J. Kędra, P. Claudepierre, R. Flipo, M. Garrido-Cumbrera, F. Alliot-Launois, E. Desfleurs, L. Grange, L. Gossec
The effect of axial spondyloarthritis (axSpA) on patients' quality of life (QOL) has been well assessed in terms of body structures and functions, but literature is scarce in terms of social interactions and activities, work, and fears related to social interactions or activities.1.
{"title":"Impact of Axial Spondyloarthritis on Quality of Life: Results From the European Map of Axial Spondyloarthritis (EMAS) Study in France","authors":"J. Kędra, P. Claudepierre, R. Flipo, M. Garrido-Cumbrera, F. Alliot-Launois, E. Desfleurs, L. Grange, L. Gossec","doi":"10.3899/jrheum.210864","DOIUrl":"https://doi.org/10.3899/jrheum.210864","url":null,"abstract":"The effect of axial spondyloarthritis (axSpA) on patients' quality of life (QOL) has been well assessed in terms of body structures and functions, but literature is scarce in terms of social interactions and activities, work, and fears related to social interactions or activities.1.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"43 1","pages":"1176 - 1178"},"PeriodicalIF":0.0,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84884285","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}
Realizing in the fall of 2021 that I had started medical school exactly 50 years ago, on September 7, 1971, I thought that it would be interesting for the 2022 Dunlop-Dottridge Lecture to briefly review what we knew about vasculitis prior to 1971 and then reflect on what we have learned since.
{"title":"Vasculitis: What Have We Learned in the Last 50 Years?","authors":"S. Carette","doi":"10.3899/jrheum.220207","DOIUrl":"https://doi.org/10.3899/jrheum.220207","url":null,"abstract":"Realizing in the fall of 2021 that I had started medical school exactly 50 years ago, on September 7, 1971, I thought that it would be interesting for the 2022 Dunlop-Dottridge Lecture to briefly review what we knew about vasculitis prior to 1971 and then reflect on what we have learned since.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"24 1","pages":"848 - 852"},"PeriodicalIF":0.0,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82587023","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}
Calcinosis (hydroxyapatite and calcium phosphate crystal deposition) within the extracellular matrix of the dermis and subcutaneous tissue is a frequent manifestation of adult and pediatric systemic autoimmune rheumatic diseases, specifically systemic sclerosis, dermatomyositis, mixed connective tissue disease, and systemic lupus erythematosus. In this article, we review classification of calcinosis, highlight mechanisms that may contribute to the pathogenesis of calcinosis, and summarize the evidence evaluating nonpharmacologic and pharmacologic interventions for the treatment of calcinosis.
{"title":"Management of Calcinosis Cutis in Rheumatic Diseases","authors":"Hadiya Elahmar, B. Feldman, S. Johnson","doi":"10.3899/jrheum.211393","DOIUrl":"https://doi.org/10.3899/jrheum.211393","url":null,"abstract":"Calcinosis (hydroxyapatite and calcium phosphate crystal deposition) within the extracellular matrix of the dermis and subcutaneous tissue is a frequent manifestation of adult and pediatric systemic autoimmune rheumatic diseases, specifically systemic sclerosis, dermatomyositis, mixed connective tissue disease, and systemic lupus erythematosus. In this article, we review classification of calcinosis, highlight mechanisms that may contribute to the pathogenesis of calcinosis, and summarize the evidence evaluating nonpharmacologic and pharmacologic interventions for the treatment of calcinosis.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"19 1","pages":"980 - 989"},"PeriodicalIF":0.0,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75073049","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}
We thank Dr Schou for her insightful comments.1 The interpretation of data from an observational study such as this is complex, and the conclusions are by necessity less robust than in a randomized controlled trial.
{"title":"Dr. Griffiths et al reply","authors":"J. Leadbetter, H. Griffiths","doi":"10.3899/jrheum.220120","DOIUrl":"https://doi.org/10.3899/jrheum.220120","url":null,"abstract":"We thank Dr Schou for her insightful comments.1 The interpretation of data from an observational study such as this is complex, and the conclusions are by necessity less robust than in a randomized controlled trial.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"29 1","pages":"1075 - 1075"},"PeriodicalIF":0.0,"publicationDate":"2022-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89469464","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}
S. Matsuda, T. Kotani, H. Kuwabara, Takayasu Suzuka, Takao Kiboshi, Y. Wada, T. Ishida, Youhei Fujiki, Hideyuki Shiba, K. Hata, T. Shoda, Y. Hirose, T. Takeuchi
Objective To address the pathomechanism of microscopic polyangiitis (MPA) complicated by interstitial lung disease (ILD) using serum biomarker profile and pulmonary histopathology. Methods Serum biomarkers from patients with MPA-ILD (n = 32), MPA without ILD (n = 17), and healthy controls (n = 10) were examined. Based on the biomarker profiles, principal component analysis (PCA) and cluster analysis were performed to classify patients with MPA-ILD into subgroups. Clinical characteristics and prognosis were assessed for each subgroup. Two lung biopsies were examined following H&E staining and immunostaining. Results T cell and macrophage polarization was skewed toward the T helper (Th) 2 cells and M2 macrophages in the MPA-ILD group relative to that in MPA without ILD group. The PCA allowed classification of the 19 biomarker profiles into 3 groups: (1) B cell– and neutrophil-related cytokines, vascular angiogenesis-related factors, extracellular matrix-producing factors; (2) Th1-driven cytokines, M1 macrophage-driven cytokines, and Th2-driven cytokines; and (3) M2 macrophage-induced and driven cytokines. The cluster analysis stratified the patients with MPA-ILD into clinically fibrotic-dominant (CFD) and clinically inflammatory-dominant (CID) groups. Notably, severe infections were significantly higher in the CFD group than in the CID group. Immunohistochemical staining demonstrated intense CXC motif chemokine ligand 13 staining in B cells and Th2 cells in the interstitium of the lungs of patients with MPA-ILD. Conclusion. The activation of M2 macrophages, Th2 cells, and B cells plays a key role in the pathomechanism of MPA-ILD. Classification of MPA-ILD based on serum biomarker profile would be useful in predicting the disease activity and the complications of severe infection in MPA-ILD.
{"title":"Association of M2 Macrophages, Th2, and B Cells With Pathomechanism in Microscopic Polyangiitis Complicated by Interstitial Lung Disease","authors":"S. Matsuda, T. Kotani, H. Kuwabara, Takayasu Suzuka, Takao Kiboshi, Y. Wada, T. Ishida, Youhei Fujiki, Hideyuki Shiba, K. Hata, T. Shoda, Y. Hirose, T. Takeuchi","doi":"10.3899/jrheum.220123","DOIUrl":"https://doi.org/10.3899/jrheum.220123","url":null,"abstract":"Objective To address the pathomechanism of microscopic polyangiitis (MPA) complicated by interstitial lung disease (ILD) using serum biomarker profile and pulmonary histopathology. Methods Serum biomarkers from patients with MPA-ILD (n = 32), MPA without ILD (n = 17), and healthy controls (n = 10) were examined. Based on the biomarker profiles, principal component analysis (PCA) and cluster analysis were performed to classify patients with MPA-ILD into subgroups. Clinical characteristics and prognosis were assessed for each subgroup. Two lung biopsies were examined following H&E staining and immunostaining. Results T cell and macrophage polarization was skewed toward the T helper (Th) 2 cells and M2 macrophages in the MPA-ILD group relative to that in MPA without ILD group. The PCA allowed classification of the 19 biomarker profiles into 3 groups: (1) B cell– and neutrophil-related cytokines, vascular angiogenesis-related factors, extracellular matrix-producing factors; (2) Th1-driven cytokines, M1 macrophage-driven cytokines, and Th2-driven cytokines; and (3) M2 macrophage-induced and driven cytokines. The cluster analysis stratified the patients with MPA-ILD into clinically fibrotic-dominant (CFD) and clinically inflammatory-dominant (CID) groups. Notably, severe infections were significantly higher in the CFD group than in the CID group. Immunohistochemical staining demonstrated intense CXC motif chemokine ligand 13 staining in B cells and Th2 cells in the interstitium of the lungs of patients with MPA-ILD. Conclusion. The activation of M2 macrophages, Th2 cells, and B cells plays a key role in the pathomechanism of MPA-ILD. Classification of MPA-ILD based on serum biomarker profile would be useful in predicting the disease activity and the complications of severe infection in MPA-ILD.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"51 1","pages":"913 - 921"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90691548","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}
Y. Lo, Tang Jun Tiffany Li, Ting-Chun Lin, You-Yin Chen, Jiunn-Horng Kang
Objective In patients with fibromyalgia (FM), the brain shows altered structure and functional connectivity, but the mechanisms underlying these changes remain unclear. This study investigated the associated changes in brain microstructures and neuroinflammation of patients with FM. Methods We recruited 14 patients with FM and 14 healthy controls (HCs). Visual analog scale (VAS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II) were used for assessing their pain, anxiety, and depression levels, respectively. Diffusion kurtosis imaging (DKI) was used to visualize microstructural alterations associated with neuroinflammation in specific brain regions. The biomarkers for neuron damage, including serum tau and amyloid β protein fragment 1-42 (Aβ1-42) levels, were assessed. Spearman correlation of DKI parameters with VAS, BAI, and BDI-II scores as well as tau and Aβ1-42 levels were assessed. Results The patients with FM had significantly higher levels of Aβ1-42 levels than HCs. Compared with HCs, the patients with FM showed significantly lower DKI parameters in the bilateral dorsolateral prefrontal cortex and orbitofrontal cortex. Patients with FM showed a significant correlation between the axial kurtosis values of the amygdala and VAS scores (left: ρ = −0.60, P = 0.02; right: ρ = −7.04, P = 0.005). Conclusion To the best of our knowledge, this is the first study to use DKI to examine the brains of patients with FM. We noted significant DKI changes associated with neuroinflammation at specific areas in patients with FM. Our results provide valuable information on brain neuroinflammation and pathophysiological changes in patients with FM.
{"title":"Microstructural Evidence of Neuroinflammation for Psychological Symptoms and Pain in Patients With Fibromyalgia","authors":"Y. Lo, Tang Jun Tiffany Li, Ting-Chun Lin, You-Yin Chen, Jiunn-Horng Kang","doi":"10.3899/jrheum.211170","DOIUrl":"https://doi.org/10.3899/jrheum.211170","url":null,"abstract":"Objective In patients with fibromyalgia (FM), the brain shows altered structure and functional connectivity, but the mechanisms underlying these changes remain unclear. This study investigated the associated changes in brain microstructures and neuroinflammation of patients with FM. Methods We recruited 14 patients with FM and 14 healthy controls (HCs). Visual analog scale (VAS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II) were used for assessing their pain, anxiety, and depression levels, respectively. Diffusion kurtosis imaging (DKI) was used to visualize microstructural alterations associated with neuroinflammation in specific brain regions. The biomarkers for neuron damage, including serum tau and amyloid β protein fragment 1-42 (Aβ1-42) levels, were assessed. Spearman correlation of DKI parameters with VAS, BAI, and BDI-II scores as well as tau and Aβ1-42 levels were assessed. Results The patients with FM had significantly higher levels of Aβ1-42 levels than HCs. Compared with HCs, the patients with FM showed significantly lower DKI parameters in the bilateral dorsolateral prefrontal cortex and orbitofrontal cortex. Patients with FM showed a significant correlation between the axial kurtosis values of the amygdala and VAS scores (left: ρ = −0.60, P = 0.02; right: ρ = −7.04, P = 0.005). Conclusion To the best of our knowledge, this is the first study to use DKI to examine the brains of patients with FM. We noted significant DKI changes associated with neuroinflammation at specific areas in patients with FM. Our results provide valuable information on brain neuroinflammation and pathophysiological changes in patients with FM.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"7 1","pages":"942 - 947"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84974069","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}
G. Cagnotto, L. Jacobsson, E. Rydell, A. Eberhard, M. Compagno, C. Turesson
Objective The aim of the present study was to investigate whether the relationship between sex and clinical outcomes in early rheumatoid arthritis (RA) varies by autoantibody status. Methods Two inception cohorts of consecutive patients with early RA (ie, symptom duration ≤ 12 months) in the southern region of Sweden were investigated. Patients were stratified by anticitrullinated peptide antibody (ACPA) status. The primary outcome was remission (Disease Activity Score in 28 joints [DAS28] < 2.6) at 12 months. Secondary outcomes were remission at 6 months and European Alliance of Associations for Rheumatology good response at 6 and 12 months compared to baseline. In logistic regression models, which were adjusted for age, DAS28 values, and Health Assessment Questionnaire values at baseline, the relationship between sex and clinical outcomes, stratified by ACPA status, was investigated. Results In total, 426 patients with early RA were included: 160 patients were ACPA negative and 266 patients were ACPA positive. At 12 months, 27.1% (38/140) of females and 24.1% (13/54) of males with ACPA-positive RA achieved DAS28 remission. In ACPA-negative RA, 16.0% (13/81) of females and 48.6% (18/37) of males achieved DAS28 remission at 12 months. Males had higher odds of reaching remission at 12 months in the ACPA-negative patient group (pooled adjusted odds ratio [OR] 4.79, 95% CI 1.97-11.6), but not in the ACPA-positive group (pooled adjusted OR 1.06, 95% CI 0.49-2.30). Conclusion Male sex was associated with better clinical outcomes in ACPA-negative early RA, but not in ACPA-positive early RA. The poor outcomes in females with early seronegative RA suggest that this represents a difficult-to-treat patient group.
目的探讨性别与早期类风湿关节炎(RA)临床结局之间的关系是否因自身抗体状态而异。方法对瑞典南部地区两个连续的早期RA患者(即症状持续时间≤12个月)进行初始队列调查。根据抗瓜氨酸肽抗体(ACPA)水平对患者进行分层。主要终点是12个月时的缓解(28个关节的疾病活动评分[DAS28] < 2.6)。次要结果是6个月时缓解，欧洲风湿病协会联盟在6和12个月时与基线相比有良好的反应。在逻辑回归模型中，调整了年龄、DAS28值和基线健康评估问卷值，研究了性别与临床结果之间的关系，并按ACPA状态分层。结果共纳入426例早期RA患者，其中ACPA阴性160例，ACPA阳性266例。12个月时，27.1%(38/140)的女性和24.1%(13/54)的男性acpa阳性RA患者达到DAS28缓解。在acpa阴性RA中，16.0%(13/81)的女性和48.6%(18/37)的男性在12个月时达到DAS28缓解。在acpa阴性患者组中，男性在12个月时达到缓解的几率更高(综合校正比值比[OR] 4.79, 95% CI 1.97-11.6)，但在acpa阳性患者组中没有(综合校正比值比[OR] 1.06, 95% CI 0.49-2.30)。结论男性与acpa阴性早期RA的临床预后相关，而与acpa阳性早期RA的临床预后无关。早期血清阴性RA的女性患者预后不佳，表明这是一个难以治疗的患者群体。
{"title":"Male Sex Predicts a Favorable Outcome in Early ACPA-Negative Rheumatoid Arthritis: Data From an Observational Study","authors":"G. Cagnotto, L. Jacobsson, E. Rydell, A. Eberhard, M. Compagno, C. Turesson","doi":"10.3899/jrheum.211199","DOIUrl":"https://doi.org/10.3899/jrheum.211199","url":null,"abstract":"Objective The aim of the present study was to investigate whether the relationship between sex and clinical outcomes in early rheumatoid arthritis (RA) varies by autoantibody status. Methods Two inception cohorts of consecutive patients with early RA (ie, symptom duration ≤ 12 months) in the southern region of Sweden were investigated. Patients were stratified by anticitrullinated peptide antibody (ACPA) status. The primary outcome was remission (Disease Activity Score in 28 joints [DAS28] < 2.6) at 12 months. Secondary outcomes were remission at 6 months and European Alliance of Associations for Rheumatology good response at 6 and 12 months compared to baseline. In logistic regression models, which were adjusted for age, DAS28 values, and Health Assessment Questionnaire values at baseline, the relationship between sex and clinical outcomes, stratified by ACPA status, was investigated. Results In total, 426 patients with early RA were included: 160 patients were ACPA negative and 266 patients were ACPA positive. At 12 months, 27.1% (38/140) of females and 24.1% (13/54) of males with ACPA-positive RA achieved DAS28 remission. In ACPA-negative RA, 16.0% (13/81) of females and 48.6% (18/37) of males achieved DAS28 remission at 12 months. Males had higher odds of reaching remission at 12 months in the ACPA-negative patient group (pooled adjusted odds ratio [OR] 4.79, 95% CI 1.97-11.6), but not in the ACPA-positive group (pooled adjusted OR 1.06, 95% CI 0.49-2.30). Conclusion Male sex was associated with better clinical outcomes in ACPA-negative early RA, but not in ACPA-positive early RA. The poor outcomes in females with early seronegative RA suggest that this represents a difficult-to-treat patient group.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"41 ","pages":"990 - 997"},"PeriodicalIF":0.0,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72495682","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}
L. Lally, N. Narula, N. Goodfellow, R. Luqmani, D. Pisapia, R. Spiera
Objective Aberrant Rho-associated protein kinase (ROCK) activity is implicated in several vascular and immunologic disorders. We previously demonstrated increased ROCK activity in histopathologically negative temporal artery biopsies (TABs) in subjects with clinical giant cell arteritis (GCA) compared to those without GCA. This current study aimed to examine ROCK activity in a larger cohort of biopsy-negative GCA subjects and to validate the prior findings. Methods. Based on clinical data 6 months after TAB, subjects were categorized into 2 groups: biopsy-negative GCA and controls without GCA. Paraffin-embedded TABs were stained for phosphorylated ezrin/radixin/ moesin (pERM), a surrogate of ROCK activity, and scored by 2 pathologists blinded to clinical diagnosis using a previously derived scoring system measuring staining intensity in 3 areas of the vessel. Results. Thirty-six subjects with biopsy-negative GCA and 43 controls were analyzed. The mean (SD) pERM intensity score in non-GCA subjects was 3.9 (1.4), compared to 5.0 (1.4) in those with GCA (P = 0.002). Using the predetermined cut-off of 4 to define high pERM intensity, subjects with GCA were significantly more likely to have a high pERM intensity score compared to non-GCA (odds ratio 3.67, 95% CI 1.19-11.36; P = 0.02. The sensitivity of high pERM intensity score for diagnosis of GCA in histologically negative TABs was 86% (95% CI 70-95). Conclusion. In this well-characterized cohort, those with biopsy-negative GCA had significantly higher pERM intensity scores compared to subjects without GCA. pERM staining has diagnostic significance in enhancing the sensitivity of TAB and may help to define the clinically important group of biopsy-negative GCA.
目的rho相关蛋白激酶(ROCK)活性异常与多种血管和免疫疾病有关。我们之前证明，与没有巨细胞动脉炎的受试者相比，临床巨细胞动脉炎(GCA)患者在组织病理学阴性的颞动脉活检(TABs)中ROCK活性增加。目前的研究目的是在更大的活检阴性GCA受试者队列中检查ROCK活性，并验证先前的发现。方法。根据TAB术后6个月的临床资料，将受试者分为GCA活检阴性组和未GCA对照组。对石蜡包埋的标签进行磷酸化ezrin/radixin/ moesin (pERM)染色，这是ROCK活性的替代物，并由2名不知道临床诊断的病理学家使用先前衍生的评分系统测量血管3个区域的染色强度进行评分。结果。对36例活检阴性GCA患者和43例对照进行分析。非GCA患者的平均(SD) pERM强度评分为3.9(1.4)，而GCA患者的平均(SD)评分为5.0 (1.4)(P = 0.002)。使用预先确定的临界值4来定义高pERM强度，与非GCA相比，GCA受试者明显更有可能获得高pERM强度评分(优势比3.67,95% CI 1.19-11.36;P = 0.02。高pERM强度评分对组织学阴性tab诊断GCA的敏感性为86% (95% CI 70-95)。结论。在这个特征明确的队列中，与没有GCA的受试者相比，活检阴性GCA患者的pERM强度评分显着更高。pERM染色对提高TAB的敏感性具有诊断意义，可能有助于确定活检阴性GCA的临床重要组。
{"title":"Rho Kinase Expression in Giant Cell Arteritis: Validating Phosphorylated Ezrin/Radixin/Moesin Intensity Score to Increase Sensitivity of Temporal Artery Biopsy","authors":"L. Lally, N. Narula, N. Goodfellow, R. Luqmani, D. Pisapia, R. Spiera","doi":"10.3899/jrheum.220012","DOIUrl":"https://doi.org/10.3899/jrheum.220012","url":null,"abstract":"Objective Aberrant Rho-associated protein kinase (ROCK) activity is implicated in several vascular and immunologic disorders. We previously demonstrated increased ROCK activity in histopathologically negative temporal artery biopsies (TABs) in subjects with clinical giant cell arteritis (GCA) compared to those without GCA. This current study aimed to examine ROCK activity in a larger cohort of biopsy-negative GCA subjects and to validate the prior findings. Methods. Based on clinical data 6 months after TAB, subjects were categorized into 2 groups: biopsy-negative GCA and controls without GCA. Paraffin-embedded TABs were stained for phosphorylated ezrin/radixin/ moesin (pERM), a surrogate of ROCK activity, and scored by 2 pathologists blinded to clinical diagnosis using a previously derived scoring system measuring staining intensity in 3 areas of the vessel. Results. Thirty-six subjects with biopsy-negative GCA and 43 controls were analyzed. The mean (SD) pERM intensity score in non-GCA subjects was 3.9 (1.4), compared to 5.0 (1.4) in those with GCA (P = 0.002). Using the predetermined cut-off of 4 to define high pERM intensity, subjects with GCA were significantly more likely to have a high pERM intensity score compared to non-GCA (odds ratio 3.67, 95% CI 1.19-11.36; P = 0.02. The sensitivity of high pERM intensity score for diagnosis of GCA in histologically negative TABs was 86% (95% CI 70-95). Conclusion. In this well-characterized cohort, those with biopsy-negative GCA had significantly higher pERM intensity scores compared to subjects without GCA. pERM staining has diagnostic significance in enhancing the sensitivity of TAB and may help to define the clinically important group of biopsy-negative GCA.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"2 1","pages":"908 - 912"},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85094319","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}
A. Armstrong, Rasika M Reddy, O. FitzGerald, K. Callis Duffin, P. Helliwell, P. Mease, A. Kavanaugh, J. Merola, William Tillet, M. D. de Wit
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis hosted a Meet the Experts session at its 2021 virtual meeting. Dermatology and rheumatology experts held 5 sessions that broadly centered on psoriasis and psoriatic arthritis.
{"title":"2021 GRAPPA Meet the Experts Session: A Summary of Presentations.","authors":"A. Armstrong, Rasika M Reddy, O. FitzGerald, K. Callis Duffin, P. Helliwell, P. Mease, A. Kavanaugh, J. Merola, William Tillet, M. D. de Wit","doi":"10.3899/jrheum.211326","DOIUrl":"https://doi.org/10.3899/jrheum.211326","url":null,"abstract":"The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis hosted a Meet the Experts session at its 2021 virtual meeting. Dermatology and rheumatology experts held 5 sessions that broadly centered on psoriasis and psoriatic arthritis.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"237 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86977262","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}
P. Mease, D. Gladman, J. Merola, A. Deodhar, A. Ogdie, D. Collier, L. Liu, A. Kavanaugh
Objective In this post hoc analysis, we examined the potential impact of sex and BMI on response in the Study of Etanercept and Methotrexate in Combination or as Monotherapy in Subjects with Psoriatic Arthritis (SEAM-PsA) trial (NCT02376790), a 48-week, phase III, randomized controlled trial that compared outcomes with methotrexate (MTX) monotherapy, etanercept (ETN) monotherapy, and MTX+ETN combination therapy in patients with psoriatic arthritis (PsA) who were naïve to MTX and biologics. Methods We evaluated key outcomes at week 24 stratified by sex (male vs female) and BMI (kg/m2; ≤ 30 vs > 30), including the American College of Rheumatology 20 (ACR20) criteria, minimal disease activity (MDA), very low disease activity (VLDA), and Psoriatic Arthritis Disease Activity Score (PASDAS). We analyzed data using descriptive statistics, normal approximation, logistic model, and analysis of covariance. Results A total of 851 patients completed the SEAM-PsA trial. Higher proportions of men than women who received MTX+ETN combination therapy achieved ACR20 (71.5% vs 58.3%; P = 0.02), MDA (45.8% vs 25.2%; P = 0.0003), and VLDA (19.1% vs 9.5%; P = 0.03), and men achieved better PASDAS (-3.0 vs -2.3; P = 0.0004). Patients with BMI ≤ 30 generally had better outcomes than those with BMI > 30 in some treatment arms for ACR20, MDA, VLDA, and PASDAS; however, there was no consistent pattern regarding the treatment arm in which the difference occurred. Conclusion Improved outcomes were observed more in men than in women for MDA and PASDAS with MTX+ETN combination therapy. Patients with BMI ≤ 30 had better outcomes than those with BMI > 30, with no clear pattern regarding treatment received. These findings suggest that contextual factors such as sex and BMI may affect response to PsA therapy.
在这项事后分析中，我们研究了性别和BMI对银屑病关节炎患者(seama -PsA)研究(NCT02376790)反应的潜在影响，这是一项为期48周的III期随机对照试验，比较了甲氨蝶呤(MTX)单药治疗、依那西普(ETN)单药治疗和MTX+ETN联合治疗银屑病关节炎(PsA)患者(对MTX和生物制剂naïve)的结果。方法按性别(男性vs女性)和BMI (kg/m2;≤30 vs bbb30)，包括美国风湿病学会20 (ACR20)标准、最小疾病活动性(MDA)、极低疾病活动性(VLDA)和银屑病关节炎疾病活动性评分(PASDAS)。我们使用描述性统计、正态近似、逻辑模型和协方差分析来分析数据。结果共有851例患者完成了SEAM-PsA试验。接受MTX+ETN联合治疗的男性达到ACR20的比例高于女性(71.5% vs 58.3%;P = 0.02)， MDA (45.8% vs 25.2%;P = 0.0003)， VLDA (19.1% vs 9.5%;P = 0.03)，男性获得更好的PASDAS (-3.0 vs -2.3;P = 0.0004)。在ACR20、MDA、VLDA和PASDAS的某些治疗组中，BMI≤30的患者通常比BMI≤30的患者预后更好;然而，没有一致的模式关于治疗组的差异发生。结论MTX+ETN联合治疗MDA和PASDAS患者，男性预后明显优于女性。BMI≤30的患者预后优于BMI≤30的患者，治疗方式无明显规律。这些发现表明，性别和体重指数等环境因素可能影响对PsA治疗的反应。
{"title":"Potential Impact of Sex and BMI on Response to Therapy in Psoriatic Arthritis: Post Hoc Analysis of Results From the SEAM-PsA Trial","authors":"P. Mease, D. Gladman, J. Merola, A. Deodhar, A. Ogdie, D. Collier, L. Liu, A. Kavanaugh","doi":"10.3899/jrheum.211037","DOIUrl":"https://doi.org/10.3899/jrheum.211037","url":null,"abstract":"Objective In this post hoc analysis, we examined the potential impact of sex and BMI on response in the Study of Etanercept and Methotrexate in Combination or as Monotherapy in Subjects with Psoriatic Arthritis (SEAM-PsA) trial (NCT02376790), a 48-week, phase III, randomized controlled trial that compared outcomes with methotrexate (MTX) monotherapy, etanercept (ETN) monotherapy, and MTX+ETN combination therapy in patients with psoriatic arthritis (PsA) who were naïve to MTX and biologics. Methods We evaluated key outcomes at week 24 stratified by sex (male vs female) and BMI (kg/m2; ≤ 30 vs > 30), including the American College of Rheumatology 20 (ACR20) criteria, minimal disease activity (MDA), very low disease activity (VLDA), and Psoriatic Arthritis Disease Activity Score (PASDAS). We analyzed data using descriptive statistics, normal approximation, logistic model, and analysis of covariance. Results A total of 851 patients completed the SEAM-PsA trial. Higher proportions of men than women who received MTX+ETN combination therapy achieved ACR20 (71.5% vs 58.3%; P = 0.02), MDA (45.8% vs 25.2%; P = 0.0003), and VLDA (19.1% vs 9.5%; P = 0.03), and men achieved better PASDAS (-3.0 vs -2.3; P = 0.0004). Patients with BMI ≤ 30 generally had better outcomes than those with BMI > 30 in some treatment arms for ACR20, MDA, VLDA, and PASDAS; however, there was no consistent pattern regarding the treatment arm in which the difference occurred. Conclusion Improved outcomes were observed more in men than in women for MDA and PASDAS with MTX+ETN combination therapy. Patients with BMI ≤ 30 had better outcomes than those with BMI > 30, with no clear pattern regarding treatment received. These findings suggest that contextual factors such as sex and BMI may affect response to PsA therapy.","PeriodicalId":35278,"journal":{"name":"The Journal of rheumatology. Supplement","volume":"54 1","pages":"885 - 893"},"PeriodicalIF":0.0,"publicationDate":"2022-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88414060","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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