other, have similar effects in relation to pro-inflammatory cytokines, lipid and carbohydrate metabolism.Visfatin (V) and Nesfatin-1 (N-1) are pro-inflammatory adipokines. B is produced by cells of the mononuclear phagocytic system and connective tissue. N-1 - is produced by the cells of the intermediate and medulla oblongata and by the cells of the gastric mucosa.Objectives:to study the correlation of B, H-1, A and FA with the severity of inflammation in RAMethods:60 patients with RA and 30 healthy individuals were examined. The level of cytokines was determined by an indirect enzyme-linked immunosorbent assay using commercial test systems (Bio Vendor, cat No. RD195023100, Bio Vendor Human Fetuin-A, RaiBiotech, cat No. EIA-VIS-1, RaiBiotech, cat No. EIA-NESF). All patients underwent a full examination. Diagnosed with 2010 EULAR / ACR recommendations.Results:A decreased level of A (less than 0.8 μg/ml) was detected in 15 patients (25%), F-A (less than 653.55 μg/ml) in 16 (27%), a high level of V (more than 39 ng/ml) - in 55 (91%), N-1 (more than 37.95 ng/ml) - in 36 (60%), which is significantly more often than in healthy individuals. No significant difference in the levels of determined adipokines was found depending on the gender and body weight of patients with RA. The level of cytokines in RA is associated with high activity according to DAS 28, positivity by Anti-CCP, extraarticular manifestations of RA. The greatest correlation with extraarticular manifestations is with cutaneous and cerebral vasculitis. The levels of FA and N-1 also correlated with more pronounced radiological changes (X-ray stage III). FA circulating inhibitor of ectopic calcification. N-1 level is positively correlated with systolic blood pressure.Conclusion:A low level of A and FA, a high level of V and N-1 is characteristic of RA with the presence of high activity and positivity in the RF and Anti-CCP. An increased level of B is determined by more than 90% of patients, which indicates its high pro-inflammatory activity. The level of F and N-1 is also associated with the degree of damage to bone tissue (stage III, a lot of erosion). A positive correlation of level V and N-1, negative A and FA with the severity of inflammation in RA confirms the involvement of these proteins in the pathogenesis. A high level of A and V increases the risk of developing cardiovascular diseases and their complications, the effect of N-1 and FA is being studied. The effect of cytokines on osteoclasts and osteoblasts in RA is ambiguousReferences:[1]Visfatin and Rheumatoid Arthritis: Pathogenetic Implications and Clinical Utility. Polyakova Y. Curr Rheumatol Rev.2019[2]Serum nesfatin -1 as a marker of systemic inflammation in rheumatoid arthritis. Kvlividze T. Klinicheskaya Laboratornaya Diagnostika.2019; 64 (1):53-56 (in Russ)[3]Fetuin-A. Novel hepatokine in rheumatoid arthritis laboratory diagnostics. Papichev E. Klinicheskaya Laboratornaya Diagnostika.2018; 63 (12):756-760 (in Russ)Disclosure of Interests:None declared

Clinical Features of Reiter’s Syndrome in Children

The clinical features of articular syndrome and extra-articular manifestations in children with Reiter’s syndrome (illness) were studied. Reiter’s syndrome in childhood has some features of the course and development of the disease. In childhood, asymmetry of lesions of the joints of the lower extremities with early involvement of small feet joints in the process, possible flushing of the skin over the affected joints, intense pain, rare involvement in the process of the hip joints, lumbar spine and unilateral sacroiliitis is characteristic. Extraarticular manifestations proceeded often erased, and sometimes were not determined at all. Relapses and a chronic course are not excluded.

VAV1 Gene Polymorphisms in Patients with Rheumatoid Arthritis

Introduction: Rheumatoid arthritis (RA) is an important public health problem because this disease often causes disability. RA is a chronic, destructive autoimmune disease that leads to joint destruction and the development of extraarticular manifestations. VAV1 is an intracellular signal transduction protein that plays a significant role in signal transduction in T cells and affects T cell development, proliferation and activation. The VAV1 gene contains 27 exons and is located on chromosome 19. In this study, we examined the association between VAV1 rs2546133 and rs2617822 polymorphisms and RA. Methods: We examined 422 patients with RA and 338 healthy subjects as the control group. Results: Among RA patients, there was a statistically significant increase in the frequency of VAV1 rs2546133 polymorphism in T allele carriers (TT + CT versus CC, odds ratio: 1.69, 95% confidence interval 1.05–2.73, p = 0.035). There was no statistically significant difference in the distribution of the rs2617822 genotypes and alleles between RA patients and the control group. Additionally, patients who carried the VAV1 rs2546133 T and rs2617822 G allele presented an increased frequency of extraarticular manifestations: vasculitis, amyloidosis and Sjogren syndrome. Conclusions: The results suggest an association between VAV1 gene rs2617822 polymorphism and RA.

Pulmonary Complications of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that characteristically causes joint inflammation and damage. In addition, many patients develop extraarticular manifestations which may cause significant comorbidity and premature mortality.Some respiratory tract involvement of the upper and lower airways and parenchymal disease features are unique to RA, including cricoarytenoid arthritis and RA pulmonary nodulosis, and others, especially the interstitial parenchymal involvement, occur in many other idiopathic and autoimmune diseases. The pathophysiology of lung disease is not well understood. Rheumatoid lung disease may even predate the onset of joint disease, and could be triggered by chronic airway and alveolar epithelial injury. Chronic systemic inflammation and risk factors such as cigarette smoking, infection, host genetics, and immune dysregulation are contributors. Treatment of the respiratory disease is directed at reducing the systemic inflammation of RA. Less well understood is the management of the interstitial lung disease of RA, for which antifibrotic and immune suppressive agents may be helpful. The management of RA-related lung disease is perhaps the major remaining hurdle in reduction of the disease burden related to extraarticular manifestations of this disease.

Is Smoking an Unfavorable Prognostic Factor for Rheumatoid Arthritis?

Introduction: Smoking is the environmental factor that plays the most important role in the etiology of rheumatoid arthritis and the only one that can be changed. In rheumatoid arthritis patients, smoking results in erosive, rapidly progressive, poor therapeutic response. There are studies suggesting that auto antibodies (rheumatoid factor and anti citrullinated protein antibodies) production is triggered by exposure to smoking, thus contributing to rheumatoid arthritis. Objectives: In this study we have proposed to analyze the effects of smoking on the rheumatoid arthritis. Methods: We evaluated 285 patients with RA admitted to Department of Rheumatology, Clinical Emergency Hospital “St. Andrew”, Constanţa during January-December 2013. Demographics of patients and data on the onset and progression of RA were followed. We were particularly interested in the data related to the rheumatoid arthritis prognostic factors as they were established and published by the Romanian Rheumatology Society. Conclusion: Smoking influences the onset of rheumatoid arthritis, the seropositivity, the presence of extraarticular manifestations, the acute phase reactants and the number of swollen joints. We can therefore conclude that smoking is an unfavorable prognostic factor for rheumatoid arthritis, influencing both the onset and its evolution.