ARP Rheumatology最新文献

Introduction: The current standard of care of patients with spondyloarthritis (SpA), in addition to pharmacological treatment, includes regular exercise and patient education.(1) The primary goal of this systematic literature review (SLR) is to update the evidence of the effectiveness of education programs for patients with axial SpA (axSpA).

Methods: We systematically searched three databases, PubMed, Embase and Web of Science Core Collection, from January 2000 to June 2023, using the following terms: "patient education", "patient counselling", "patient teaching", "patient engaging", "patient empowerment", "health education", "spondyloarthritis", "spondyloarthropaties", "spondylitis" and "ankylosing spondylitis". The "Population (P)", "Intervention (I)", "Comparator (C)", "Outcome (O)", PICO criteria were used. "P", defined as axSpA, "I" as education, "C" as standard of care or physical exercise and "O" as disease activity, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS); disease functional repercussion, Bath Ankylosing Spondylitis Functional Index (BASFI); disease metrological repercussion, Bath Ankylosing Spondylitis Metrological Index (BASMI); disease quality of life Ankylosing Spondylitis Quality of Life (ASQoL), EuroQol-5D (EQ-5D) and Short Form 36 Health Survey (SF36); disease economic impact, cost-utility, cost-benefit and incremental cost-effectiveness ratio (ICER). Only randomized clinical trials were included. Two reviewers independently assessed the identified papers according to the established criteria and extracted the data.

Results: From the initial 494 studies identified, 6 were selected for data extraction and qualitative analysis. The study sample sizes ranged between 41-65 individuals, all diagnosed with ankylosing spondylitis. The leaders of the programs varied, the intervention period ranged between 4-12 weeks and the follow up ranged between 3-12 months. In three studies, the comparator was standard of care, and in the other three was physical exercise. Overall, there was an improvement in BASDAI, BASFI, BASMI, ASQoL and SF-36, after the application of educational programs. No studies evaluated the economic impact of educational programs.

Conclusion: Education appears to be an important adjuvant as non-pharmacological treatment for patients with axSpA, enhancing various disease outcomes, particularly when delivered by Health Professionals using physical materials such as pamphlets. However, there is an ongoing need for additional research to obtain more robust conclusions.

Background: Case reports suggest that calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) may trigger inflammatory flares in patients with autoimmune diseases.

Case description: A 56-year-old woman with a history of severe migraines, experienced improvement in migraine frequency and intensity after starting fremanezumab 225 mg monthly. However, three months into treatment, she developed symmetric inflammatory polyarthralgias. Physical examination confirmed polyarthritis in the hands, feet, and knees. Laboratory tests showed elevated inflammatory markers and positive anti-cyclic citrullinated peptide antibodies, with baseline X-rays of hands, feet, and knees being normal. Diagnosed with rheumatoid arthritis (RA), she was treated with prednisolone, methotrexate (MTX), folic acid, calcium carbonate, and cholecalciferol, resulting in clinical improvement. Despite recommendations, she continued fremanezumab; her articular symptoms persisted after discontinuation. Later, she switched to leflunomide 20 mg due to gastrointestinal intolerance to MTX and is currently in remission.

Discussion/conclusions: CGRP mAbs are effective for migraine prevention, but cases of immune-mediated disease flares are documented. This case suggests a possible association between CGRP mAbs and RA onset. Further research is essential to understand the impact of CGRP modulation in autoimmune diseases.

Background: Axial Spondyloarthritis (axSpA) is a chronic inflammatory rheumatic condition affecting the axial skeleton, leading to pain, stiffness, and fatigue. While biologic therapies have improved clinical management, many patients experience partial or no responses, resulting in delays in disease control. Additionally, the risk of adverse events and increased costs remains a concern.

Objectives: Our primary objectives are: 1. to identify reliable markers for treatment response to Tumor Necrosis Factor alpha inhibitors (TNFi), in particular Adalimumab, enabling the identification of individuals most likely to benefit; 2. to analyze the impact of TNFi on gene and protein expression.

Methods: A multicenter, prospective 14-week study will be conducted with 36 participants aged 18-75 years, meeting the ASAS criteria for axSpA. Patient enrollment will follow the National Guidelines for the use of TNFi in axSpA treatment, with all included patients using TNFi (Adalimumab) as a first-line option. Epidemiological and clinical data will be collected, along with peripheral blood samples, for integrated transcriptome, using RNA Seq (whole genome sequencing) and proteome analysis at various time points (baseline, 3-5 days, weeks 2 and 14), corresponding to the initial administration of TNFi. Patients will be classified as responders and non-responders, primarily based on ASAS20 criteria and secondarily based on ASDAS-C Reactive Protein (CRP), at week 14.

Discussion: This project's innovative approach lies in identifying potential biomarkers for TNFi (Adalimumab) response at baseline, paving the way for advancements in precision medicine in this field. Additionally, it seeks to establish evidence of the therapy's impact on gene and protein expression, offering deeper insights into the pathophysiological mechanisms underlying the therapeutic response.

Background: The percentage of Portuguese psoriasis patients with psoriatic arthritis is unknown but musculoskeletal complaints related to PsA affect up to a third of patients. Dermatologists can identify early PsA as skin symptoms often precede joint symptoms in 80% of patients. Efficient and easy to perform screening tools are needed to help dermatologists effectively discriminate between Pso and PsA patients. The present study aims to evaluate the prevalence of PsA in Pso patients followed in Portuguese dermatology clinics. Additionally, it aims to evaluate the EARP-PT performance (validity, sensitivity, specificity) and the best cut-off point to allow an early identification of PsA potential patients.

Methods: A multicentre national, cross-sectional, observational study with two independent assessments (dermatologist and rheumatologist), was performed. A PsA case was defined by a combination of expert opinion and classification criteria for psoriatic arthritis (CASPAR). The EARP-PT questionnaire screening performance was evaluated.

Results: Pso patients (n=172) were included with a mean age of 53.8+/-14.5 years, 53.5% were male with a mean time of diagnosis of 17.4+/-14.9 years. The prevalence of PsA in patients with Pso in our sample was 8.70% (95% CI: 4.8-14.2). The EARP-PT questionnaire displayed good internal consistency (Cronbach's α=0.81) and, using a validated initial cut-off point of 3, demonstrated a sensitivity of 71.4% and specificity of 40.1%.

Conclusion: The estimated prevalence of PsA in a population of Pso patients followed in Portuguese dermatology clinics, is 8.7%. The EARP-PT questionnaire appears to be a useful tool for dermatologists in the early detection of PsA.

Introduction - Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease, which causes local and systemic bone damage. The main goal of this work was to analyze, how treatment intervention with Ab501 (certolizumab mice equivalent) prevents the disturbances on bone structure and mechanics induced by arthritis. Methods - Thirty DBA/1 collagen-induced arthritis (CIA) mice were randomly housed in experimental groups, as follows: arthritic untreated (N=9), preventive intervention (N=10) and treatment intervention (N=11). A non-induced group (N=5) was used as a control. Mice were monitored during 70 days after disease induction for the inflammatory score, ankle perimeter and body weight. After 70 days of disease progression mice were sacrificed and bone samples were collected for histology, micro-computed tomography (µCT) and 3-point bending analysis. In addition, blood samples were also collected for bone turnover markers quantification. Results - Results showed that Ab501 administration was able to control and abrogate disease development both in preventive and early therapeutic intervention. µCT results revealed that Ab501 was able to preserve trabecular bone structure when delivered before arthritis induction. Conclusion - Ab501 preventive administration was able to control inflammation and prevent the degradative effects of arthritis on trabecular bone structure in a CIA DBA/1 mice model.

Objectives: We aimed to assess the anti-mutated citrullinated vimentin (anti-MCV) antibodies in RA patients' serum and to explore their association with interstitial lung disease (ILD).

Methods: Eighty rheumatoid arthritis (RA) patients and forty healthy controls were included in this case-control study. Of these patients, forty had ILD, and forty without ILD. Patients were subjected to clinical and laboratory assessment, measurement of anti-MCV serum levels by ELISA, X-ray of hands and feet, pulmonary function tests, and high-resolution computed tomography (HRCT) of the chest.

Results: Increased serum level of anti-MCV antibodies was found in RA patients compared with the controls and in RA patients with ILD compared to those without ILD. The serum anti-MCV level was correlated positively with disease activity score 28 (DAS28), Larsen, erythrocyte sedimentation rate (ESR), and anti-citrullinated peptides antibodies (ACPA) and negatively with the diffusing capacity for carbon monoxide (DLCO), and forced vital capacity (FVC). Patients' age, disease duration, ACPA level, anti-MCV level, and anti-MCV positivity were predictors of ILD in our patients. At the 42.5 U/ml cut-off, the anti-MCV antibodies have 78.8% sensitivity and 80% specificity for RA, and at the 155.5 U/ml cut-off, their sensitivity is 80%, and their specificity is 75% for ILD.

Conclusion: Anti-MCV antibodies are increased in RA patients with ILD with high sensitivity and specificity; thus, they may represent a promising marker for early detection and prediction of RA-related ILD. In addition, anti-MCV antibodies positively correlate with the Larsen score; hence, they may be a valuable serological marker for predicting joint damage in RA patients. More research with large sample sizes is recommended to support our findings.

Introduction: Anakinra has dramatically improved the management of systemic juvenile idiopathic arthritis (SJIA) over the last decade. Nevertheless, management remains inconsistent; corticosteroids are still frequently used. We analyzed the course of SJIA in children treated with anakinra according to the time of treatment initiation after disease onset.

Method: Children with SJIA treated with anakinra between 2006 and 2020 were included in this single-center, retrospective observational study.

Results: Twenty-four children received anakinra at a median time of 58 (range 12-2940) days after SJIA onset, all after failure of nonsteroidal anti-inflammatory drug (NSAID) treatment. Eighteen were males and the median age at disease onset was 6.04 (range 0.8-13) years. The median follow-up time was 3.5 (range 0.5-10.8) years after treatment initiation. At the last follow-up, remission attributable to anakinra was observed in 18/24 (75%) children and treatment-free remission was observed in 12 (67%). For each child, the response to anakinra was the same at 3 months and at the last follow-up. The 15 children treated with anakinra within the first 3 months after disease onset exhibited better remission (93%) than did the 9 children treated after 3 months (44%) (p = 0.015) and the former received fewer corticosteroids (7% versus 67%) (p = 0.004). One child with long-standing disease died of the disease.

Conclusions: Early anakinra initiation within the first 3 months of SJIA onset after NSAID failure ensures long-term remission and reduces corticosteroid use. Anakinra should not be continued for more than 3 months in nonresponding children.