Scandinavian Journal of Rheumatology最新文献

Objective: Complete response to colchicine is reported in 60-65% of patients with familial Mediterranean fever (FMF), partial response in 30-35%, and poor response in 5-10% of patients. The objective of our study was to revisit colchicine response rates for the common FMF gene (MEFV) genotypes in view of newly available treatments.

Method: Data were retrieved from medical files of 106 consecutive FMF patients, who were divided into four groups: patients with complete response, having had no attacks in the past year; near complete, with one or two attacks; fairly controlled, with three to six attacks; and poorly controlled, with more than six attacks in the past year.

Results: Only 34% of M694V homozygotes were adequately controlled, having had zero to two attacks in the past year, compared to 66% of the patients with all other genotypes combined (p < 0.002). Furthermore, 42% of M694V homozygotes were poorly controlled compared to 13% of all other genotypes combined (p < 0.001). Patients categorized as adequately controlled received a lower dose of colchicine compared to the rest of the cohort (p = 0.042). None of the patients had amyloidosis.

Conclusion: We found a relatively large group of FMF patients with inadequate response to colchicine. This underlines the importance of improving disease control and quality of life for patients with FMF.

Objective: The causative agent behind gouty inflammation, monosodium urate (MSU) crystals, triggers neutrophils to produce reactive oxygen species (ROS) and cast out neutrophil extracellular traps (NETs). We have previously demonstrated that when neutrophils encounter MSU crystals in vitro, they produce ROS that are strictly intracellular, and this response is highly primed in in vivo transmigrated neutrophils. Since neutrophil activation markers in blood have been linked to active gout and cardiovascular events during long-term follow-up, we wanted to further investigate neutrophil activation in gout.

Method: Blood neutrophils from patients with polyarticular gout and healthy controls were tested for activation status, including ROS production, NET formation, and receptor expression. The majority of patients in our study were treated with urate-lowering drugs and some were also treated with colchicine and/or prednisolone. CRP (as a marker of disease activity) and plasma urate levels were measured. Statistical significance was calculated using the Wilcoxon rank-sum test.

Results: Peripheral blood neutrophils from gout patients, similarly to those from healthy controls, displayed a resting phenotype with regard to surface receptor expression, and neither NET formation nor ROS production was primed compared to neutrophils from healthy controls. Levels of ROS production did not correlate with CRP or plasma urate levels, but a trend towards lower intracellular ROS production in colchicine-treated patients was noted.

Conclusions: Blood neutrophils from patients with polyarticular gout do not display an activated phenotype, and respond in a functionally similar way to neutrophils from healthy controls.

Objective: The aim of the study was to analyse associations between anti-inflammatory treatment before a first acute myocardial infarction (AMI) and survival up to 365 days post-AMI in patients with and without rheumatoid arthritis (RA).

Method: Data for 199 071 patients with a first AMI during 2006-2017, including 3725 RA patients, and for anti-inflammatory medical treatment during the 6 months before a first AMI, were drawn from Swedish registries. Drugs were categorized as corticosteroids, non-steroidal anti-inflammatory drugs, conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs), tumour necrosis factor inhibitors (anti-TNFs), or other biological DMARDs. Multivariable logistic regression analysis was used to assess mortality associations up to 30 days and multivariable Cox proportional hazard models to assess associations from 31 to 365 days.

Results: No treatment was associated with survival within 30 days after the AMI. From 31 to 365 days post-AMI, corticosteroid treatment was associated with increased mortality [in RA: hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.27-1.62; without RA: HR 1.37, 95% CI 1.33-1.41]. csDMARDs were associated with increased survival in RA patients (HR 0.86, 95% CI 0.78-0.96), as were anti-TNF treatments (HR 0.72, 95% CI 0.56-0.94). Among non-RA patients, csDMARDs were associated with increased mortality (HR 1.14, 95% CI 1.04-1.24).

Conclusion: Anti-inflammatory treatment was not associated with mortality within 30 days after a first AMI. From 31 to 365 days post-AMI, corticosteroid treatment was associated with increased mortality risk for all patients, and csDMARDs and anti-TNFs were associated with increased survival for RA patients.

Objectives: To study the correlation of thermography with ultrasonography, and whether thermography can help to predict ultrasound-detected joint inflammation at the metacarpophalangeal joints (MCPJs) in patients with rheumatoid arthritis (RA).

Method: Maximum, average, and minimum temperatures were recorded by thermography and summed for the MCPJs of each hand. Their relationship with the summed power Doppler (PD) and grey-scale (GS) scores was explored using correlation analysis and simple linear regression. The ability of summed thermographic temperatures to predict summed PD score ≥ 1 and summed GS score ≥ 18 (median score) was studied using receiver operating characteristics (ROC) curve analysis. Intraobserver reliability (single observer) was analysed using intraclass correlation coefficients (ICCs).

Results: This cross-sectional study examined 810 joints from 81 RA patients. At both right and left MCPJs, all summed thermographic temperatures correlated significantly (p < 0.05) and had significant relationships (p < 0.05) with summed ultrasound scores (for PD and GS, respectively, correlation coefficients ranged from 0.45 to 0.52 and 0.26 to 0.29, and regression coefficients from 0.094 to 0.137 and 0.058 to 0.086). At the bilateral MCPJs, the area under the ROC curves for summed thermographic temperatures in predicting summed PD score ≥ 1 and summed GS score ≥ 18 ranged from 0.80 to 0.82 and 0.65 to 0.66, respectively. ICC values (for 45 baseline MCPJs for which thermographic temperatures were resegmented > 2 weeks apart) were excellent (all > 0.90).

Conclusion: Thermographic temperatures reflect ultrasound-detected joint inflammation, and appear useful in predicting PD vascularity at the MCPJs of patients with RA.

Objectives: Calprotectin (S100A8/A9) is an established inflammatory marker in rheumatoid arthritis (RA), but its role in psoriatic arthritis (PsA) is less studied. This study evaluated plasma calprotectin as a biomarker of inflammatory activity in PsA by assessing its association with ultrasound-detected synovitis before and during treatment with a biological disease-modifying anti-rheumatic drug (bDMARD). The potential of S100A12, vascular endothelial growth factor, interleukin-6 (IL-6), IL-17A, IL-23, and C-X-C motif chemokine ligand 10 (CXCL10) was also explored.

Method: Forty-three PsA patients initiating bDMARD therapy were assessed clinically and by ultrasound at baseline and after 3, 6, 9, and 12 months. Biomarkers were measured using enzyme-linked immunosorbent assays and Luminex assays. Changes were analysed using the Wilcoxon signed-rank test, and correlations with Spearman's rank analysis.

Results: Mean (± SD) age was 47.6 (± 12.9) years, 60.5% were women, and median disease duration was 10 years (interquartile range 4.2-21.9). Significant reductions were observed in joint counts and in the Disease Activity Index for Psoriatic Arthritis, Disease Activity Score for 28 joints including CRP, and Bath Ankylosing Spondylitis Disease Activity Index. Baseline levels of calprotectin, S100A12, IL-6, IL-17A, IL-23, and CXCL10 were higher in PsA than in controls (p < 0.05). Calprotectin, S100A12, and IL-6 levels decreased during follow-up (p < 0.05). No clinically relevant correlations between the ultrasound scores and inflammatory markers were observed.

Conclusion: Calprotectin levels were elevated in PsA patients and decreased with treatment but showed no clinically significant correlation with ultrasound-detected synovitis. Further studies are needed, particularly in cohorts with higher levels of inflammation.

Objective: To investigate globally the ratio between biological and targeted synthetic disease-modifying anti-rheumatic drugs (btsDMARDs) and glucocorticoid (GC) use in patients with rheumatoid arthritis (RA), in relation to country-level socioeconomic status (SES).

Method: Data on btsDMARD and GC use between 1 January 2007 and 13 September 2021 were extracted from the international observational METEOR RA registry. The ratio between the proportion of patients who had ever used a btsDMARD and those who had ever used a GC and never a btsDMARD, during 2 years of follow-up, was calculated per country. Associations between the btsDMARD/GC ratios and country-level indicators of SES were assessed with linear regression.

Results: Data from 10 856 patients covering eight geographically spread countries, of whom 8484 were from India, showed a wide range of drug use during 2 years of follow-up: btsDMARD (with or without GC), from 1% (South Africa, India) to 26% (Massachusetts, USA); GC and never btsDMARD use, 19% (UK) to 92% (South Africa). Higher country-level SES was related to a higher btsDMARD/GC ratio. For every additional 10 000 International $, GDP per capita, household net adjusted disposable income, and health expenditure per capita, the estimated increase in btsDMARD/GC ratio (range 0-1) was 0.1 (95% CI 0.05;0.1), 0.2 (95% CI 0.08;0.3), and 0.6 (95% CI 0.4;0.8), respectively.

Conclusion: In this analysis based on eight different countries, we show that the btsDMARD/GC ratio varies widely across countries. This was strongly associated with general country-level indicators of level of wealth, i.e. greater wealth was associated with a higher ratio.