Pub Date : 2023-11-01DOI: 10.1142/s2661341723740280
Shiyu Xiao, W. Xie
Background Rheumatoid arthritis (RA) is a debilitating and financially burdensome disease because of frequent presence of comorbidities including metabolic and cardiovascular abnormalities. Growing evidence suggests a link between RA and nonalcoholic fatty liver disease (NAFLD). We aimed to determine the prevalence and explore the risk factors of developing NAFLD in RA population. Methods This population-based, cross-sectional study utilized data on US adults aged [Formula: see text]20 years old from the National Health and Nutrition Examination Survey (NHANES) 2017-2018, a representative sample of the general US population. Diagnosis of RA was derived from questionnaire data. NAFLD was defined by controlled attenuation parameter (CAP) scores of [Formula: see text]278 dB/m using vibration controlled transient elastography (VCTE) in the absence of other liver disease. Weighted multiple regression analysis was further performed to assess the independent risk factors. Results Of 2,848 people included in this study, 224 of them had self-reported RA. The prevalence of NAFLD in the overall sample was 41%, with a numerically higher prevalence in RA patients than those without arthritis (47% vs. 40%, p=0.30). Compared to those without NAFLD, RA patients with concomitant NAFLD had more prevalent metabolic comorbidities including obese (75% vs. 32%, p=0.006), central obesity (100% vs. 71%, p=0.008), diabetes (39% vs. 14%, p=0.003) and hyperlipidemia (88% vs. 76%, p=0.042). Regarding laboratory findings, RA patients with NAFLD exhibited higher levels of triglyceride (188 mg/dL vs. 131 mg/dL, p=0.010), fasting plasma glucose (131 mg/dL vs. 109 mg/dL, p=0.010) and HbA1c (5.77% vs. 6.41%, p=0.002). Meanwhile, elevated levels of liver enzymes (ALT: 29 U/L vs. 19 U/L, p=0.015; AST: 25 U/L vs. 19 U/L, p=0.007) and inflammatory indicator CRP (5.1 mg/dL vs. 3.4 mg/dL, p<0.001]) were more frequently reported in RA patients with NAFLD as compared with those without. Further, weighted multivariate logistic regression analysis showed that the presence of central obesity (adjusted OR=1.56 [95% CI 1.16-2.11], p=0.008) and diabetes (adjusted OR=1.28 [95% CI 1.07-1.54], p=0.014) were significantly associated with prevalent NAFLD in patients with RA. Conclusion In this population-based study, about one in two patients with RA had NAFLD, which is higher than its overall prevalence among general population. Central obesity and diabetes are predisposing factors for NAFLD in RA. Our results highlight the importance of active NAFLD screening in RA population, especially for high-risk subsets.
背景类风湿性关节炎（RA）是一种使人衰弱、经济负担沉重的疾病，因为它经常出现合并症，包括代谢和心血管异常。越来越多的证据表明，RA 与非酒精性脂肪肝（NAFLD）之间存在联系。我们的目的是确定 RA 患者非酒精性脂肪肝的患病率并探讨其风险因素。方法 这项基于人群的横断面研究利用了美国2017-2018年全国健康与营养调查（NHANES）中20岁[公式：见正文]美国成年人的数据，NHANES是美国普通人群的代表性样本。RA诊断来自问卷调查数据。在无其他肝脏疾病的情况下，使用振动控制瞬态弹性成像（VCTE），非酒精性脂肪肝的控制衰减参数（CAP）分数达到[公式：见正文]278 dB/m。为评估独立风险因素，进一步进行了加权多元回归分析。结果 在这项研究纳入的2848人中，有224人自我报告患有RA。在所有样本中，非酒精性脂肪肝的患病率为41%，其中RA患者的患病率高于无关节炎患者（47%对40%，P=0.30）。与没有非酒精性脂肪肝的患者相比，合并非酒精性脂肪肝的 RA 患者有更多的代谢合并症，包括肥胖（75% 对 32%，P=0.006）、中心性肥胖（100% 对 71%，P=0.008）、糖尿病（39% 对 14%，P=0.003）和高脂血症（88% 对 76%，P=0.042）。在实验室检查结果方面，患有非酒精性脂肪肝的 RA 患者甘油三酯（188 mg/dL vs. 131 mg/dL，p=0.010）、空腹血浆葡萄糖（131 mg/dL vs. 109 mg/dL，p=0.010）和 HbA1c（5.77% vs. 6.41%，p=0.002）水平较高。同时，与无非酒精性脂肪肝的 RA 患者相比，非酒精性脂肪肝的 RA 患者肝酶水平升高（ALT：29 U/L vs. 19 U/L，p=0.015；AST：25 U/L vs. 19 U/L，p=0.007）和炎症指标 CRP（5.1 mg/dL vs. 3.4 mg/dL，p<0.001]）的频率更高。此外，加权多变量逻辑回归分析显示，中心性肥胖（调整后 OR=1.56 [95% CI 1.16-2.11]，p=0.008）和糖尿病（调整后 OR=1.28 [95% CI 1.07-1.54]，p=0.014）与 RA 患者的非酒精性脂肪肝发病率显著相关。结论 在这项基于人群的研究中，大约每两名 RA 患者中就有一人患有非酒精性脂肪肝，高于普通人群的总体患病率。中心性肥胖和糖尿病是导致 RA 非酒精性脂肪肝的易感因素。我们的研究结果突显了在RA人群中积极筛查非酒精性脂肪肝的重要性，尤其是对高危人群。
{"title":"Abstract 12 — Prevalence and Risk Factors of Non-Alcoholic Fatty Liver Disease in Patients with Rheumatoid Arthritis: A Nationwide Population-Based Study","authors":"Shiyu Xiao, W. Xie","doi":"10.1142/s2661341723740280","DOIUrl":"https://doi.org/10.1142/s2661341723740280","url":null,"abstract":"Background Rheumatoid arthritis (RA) is a debilitating and financially burdensome disease because of frequent presence of comorbidities including metabolic and cardiovascular abnormalities. Growing evidence suggests a link between RA and nonalcoholic fatty liver disease (NAFLD). We aimed to determine the prevalence and explore the risk factors of developing NAFLD in RA population. Methods This population-based, cross-sectional study utilized data on US adults aged [Formula: see text]20 years old from the National Health and Nutrition Examination Survey (NHANES) 2017-2018, a representative sample of the general US population. Diagnosis of RA was derived from questionnaire data. NAFLD was defined by controlled attenuation parameter (CAP) scores of [Formula: see text]278 dB/m using vibration controlled transient elastography (VCTE) in the absence of other liver disease. Weighted multiple regression analysis was further performed to assess the independent risk factors. Results Of 2,848 people included in this study, 224 of them had self-reported RA. The prevalence of NAFLD in the overall sample was 41%, with a numerically higher prevalence in RA patients than those without arthritis (47% vs. 40%, p=0.30). Compared to those without NAFLD, RA patients with concomitant NAFLD had more prevalent metabolic comorbidities including obese (75% vs. 32%, p=0.006), central obesity (100% vs. 71%, p=0.008), diabetes (39% vs. 14%, p=0.003) and hyperlipidemia (88% vs. 76%, p=0.042). Regarding laboratory findings, RA patients with NAFLD exhibited higher levels of triglyceride (188 mg/dL vs. 131 mg/dL, p=0.010), fasting plasma glucose (131 mg/dL vs. 109 mg/dL, p=0.010) and HbA1c (5.77% vs. 6.41%, p=0.002). Meanwhile, elevated levels of liver enzymes (ALT: 29 U/L vs. 19 U/L, p=0.015; AST: 25 U/L vs. 19 U/L, p=0.007) and inflammatory indicator CRP (5.1 mg/dL vs. 3.4 mg/dL, p<0.001]) were more frequently reported in RA patients with NAFLD as compared with those without. Further, weighted multivariate logistic regression analysis showed that the presence of central obesity (adjusted OR=1.56 [95% CI 1.16-2.11], p=0.008) and diabetes (adjusted OR=1.28 [95% CI 1.07-1.54], p=0.014) were significantly associated with prevalent NAFLD in patients with RA. Conclusion In this population-based study, about one in two patients with RA had NAFLD, which is higher than its overall prevalence among general population. Central obesity and diabetes are predisposing factors for NAFLD in RA. Our results highlight the importance of active NAFLD screening in RA population, especially for high-risk subsets.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139304112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1142/s2661341723740012
Hui Zhang
Metabolic reprograming drives the activation of lymphocytes, allowing them to turn into highly autoreactive T cells and B cells in systemic lupus erythematosus (SLE). Metabolic demands among immune cell types are distinct and metabolic reprograming is associated with immune cell development, activation and differentiation. Recent advances in immunometabolism has defined T/B cell behaviors by the intricate interplay between metabolic rewriting and T/B cell functions. During T cell activation, T cells rely on glucose glycolysis for bioenergy fulfillment. While B cells, germinal center B cells in particular, tend to consume fatty acid for ATP synthesis. Our data revealed that T cells from patients with lupus nephritis (LN) exhibit higher level of glycose glycolysis. Nicotinamide phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in the salvage NAD+ biosynthetic pathway cntrol IFN[Formula: see text] production by CD4+ T cells in LN. Inhibition of NAMPT suppressed IFN[Formula: see text] production in CD4+ T cells and reduced inflammatory infiltrates in lupus mice. In addition, CD36-mediated lipid uptake is enhanced in SLE B cells. Accordingly, the inhibition of fatty acid oxidation results in reduced autoreactive B cell responses and ameliorated diseases in lupus mice. Ablation of CD36 in B cells impairs lipid uptake and differentiation of autoreactive B cells during autoimmune induction. Targeting the metabolic pathways that regulate T/B cell activation could modulate the metabolic reprogramming of these lymphocytes, which could have important indications for the therapy of patients with LN.
代谢重编程驱动着淋巴细胞的活化，使它们在系统性红斑狼疮（SLE）中变成高度自反应的 T 细胞和 B 细胞。免疫细胞类型之间的代谢需求各不相同，代谢重编程与免疫细胞的发育、活化和分化有关。免疫代谢学的最新进展通过新陈代谢改写与 T/B 细胞功能之间错综复杂的相互作用来定义 T/B 细胞的行为。在 T 细胞活化过程中，T 细胞依靠葡萄糖糖酵解获得生物能量。而 B 细胞，尤其是生殖中心 B 细胞，则倾向于消耗脂肪酸来合成 ATP。我们的数据显示，狼疮性肾炎（LN）患者的 T 细胞表现出较高的糖酵解水平。烟酰胺磷酸核糖转移酶（NAMPT）是挽救 NAD+ 生物合成途径中的限速酶，它能控制 LN 中 CD4+ T 细胞产生 IFN[式中：见正文]。抑制 NAMPT 可抑制 CD4+ T 细胞产生 IFN[式中：见正文]，减少狼疮小鼠的炎症浸润。此外，系统性红斑狼疮 B 细胞中 CD36 介导的脂质摄取增强。因此，抑制脂肪酸氧化可减少狼疮小鼠的自反应性 B 细胞反应，改善疾病。在自身免疫诱导过程中，消融 B 细胞中的 CD36 会损害自身反应性 B 细胞的脂质摄取和分化。以调控T/B细胞活化的代谢途径为靶点，可以调节这些淋巴细胞的代谢重编程，这对治疗狼疮患者有重要意义。
{"title":"Hong Kong Guangdong Rheumatology Meeting","authors":"Hui Zhang","doi":"10.1142/s2661341723740012","DOIUrl":"https://doi.org/10.1142/s2661341723740012","url":null,"abstract":"Metabolic reprograming drives the activation of lymphocytes, allowing them to turn into highly autoreactive T cells and B cells in systemic lupus erythematosus (SLE). Metabolic demands among immune cell types are distinct and metabolic reprograming is associated with immune cell development, activation and differentiation. Recent advances in immunometabolism has defined T/B cell behaviors by the intricate interplay between metabolic rewriting and T/B cell functions. During T cell activation, T cells rely on glucose glycolysis for bioenergy fulfillment. While B cells, germinal center B cells in particular, tend to consume fatty acid for ATP synthesis. Our data revealed that T cells from patients with lupus nephritis (LN) exhibit higher level of glycose glycolysis. Nicotinamide phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in the salvage NAD+ biosynthetic pathway cntrol IFN[Formula: see text] production by CD4+ T cells in LN. Inhibition of NAMPT suppressed IFN[Formula: see text] production in CD4+ T cells and reduced inflammatory infiltrates in lupus mice. In addition, CD36-mediated lipid uptake is enhanced in SLE B cells. Accordingly, the inhibition of fatty acid oxidation results in reduced autoreactive B cell responses and ameliorated diseases in lupus mice. Ablation of CD36 in B cells impairs lipid uptake and differentiation of autoreactive B cells during autoimmune induction. Targeting the metabolic pathways that regulate T/B cell activation could modulate the metabolic reprogramming of these lymphocytes, which could have important indications for the therapy of patients with LN.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139294263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1142/s2661341723740322
Isaac T Cheng, Ho So, Carson CY Yip, YING-YING Leung, Kichul Shin, Muhammad Ahmed Saeed, P. Chiowchanwisawakit, M. Hammoudeh, Muhammad Haroon, S. Nallasivan, S. Angkodjojo, James Ho Yin Chung, Mitsumasa Kishimoto, James Wei, L. Tam
Background This analysis aimed to evaluate the extent of treat-to-target (T2T) achievement after 1-year intensive treatment in patients enrolled to the APLAR SpA registry. Methods Patients who fulfilled the CASPAR2006 for psoriatic arthritis (PsA), and 2009ASAS criteria for axial spondylitis (AxSpA) were recruited. Current analysis included the first 143 patients reaching the 1-year timepoint across 7 Asia-Pacific regions (Hong Kong, Singapore, Korea, India, Pakistan, Qatar and Thailand). Results 79 patients with PsA(age: 52±13 years, 43(55%) male, disease duration: 8.0±8.3 years) and 64 patients with AxSpA (age:41±16 years, 48(75%) male, disease duration: 4.8±7.2 years) were included. There were significant improvement in Disease Activity in Psoriatic Arthritis (DAPSA) (22.1±14.4 at baseline vs 11.5±10.0 at 1-year, p<0.001) while Ankylosing Spondylitis Disease Activity Score (ASDAS) remained stable. Other characteristics are listed in Table 1. Concerning the medication use, there was an increase in the number of patients receiving biologic/target synthetic disease-modifying drug (b/tsDMARDS, 29% at baseline to 61% at 1-year for PsA, and 52% at baseline to 64% at 1-year for AxSpA) (Fig. 1). Regarding T2T, 62% and 45% of PsA patient achieved DAPSA-low disease activity (DAPSA-LDA) and minimal disease activity (MDA) respectively, while 53% of patients with Axial SpA achieved ASDAS-LDA. The use of b/tsDMARDs was significantly higher in patient who achieved MDA when compared to those who did not (Fig. 1). The MDA/ASDAS-LDA achievement rate were comparable to that of the tight control arm of TICOPA cohort (41%) or TICOSPA study (60%) respectively. Treatment was escalated in 86% of visits when treatment target was not met. The reason for non-escalation of drug included: patients’choice (42%), mild symptoms only and physician decides to keep current regime (27%), adverse events (19%), no viable alternatives (8%) and others (4%). Conclusions Implementing the T2T strategy in patient with SpA was feasible in selected centres from the APLAR region, with similar target achievement rate compared to T2T studies conducted in Europe.
{"title":"Abstract 16 — Are We Treating-to-Target on Spondyloarthritis (SpA)? A One-Year Analysis from the Asia Pacific League of Associations for Rheumatology (APLAR) SpA Registry","authors":"Isaac T Cheng, Ho So, Carson CY Yip, YING-YING Leung, Kichul Shin, Muhammad Ahmed Saeed, P. Chiowchanwisawakit, M. Hammoudeh, Muhammad Haroon, S. Nallasivan, S. Angkodjojo, James Ho Yin Chung, Mitsumasa Kishimoto, James Wei, L. Tam","doi":"10.1142/s2661341723740322","DOIUrl":"https://doi.org/10.1142/s2661341723740322","url":null,"abstract":"Background This analysis aimed to evaluate the extent of treat-to-target (T2T) achievement after 1-year intensive treatment in patients enrolled to the APLAR SpA registry. Methods Patients who fulfilled the CASPAR2006 for psoriatic arthritis (PsA), and 2009ASAS criteria for axial spondylitis (AxSpA) were recruited. Current analysis included the first 143 patients reaching the 1-year timepoint across 7 Asia-Pacific regions (Hong Kong, Singapore, Korea, India, Pakistan, Qatar and Thailand). Results 79 patients with PsA(age: 52±13 years, 43(55%) male, disease duration: 8.0±8.3 years) and 64 patients with AxSpA (age:41±16 years, 48(75%) male, disease duration: 4.8±7.2 years) were included. There were significant improvement in Disease Activity in Psoriatic Arthritis (DAPSA) (22.1±14.4 at baseline vs 11.5±10.0 at 1-year, p<0.001) while Ankylosing Spondylitis Disease Activity Score (ASDAS) remained stable. Other characteristics are listed in Table 1. Concerning the medication use, there was an increase in the number of patients receiving biologic/target synthetic disease-modifying drug (b/tsDMARDS, 29% at baseline to 61% at 1-year for PsA, and 52% at baseline to 64% at 1-year for AxSpA) (Fig. 1). Regarding T2T, 62% and 45% of PsA patient achieved DAPSA-low disease activity (DAPSA-LDA) and minimal disease activity (MDA) respectively, while 53% of patients with Axial SpA achieved ASDAS-LDA. The use of b/tsDMARDs was significantly higher in patient who achieved MDA when compared to those who did not (Fig. 1). The MDA/ASDAS-LDA achievement rate were comparable to that of the tight control arm of TICOPA cohort (41%) or TICOSPA study (60%) respectively. Treatment was escalated in 86% of visits when treatment target was not met. The reason for non-escalation of drug included: patients’choice (42%), mild symptoms only and physician decides to keep current regime (27%), adverse events (19%), no viable alternatives (8%) and others (4%). Conclusions Implementing the T2T strategy in patient with SpA was feasible in selected centres from the APLAR region, with similar target achievement rate compared to T2T studies conducted in Europe.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"179 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139300367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1142/s2661341723740346
Carolyn Lee
Background To report standardized mortality ratio (SMR) and assess risk factors for mortality and recurrence in Hong Kong Chinese patients with antiphospholipid syndrome (APS). Methods Patients followed up in 16 public hospitals in Hong Kong were identified by the Hospital Authority Clinical Data Retrieval System (CDARS) using the ICD-10 diagnostic code of APS. Their diagnoses were verified using the 2006 modified consensus criteria (1) for APS. The mortality, thrombosis recurrence rate and their associated risk factors were studied by Kaplan-Meier method and Cox Regression. Results Four hundred twenty-three Chinses APS patients were identified. Among them, 288 patients fulfilled the 2006 criteria for APS and were classified as definite APS, while 135 patients had probable APS. APS was primary in 204 patients and secondary in 219 patients. On presentation, 369 patients had thrombotic events. Arterial thrombosis occurred in 177 patients and venous thrombosis occurred in 189 patients. Obstetric morbidities occurred in 77 patients. Twenty three patients had both obstetric and thrombotic events. Over a mean follow-up of 9.7±7.2 years, 75 (17.7%) patients succumbed. The age and sex adjusted SMR relative to general population was 4.34[95% CI 3.44-5.41]. In thrombotic APS patients, mortality was associated with age [Formula: see text]60 years at diagnosis (HR 5.30 [95% CI 3.11-9.03]; p<0.001), presence of arterial hypertension (HR 1.89 [95% CI 1.11-3.19]; p =0.018), and presence of arterial thrombosis (HR 1.81 [95% CI 1.06-3.10]; p=0.031). Recurrence of thrombosis occurred in 89 (21%) patients (15% arterial, 5.2% venous). Recurrence of thrombosis was found to be associated with triple positive antibodies (HR 2.71 [95% CI 1.15-6.42]; p=0.023) independent of other risk factors in a multivariate model. Conclusion Increased mortality rate was observed in Chinese APS patient, with older age at diagnosis, presence of arterial hypertension and arterial thrombosis being independent risk factors for mortality. Recurrence of thrombotic events was not uncommon and associated with the presence of triple positive aPL antibodies.
{"title":"Abstract 18 — Standardized Mortality Ratio and Risk Factors for Mortality and Recurrence in Hong Kong Chinese Patients with Antiphospholipid Syndrome","authors":"Carolyn Lee","doi":"10.1142/s2661341723740346","DOIUrl":"https://doi.org/10.1142/s2661341723740346","url":null,"abstract":"Background To report standardized mortality ratio (SMR) and assess risk factors for mortality and recurrence in Hong Kong Chinese patients with antiphospholipid syndrome (APS). Methods Patients followed up in 16 public hospitals in Hong Kong were identified by the Hospital Authority Clinical Data Retrieval System (CDARS) using the ICD-10 diagnostic code of APS. Their diagnoses were verified using the 2006 modified consensus criteria (1) for APS. The mortality, thrombosis recurrence rate and their associated risk factors were studied by Kaplan-Meier method and Cox Regression. Results Four hundred twenty-three Chinses APS patients were identified. Among them, 288 patients fulfilled the 2006 criteria for APS and were classified as definite APS, while 135 patients had probable APS. APS was primary in 204 patients and secondary in 219 patients. On presentation, 369 patients had thrombotic events. Arterial thrombosis occurred in 177 patients and venous thrombosis occurred in 189 patients. Obstetric morbidities occurred in 77 patients. Twenty three patients had both obstetric and thrombotic events. Over a mean follow-up of 9.7±7.2 years, 75 (17.7%) patients succumbed. The age and sex adjusted SMR relative to general population was 4.34[95% CI 3.44-5.41]. In thrombotic APS patients, mortality was associated with age [Formula: see text]60 years at diagnosis (HR 5.30 [95% CI 3.11-9.03]; p<0.001), presence of arterial hypertension (HR 1.89 [95% CI 1.11-3.19]; p =0.018), and presence of arterial thrombosis (HR 1.81 [95% CI 1.06-3.10]; p=0.031). Recurrence of thrombosis occurred in 89 (21%) patients (15% arterial, 5.2% venous). Recurrence of thrombosis was found to be associated with triple positive antibodies (HR 2.71 [95% CI 1.15-6.42]; p=0.023) independent of other risk factors in a multivariate model. Conclusion Increased mortality rate was observed in Chinese APS patient, with older age at diagnosis, presence of arterial hypertension and arterial thrombosis being independent risk factors for mortality. Recurrence of thrombotic events was not uncommon and associated with the presence of triple positive aPL antibodies.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139301646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1142/s2661341723740097
Xenofon Baraliakos
Ankylosing spondylitis (AS), also referred to as radiographic axial spondyloarthritis (r-axSpA), is a challenging, inflammatory rheumatic condition primarily impacting the sacroiliac joints and often extending to the spine. The prevalence of axSpA, encompassing both radiographic AS and non-radiographic axSpA, is estimated to vary between 0.2% and 0.5% among Chinese adults, depending on the classification criteria employed. Treatment objectives for AS focus on improving the patient’s quality of life, function, and social involvement by managing inflammation and other disease symptoms. To achieve these goals, the American College of Rheumatology (ACR), the Spondylitis Association of America (SAA), and the Spondyloarthritis Research and Treatment Network (SPARTAN) advocate the use of non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for AS, followed by biologic disease-modifying anti-rheumatic drugs (bDMARDs) like TNF inhibitors. While it has been common practice to initiate treatment with a TNF inhibitor or IL-17 inhibitor, the updated recommendations from the Assessment of SpondyloArthritis International Society (ASAS) and the European League Against Rheumatism (EULAR) now suggest the consideration of Janus kinase (JAK) inhibitors for patients with persistent high disease activity despite conventional therapy. Furthermore, the updated guidelines propose switching to another biologic DMARD (TNF inhibitor or IL-17 inhibitor) or JAK inhibitor if the first biologic DMARD proves ineffective. Despite recent advancement, there remains an unmet need for effective therapies in the treatment of AS. Across various biologic studies, only 40-50% of patients achieve an ASAS40 response. Moreover, approximately one-third of patients fail to attain low disease activity according to the Ankylosing Spondylitis Disease Activity Score (ASDAS), and 65% do not achieve inactive disease status on ASDAS after one year of bDMARD therapy. There is a lack of oral treatment options for AS beyond NSAIDs, as all current biologics are administered via injection or infusion. Targeting JAK-mediated pathways with an oral option holds promise as a potential approach for treating adult AS patients.
{"title":"Opening Lecture","authors":"Xenofon Baraliakos","doi":"10.1142/s2661341723740097","DOIUrl":"https://doi.org/10.1142/s2661341723740097","url":null,"abstract":"Ankylosing spondylitis (AS), also referred to as radiographic axial spondyloarthritis (r-axSpA), is a challenging, inflammatory rheumatic condition primarily impacting the sacroiliac joints and often extending to the spine. The prevalence of axSpA, encompassing both radiographic AS and non-radiographic axSpA, is estimated to vary between 0.2% and 0.5% among Chinese adults, depending on the classification criteria employed. Treatment objectives for AS focus on improving the patient’s quality of life, function, and social involvement by managing inflammation and other disease symptoms. To achieve these goals, the American College of Rheumatology (ACR), the Spondylitis Association of America (SAA), and the Spondyloarthritis Research and Treatment Network (SPARTAN) advocate the use of non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for AS, followed by biologic disease-modifying anti-rheumatic drugs (bDMARDs) like TNF inhibitors. While it has been common practice to initiate treatment with a TNF inhibitor or IL-17 inhibitor, the updated recommendations from the Assessment of SpondyloArthritis International Society (ASAS) and the European League Against Rheumatism (EULAR) now suggest the consideration of Janus kinase (JAK) inhibitors for patients with persistent high disease activity despite conventional therapy. Furthermore, the updated guidelines propose switching to another biologic DMARD (TNF inhibitor or IL-17 inhibitor) or JAK inhibitor if the first biologic DMARD proves ineffective. Despite recent advancement, there remains an unmet need for effective therapies in the treatment of AS. Across various biologic studies, only 40-50% of patients achieve an ASAS40 response. Moreover, approximately one-third of patients fail to attain low disease activity according to the Ankylosing Spondylitis Disease Activity Score (ASDAS), and 65% do not achieve inactive disease status on ASDAS after one year of bDMARD therapy. There is a lack of oral treatment options for AS beyond NSAIDs, as all current biologics are administered via injection or infusion. Targeting JAK-mediated pathways with an oral option holds promise as a potential approach for treating adult AS patients.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"181 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139301612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1142/s2661341723740437
Shamma Al Nokhatha, F. AlKindi, Maryam Alfalasi, Merna Abdelsalhen, Fatima AlKhyeli, Ahmad R. Alsaber
Prior to immunosuppression, rheumatology patients are routinely screened for latent tuberculosis infection (LTBI) using Interferon-Gamma Release Assays (IGRA). The management of latent and indeterminate IGRA results varied among institutions and long-term outcome data is lacking. We conducted a retrospective study at Tawam Hospital, United Arab Emirates, to examine the frequency and management of positive and indeterminate IGRA results and tuberculosis infection in rheumatic patients. Methods Laboratory records and hospital electronic medical system were used to obtain information about IGRA results over a 12 years period (April 2010-April 2022). Results In our hospital record over a 12-year period, we found a total of 1012 positive and 223 indeterminate IGRA test results. Within the rheumatology department, 123 positive and 39 indeterminate IGRA results were identified. In the indeterminate IGRA group, the majority were female (n=24, 61.5%), UAE nationals (n=22, 56.4%), and had a mean age of 38.6 years. Systemic lupus erythematosus (SLE) was the most prevalent rheumatologic condition (n=21, 53.8%). 33.3% (n=13) were on disease modifying anti-rheumatic drugs (DMARDs) and 66.7% (n=26) were on corticosteroid during IGRA testing. A total of 8 patients (20.5%) received anti-TB medications. In a positive IGRA group, the mean age of 55.7 years and a female-to-male ratio of 3:1. The most common rheumatologic conditions were RA (n=67, 54.4%). Approximately 52.8% (n=65) of patients were on conventional DMARDs, 66.7% (n=26) were on corticosteroids during IGRA testing, and 60% (n=74) received anti-TB medications. Two cases (1.6%) of active TB infections were detected among patients with positive IGRA tests, both of whom were receiving anti-TNFa inhibitor treatment in combination with methotrexate. No cases of active TB infection were observed in the indeterminate IGRA group. Conclusion Tuberculosis risk in positive and indeterminate IGRA results for rheumatological conditions is low. Further multicenter studies are required to analyze patient outcomes and differences in TB-endemic and non-endemic regions.
在使用免疫抑制剂之前，风湿病患者通常会使用干扰素-伽马释放测定（IGRA）筛查潜伏结核感染（LTBI）。不同机构对潜伏和不确定 IGRA 结果的处理方法各不相同，也缺乏长期结果数据。我们在阿拉伯联合酋长国的 Tawam 医院进行了一项回顾性研究，以了解风湿病患者 IGRA 阳性和不确定结果以及结核感染的频率和处理方法。方法 使用实验室记录和医院电子医疗系统获取 12 年间（2010 年 4 月至 2022 年 4 月）IGRA 结果的相关信息。结果 在我们医院 12 年的记录中，我们共发现了 1012 次阳性和 223 次不确定的 IGRA 检测结果。在风湿免疫科，我们发现了 123 份阳性 IGRA 结果和 39 份不确定 IGRA 结果。在 IGRA 不确定组中，大多数为女性（24 人，占 61.5%）、阿联酋国民（22 人，占 56.4%），平均年龄为 38.6 岁。系统性红斑狼疮（SLE）是最常见的风湿病（21 人，占 53.8%）。在 IGRA 检测期间，33.3% 的患者（13 人）正在使用改变病情抗风湿药（DMARDs），66.7% 的患者（26 人）正在使用皮质类固醇。共有 8 名患者（20.5%）服用了抗结核药物。在 IGRA 阳性组中，平均年龄为 55.7 岁，男女比例为 3:1。最常见的风湿病是 RA（67 人，占 54.4%）。约 52.8%（n=65）的患者在使用传统的 DMARDs，66.7%（n=26）的患者在 IGRA 检测期间使用皮质类固醇，60%（n=74）的患者服用抗结核药物。在 IGRA 检测呈阳性的患者中发现了两例（1.6%）活动性结核感染，这两例患者都在接受抗肿瘤坏死因子抑制剂与甲氨蝶呤联合治疗。在 IGRA 检测结果不确定的组别中未发现活动性结核感染病例。结论 风湿病 IGRA 阳性和不确定结果的结核病风险较低。需要进一步开展多中心研究，分析患者的治疗效果以及结核病流行地区和非流行地区的差异。
{"title":"Abstract 27 — Prevalence and Management Approach of Latent Tuberculosis Infection in Rheumatology Patients","authors":"Shamma Al Nokhatha, F. AlKindi, Maryam Alfalasi, Merna Abdelsalhen, Fatima AlKhyeli, Ahmad R. Alsaber","doi":"10.1142/s2661341723740437","DOIUrl":"https://doi.org/10.1142/s2661341723740437","url":null,"abstract":"Prior to immunosuppression, rheumatology patients are routinely screened for latent tuberculosis infection (LTBI) using Interferon-Gamma Release Assays (IGRA). The management of latent and indeterminate IGRA results varied among institutions and long-term outcome data is lacking. We conducted a retrospective study at Tawam Hospital, United Arab Emirates, to examine the frequency and management of positive and indeterminate IGRA results and tuberculosis infection in rheumatic patients. Methods Laboratory records and hospital electronic medical system were used to obtain information about IGRA results over a 12 years period (April 2010-April 2022). Results In our hospital record over a 12-year period, we found a total of 1012 positive and 223 indeterminate IGRA test results. Within the rheumatology department, 123 positive and 39 indeterminate IGRA results were identified. In the indeterminate IGRA group, the majority were female (n=24, 61.5%), UAE nationals (n=22, 56.4%), and had a mean age of 38.6 years. Systemic lupus erythematosus (SLE) was the most prevalent rheumatologic condition (n=21, 53.8%). 33.3% (n=13) were on disease modifying anti-rheumatic drugs (DMARDs) and 66.7% (n=26) were on corticosteroid during IGRA testing. A total of 8 patients (20.5%) received anti-TB medications. In a positive IGRA group, the mean age of 55.7 years and a female-to-male ratio of 3:1. The most common rheumatologic conditions were RA (n=67, 54.4%). Approximately 52.8% (n=65) of patients were on conventional DMARDs, 66.7% (n=26) were on corticosteroids during IGRA testing, and 60% (n=74) received anti-TB medications. Two cases (1.6%) of active TB infections were detected among patients with positive IGRA tests, both of whom were receiving anti-TNFa inhibitor treatment in combination with methotrexate. No cases of active TB infection were observed in the indeterminate IGRA group. Conclusion Tuberculosis risk in positive and indeterminate IGRA results for rheumatological conditions is low. Further multicenter studies are required to analyze patient outcomes and differences in TB-endemic and non-endemic regions.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139292971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1142/s2661341723740085
W. Stevens
Pulmonary arterial hypertension (PAH), defined as the presence of artery pulmonary artery pressure > 20 mmHg, pulmonary artery wedge pressure [Formula: see text]15 mmHg, and pulmonary vascular resistance (PVR) > 2Wood units based on expert consensus, is characterized by a progressive and sustained increase in PVR, which may lead to right heart failure and death. PAH is a well-known complication of connective tissue diseases (CTDs), such as systemic sclerosis, systemic lupus erythematosus, Sjögren’s syndrome, and other autoimmune conditions. In the past few years, tremendous progress in the understanding of PAH pathogenesis has been made, with various novel diagnostic and screening methods for the early detection of CTD-PAH proposed worldwide. This symposium would highlight the most updated 2022 ESC/ERS guideline in the disease management of PAH, including latest haemodynmaic definitions of PAH, new risk stratification approach at reassessment and updated PAH treatment recommendations. In addition to the guideline update, important discussion would cover the important diagnostic, and screening algorithm for early detection of CTD-PAH and clinical experiences in managing difficult CTD-PAH cases.
{"title":"Lunch Symposium","authors":"W. Stevens","doi":"10.1142/s2661341723740085","DOIUrl":"https://doi.org/10.1142/s2661341723740085","url":null,"abstract":"Pulmonary arterial hypertension (PAH), defined as the presence of artery pulmonary artery pressure > 20 mmHg, pulmonary artery wedge pressure [Formula: see text]15 mmHg, and pulmonary vascular resistance (PVR) > 2Wood units based on expert consensus, is characterized by a progressive and sustained increase in PVR, which may lead to right heart failure and death. PAH is a well-known complication of connective tissue diseases (CTDs), such as systemic sclerosis, systemic lupus erythematosus, Sjögren’s syndrome, and other autoimmune conditions. In the past few years, tremendous progress in the understanding of PAH pathogenesis has been made, with various novel diagnostic and screening methods for the early detection of CTD-PAH proposed worldwide. This symposium would highlight the most updated 2022 ESC/ERS guideline in the disease management of PAH, including latest haemodynmaic definitions of PAH, new risk stratification approach at reassessment and updated PAH treatment recommendations. In addition to the guideline update, important discussion would cover the important diagnostic, and screening algorithm for early detection of CTD-PAH and clinical experiences in managing difficult CTD-PAH cases.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139293298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1142/s2661341723740073
Linda Bradbury
The management of pain in inflammatory arthritis can be complicated. Its important to differentiate between different types of pain, explain these to the patient and treat accordingly. Pain can be due to inflammatory disease eg rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis; tissue damage eg osteoarthritis; nerve pain eg shingles, carpal tunnel; or due to increased sensitivity of the pain system eg fibromyalgia. Patients may have a combination of two or more of these which can be challenging not only for the patient but also the clinician. Understanding the signs and symptoms of each is vital for the rheumatology nurse to be able to fully assess and evaluate care. Individualised care is important as everyone’s perception of pain is different. Factors such as sleep, physical health, diet and mental health can also play a role and so a holistic approach is essential. Management of the rheumatology patient involves a combination of pharmacological therapies but, probably more importantly from the rheumatology nurse point of view, non-pharmacological approaches. Of course, the diagnosis will determine the pharmacological treatments but can more be done? With a focus on pain, this presentation will follow a patient who is attending the rheumatology clinic with a diagnosis of inflammatory arthritis but their journey is not as simple as it sounds.
{"title":"Nursing Session","authors":"Linda Bradbury","doi":"10.1142/s2661341723740073","DOIUrl":"https://doi.org/10.1142/s2661341723740073","url":null,"abstract":"The management of pain in inflammatory arthritis can be complicated. Its important to differentiate between different types of pain, explain these to the patient and treat accordingly. Pain can be due to inflammatory disease eg rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis; tissue damage eg osteoarthritis; nerve pain eg shingles, carpal tunnel; or due to increased sensitivity of the pain system eg fibromyalgia. Patients may have a combination of two or more of these which can be challenging not only for the patient but also the clinician. Understanding the signs and symptoms of each is vital for the rheumatology nurse to be able to fully assess and evaluate care. Individualised care is important as everyone’s perception of pain is different. Factors such as sleep, physical health, diet and mental health can also play a role and so a holistic approach is essential. Management of the rheumatology patient involves a combination of pharmacological therapies but, probably more importantly from the rheumatology nurse point of view, non-pharmacological approaches. Of course, the diagnosis will determine the pharmacological treatments but can more be done? With a focus on pain, this presentation will follow a patient who is attending the rheumatology clinic with a diagnosis of inflammatory arthritis but their journey is not as simple as it sounds.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139295839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1142/s2661341723740383
Yingzhao Jin, Isaac T Cheng, Ho So, T. Yip, CK Wong, L. Tam
Background While C-reactive protein (CRP) is commonly used to monitor disease activity in Psoriatic Arthritis (PsA), over half of the patients with moderate-to-high disease activity had normal CRP level. Our study aims to investigate the correlation of serum protein biomarkers and disease activity in patients with PsA. Methods 176 patients fulfilled the CASPAR (ClASsification criteria for Psoriatic ARthritis) were recruited in this cross-sectional study. Disease activity was measured by the clinical Disease Activity in Psoriatic Arthritis (cDAPSA). 45 protein biomarkers, cartilage and bone turn-over markers level were assessed (Table 1). The patients were randomly divided into a derivation-cohort and a validation-cohort at a ratio of 7:3. Least absolute shrinkage and selection operator (LASSO) was used to select biomarkers which were associated with moderate/high disease activity in the derivation cohort. Receiver operating characteristic (ROC) curve, GiViTI calibration belt were used to assess the performance of the model in both cohorts. Results The cohort [age: 55.5 (44.0-62.75) years, male: 80 (45.5%)] had moderate disease activity [DAPSA: 15.9 (8.3-26.9); PASI: 3.2 (0.5-6.8)]. 101 PsA patients (57.4%) had moderate/high disease activity. Biomarker levels associated with moderate/high disease activity included SAA (Serum amyloid A), IL8 (Interleukin 8), IP10 (Interferon gamma-induced protein 10), M-CSF (Macrophage colony-stimulating factor), SCGF-[Formula: see text] (Stem cell growth factor), SDF-1[Formula: see text] (Stromal cell-derived factor 1[Formula: see text]) (Figure 1A, B). The model’s equation including the 6 biomarker levels was applied to the validation-cohort. The area under the ROC curve (AUC) for discriminating moderate/high disease activity was 0.802 and 0.835 for the derivation-and-validation-cohorts, respectively (Figure 1C, D). The multi-biomarkers panel model had higher-AUC when compared with that of CRP (AUC=0.727, p=0.022). The P-values of calibration charts in the two sets were 0.902 and 0.123 (Figure 1E, F). Conclusions The multi-biomarkers panel had excellent performance in discriminating patients with moderate/high disease activity from those with low disease activity/remission.
{"title":"Abstract 22 — Derivation and Internal Validation of a Multi-Biomarker-Based Disease Activity Prediction Score for Psoriatic Arthritis Patients","authors":"Yingzhao Jin, Isaac T Cheng, Ho So, T. Yip, CK Wong, L. Tam","doi":"10.1142/s2661341723740383","DOIUrl":"https://doi.org/10.1142/s2661341723740383","url":null,"abstract":"Background While C-reactive protein (CRP) is commonly used to monitor disease activity in Psoriatic Arthritis (PsA), over half of the patients with moderate-to-high disease activity had normal CRP level. Our study aims to investigate the correlation of serum protein biomarkers and disease activity in patients with PsA. Methods 176 patients fulfilled the CASPAR (ClASsification criteria for Psoriatic ARthritis) were recruited in this cross-sectional study. Disease activity was measured by the clinical Disease Activity in Psoriatic Arthritis (cDAPSA). 45 protein biomarkers, cartilage and bone turn-over markers level were assessed (Table 1). The patients were randomly divided into a derivation-cohort and a validation-cohort at a ratio of 7:3. Least absolute shrinkage and selection operator (LASSO) was used to select biomarkers which were associated with moderate/high disease activity in the derivation cohort. Receiver operating characteristic (ROC) curve, GiViTI calibration belt were used to assess the performance of the model in both cohorts. Results The cohort [age: 55.5 (44.0-62.75) years, male: 80 (45.5%)] had moderate disease activity [DAPSA: 15.9 (8.3-26.9); PASI: 3.2 (0.5-6.8)]. 101 PsA patients (57.4%) had moderate/high disease activity. Biomarker levels associated with moderate/high disease activity included SAA (Serum amyloid A), IL8 (Interleukin 8), IP10 (Interferon gamma-induced protein 10), M-CSF (Macrophage colony-stimulating factor), SCGF-[Formula: see text] (Stem cell growth factor), SDF-1[Formula: see text] (Stromal cell-derived factor 1[Formula: see text]) (Figure 1A, B). The model’s equation including the 6 biomarker levels was applied to the validation-cohort. The area under the ROC curve (AUC) for discriminating moderate/high disease activity was 0.802 and 0.835 for the derivation-and-validation-cohorts, respectively (Figure 1C, D). The multi-biomarkers panel model had higher-AUC when compared with that of CRP (AUC=0.727, p=0.022). The P-values of calibration charts in the two sets were 0.902 and 0.123 (Figure 1E, F). Conclusions The multi-biomarkers panel had excellent performance in discriminating patients with moderate/high disease activity from those with low disease activity/remission.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139299877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1142/s2661341723740267
Pankajkumar Yadav
Background Ketoprofen (KPN) is commonly prescribed drug to alleviate pain related with rheumatoid arthritis (RA). However, KETO belongs to the BCS class-II category, characterized by poor water solubility, resulting in less dissolution capability leading to limited systemic absorption. Purpose of this study was to increase aqueous solubility as well as rate of dissolution of KPN using solid-dispersion technique. Methods Two different hydrophilic carriers, D-mannitol and polyvinylpyrrolidone K30 (PVP K30) and, were utilized, in varying ratios with the drug, to formulate solid dispersions. Kneading and solvent evaporation techniques were employed for preparing KPN solid dispersions with PVP K30, while kneading and melting methods were utilized for solid dispersions containing D-mannitol. The liquid state of the formulations was characterized through phase-solubility studies, while Scanning Electron Microscopy (SEM), Fourier Transform Infrared (FTIR) spectroscopy, Differential Scanning Calorimetry (DSC) and X-ray diffraction (XRD) analysis were performed to examine the solid state. Results Both carriers demonstrated a favorable impact on the aqueous solubility of KPN. Solid state examination of D-mannitol solid dispersions revealed that KPN existed as fine particles, while it was entrapped within the polymer matrix in solid dispersions with PVP K30. Compared to poor rate of dissolution of pure drug KPN, the drug dispersions in both carriers showed a significantly improved dissolution rate. Improvement of dissolution rate can be ascribed to enhanced wetting behavior and dispersion of fine particles along with reduced crystalline fraction and an increase in the amorphous nature of KPN. Conclusion PVP K30 solid dispersions of KPN exhibited a noteworthy enhancement in the dissolution efficacy of KPN. Moreover, physical mixtures of KPN exhibited better dissolution profiles with D-mannitol and PVP K30 in comparison to pure KPN.
{"title":"Abstract 10 — Enhancing Dissolution Efficiency of Ketoprofen, A Rheumatoid Arthritis Pain Management Drug, through Solid Dispersion Formulation","authors":"Pankajkumar Yadav","doi":"10.1142/s2661341723740267","DOIUrl":"https://doi.org/10.1142/s2661341723740267","url":null,"abstract":"Background Ketoprofen (KPN) is commonly prescribed drug to alleviate pain related with rheumatoid arthritis (RA). However, KETO belongs to the BCS class-II category, characterized by poor water solubility, resulting in less dissolution capability leading to limited systemic absorption. Purpose of this study was to increase aqueous solubility as well as rate of dissolution of KPN using solid-dispersion technique. Methods Two different hydrophilic carriers, D-mannitol and polyvinylpyrrolidone K30 (PVP K30) and, were utilized, in varying ratios with the drug, to formulate solid dispersions. Kneading and solvent evaporation techniques were employed for preparing KPN solid dispersions with PVP K30, while kneading and melting methods were utilized for solid dispersions containing D-mannitol. The liquid state of the formulations was characterized through phase-solubility studies, while Scanning Electron Microscopy (SEM), Fourier Transform Infrared (FTIR) spectroscopy, Differential Scanning Calorimetry (DSC) and X-ray diffraction (XRD) analysis were performed to examine the solid state. Results Both carriers demonstrated a favorable impact on the aqueous solubility of KPN. Solid state examination of D-mannitol solid dispersions revealed that KPN existed as fine particles, while it was entrapped within the polymer matrix in solid dispersions with PVP K30. Compared to poor rate of dissolution of pure drug KPN, the drug dispersions in both carriers showed a significantly improved dissolution rate. Improvement of dissolution rate can be ascribed to enhanced wetting behavior and dispersion of fine particles along with reduced crystalline fraction and an increase in the amorphous nature of KPN. Conclusion PVP K30 solid dispersions of KPN exhibited a noteworthy enhancement in the dissolution efficacy of KPN. Moreover, physical mixtures of KPN exhibited better dissolution profiles with D-mannitol and PVP K30 in comparison to pure KPN.","PeriodicalId":15538,"journal":{"name":"Journal of Clinical Rheumatology and Immunology","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139300859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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