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Depression-, Pain-, and Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus 系统性红斑狼疮患者的抑郁、疼痛和健康相关生活质量
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2022-05-05 DOI: 10.1155/2022/6290736
N. Chalhoub, M. Luggen
Objectives A significant number of patients with systemic lupus erythematosus (SLE) have depression, and many are untreated. We aim to assess the frequency of moderate to severe depression (MSD) in a multiethnic group of SLE patients with different sociodemographic backgrounds, identify modifiable factors associated with depression, and determine the impact of depression, disease activity, damage, cognitive function, and pain severity on health-related quality of life (HRQoL). Methods Ninety-nine patients with SLE were evaluated in a cross-sectional study. Sociodemographic data, Beck Depression Inventory (BDI II), SLE disease activity index (SLEDAI-2K), SLICC Damage Index (SLICC-DI), pain severity (10 cm visual analogue scale), cognitive function (Automated Neuropsychologic Assessment Metrics (ANAM)), and the physical (PCS) and mental (MCS) component scores of the Short Form Health Survey (SF-36) were recorded. Bivariate analysis identified potential associations of relevant variables with BDI II and SF-36. Regression analysis determined independent correlates with MSD, PCS, and MCS. Results Over 50% of subjects (50.5%) were African-American, 37.1% had a family income of ≤$20,000, and 31.3% had MSD. In the bivariate analysis, family income, SLEDAI-2K, cognitive function, and pain severity were associated with MSD. Using binary logistic regression, SLEDAI-2K and pain severity remained independently correlated with MSD (p = 0.004). In the multiple linear regression analysis, pain severity was the only independent correlate of PCS (p < 0.0001), while cognitive function and BDI II were the main factors associated with MCS (p = 0.020 and p < 0.0001, respectively). Conclusion Pain severity and disease activity are associated with MSD in our unique population, are potentially modifiable, and deserve further attention in the clinic. Depression and pain significantly affect HRQoL and should be aggressively managed.
目的系统性红斑狼疮(SLE)患者中有相当多的患者患有抑郁症,许多患者未经治疗。我们的目的是评估具有不同社会人口背景的多民族SLE患者中中度至重度抑郁症(MSD)的发生频率,确定与抑郁症相关的可改变因素,并确定抑郁症、疾病活动、损伤、认知功能和疼痛严重程度对健康相关生活质量(HRQoL)的影响。方法对99例SLE患者进行横断面研究。社会形态图数据、Beck抑郁量表(BDI-II)、SLE疾病活动指数(SLEDAI-2K)、SLICC损伤指数(SLICC-DI)、疼痛严重程度(10 cm视觉模拟量表)、认知功能(自动神经心理评估指标(ANAM))以及短期健康调查(SF-36)的身体(PCS)和心理(MCS)成分得分。双变量分析确定了相关变量与BDI II和SF-36的潜在关联。回归分析确定了与MSD、PCS和MCS的独立相关性。结果超过50%(50.5%)的受试者是非裔美国人,37.1%的受试对象的家庭收入≤20000美元,31.3%的受试人患有默沙东。在双变量分析中,家庭收入、SLEDAI-2K、认知功能和疼痛严重程度与MSD相关。使用二元逻辑回归,SLEDAI-2K和疼痛严重程度与MSD保持独立相关性(p=0.004)。在多元线性回归分析中,疼痛严重程度是PCS的唯一独立相关性(p<0.0001),而认知功能和BDI II是与MCS相关的主要因素(分别为p=0.020和p<0.00001)。结论在我们独特的人群中,疼痛严重程度和疾病活动性与MSD相关,具有潜在的可改变性,值得临床进一步关注。抑郁和疼痛会显著影响HRQoL,应积极治疗。
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引用次数: 5
Polymorphism in STAT4 Increase the Risk of Systemic Lupus Erythematosus: An Updated Meta-Analysis STAT4基因多态性增加系统性红斑狼疮发病风险的最新Meta分析
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2022-04-22 DOI: 10.1155/2022/5565057
Shancui-zheng, Jinping-Zhang, Guoyuan-lu, Lei Liu, Zhiyong-deng
Previous studies have reported that STAT4 rs7574865 conferred the susceptibility to systemic lupus erythematosus (SLE). In this study, a meta-analysis (including 32 comparative studies of 11384 patients and 17609 controls) was conducted to investigate the role of STAT4 polymorphism in SLE in a comprehensive way. We found that the Asian population had the highest prevalence of the T allele than any other study population at 32.2% and that STAT4 rs7574865 polymorphism was associated with SLE in the overall population (OR = 1.579, 95%CI = 1.497-1.665, P < 0.001). In the subgroup analysis by ethnicity, STAT4 rs7574865 T allele was shown to be risk factor in SLE in Asian, European, and American origins. Our results do support STAT4 rs7574865 polymorphism as a susceptibility factor for SLE in populations of different ethnic and that its prevalence is ethnicity dependent.
先前的研究报道STAT4 rs7574865赋予系统性红斑狼疮(SLE)易感性。在本研究中,进行了一项荟萃分析(包括11384名患者和17609名对照的32项比较研究),以全面研究STAT4多态性在SLE中的作用。我们发现,亚洲人群的T等位基因患病率最高,为32.2%,STAT4 rs7574865多态性与整个人群的SLE相关(OR=1.579,95%CI=1.97-1.665,P<0.001)。我们的研究结果确实支持STAT4 rs7574865多态性作为不同种族人群SLE的易感因素,并且其患病率是种族依赖性的。
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引用次数: 1
Effect of Polymorphisms in the FCN1, FCN2, and FCN3 Genes on the Susceptibility to Develop Rheumatoid Arthritis: A Systematic Review. FCN1、FCN2和FCN3基因多态性对类风湿关节炎易感性的影响:系统综述
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2022-01-01 DOI: 10.1155/2022/1730996
Sebastián R Gil-Quiñones, Luz Gutierrez-Castañeda, Lorena Larios-Salazar, Susana Mejia-Mesa, Adriana Motta, David Tovar-Parra

Genetic association studies in rheumatoid arthritis conducted in various populations have yielded heterogeneous results. The present systematic review was conducted to synthesize the results of the studies in order to establish the impact of polymorphisms in the ficolin-coding genes FCN1, FCN2, and FCN3 on the susceptibility to develop rheumatoid arthritis. A systematic literature review was performed using the following keywords "gene (FCN1/FCN2/FCN3)", "Polymorphism/Genetic Variant", and "rheumatoid arthritis" in different databases until January 2022. Authors assessed articles by title/abstract and then assessed by full text for data extraction. The risk of bias was assessed using the Newcastle-Ottawa scale. Data synthesis was performed qualitatively and quantitatively. A total of 1519 articles were eligible for inclusion in this review, 3 were identified as relevant for the quantitative synthesis with 670 patients and 1019 controls. For the FCN1 gene, an association was found in the dominant and recessive genetic models of the variants rs2989727 (genotype TT = OR: 0.577, 95% CI: 0.430-0.769) and rs1071583 (genotype GG = OR: 1.537, 95% CI: 1.153-2.049, p = 0.0032) with the development of rheumatoid arthritis as a protective or susceptibility factor. FCN2 and FCN3 genes did not show association with disease development. The FCN1 gene variants rs2989727 and rs1071583 are associated with the risk of developing rheumatoid arthritis in populations from Brazil and Belgium, but not in FCN2 and FCN3 gene variants.

在不同人群中进行的类风湿关节炎遗传关联研究产生了不同的结果。本系统综述综合研究结果,以确定ficolin编码基因FCN1、FCN2和FCN3多态性对类风湿关节炎易感性的影响。使用关键词“基因(FCN1/FCN2/FCN3)”、“多态性/遗传变异”和“类风湿关节炎”在不同的数据库中进行系统的文献综述,直到2022年1月。作者通过标题/摘要评估文章,然后通过全文评估数据提取。偏倚风险采用纽卡斯尔-渥太华量表进行评估。定性和定量地进行数据综合。共有1519篇文章符合纳入本综述的条件,其中3篇被确定为与670例患者和1019例对照的定量合成相关。对于FCN1基因,在显性和隐性遗传模型中发现变异rs2989727(基因型TT = OR: 0.577, 95% CI: 0.430-0.769)和rs1071583(基因型GG = OR: 1.537, 95% CI: 1.153-2.049, p = 0.0032)作为类风湿关节炎的保护或易感因素与类风湿关节炎的发生存在关联。FCN2和FCN3基因未显示与疾病发展相关。FCN1基因变异rs2989727和rs1071583与巴西和比利时人群发生类风湿性关节炎的风险相关,但与FCN2和FCN3基因变异无关。
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引用次数: 2
Autoimmune Regulator Gene Polymorphisms in Egyptian Systemic Lupus Erythematosus Patients: Preliminary Results. 埃及系统性红斑狼疮患者自身免疫调节基因多态性:初步结果
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2021-09-28 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5546639
Doaa Hs Attia, Dalia Ah Dorgham, Ahmed A El Maghraby, Marwa Alkaffas, Mahitab A Abdel Kawy, Mai M Sherif, Radwa M Abdel Halim

Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease. The autoimmune regulator (AIRE) is a master regulator of self-tolerance development. AIRE mutations lead to the development of autoimmune polyglandular syndrome type 1 while AIRE polymorphisms have been linked to organ-specific autoimmunity. The study is aimed at addressing the association between AIRE polymorphisms, rs2075876 (G > A) and rs760426 (A > G), and SLE susceptibility and expression in Egyptian patients.

Methods: Ninety-nine patients were included. One hundred and ten, and 123 control subjects were genotyped for rs2075876 and rs760426, respectively. Lupus severity was assessed using the Lupus Severity of Disease Index and Lupus Severity Index (LSI). Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index was considered. Genotyping was done using StepOne Real-Time PCR. Results. AIRE rs760426 GG was more frequent in the patients under the genotype level (14.1% vs. 4.9%, p = 0.032) and recessive model (14.1% vs. 4.9%, p = 0.017, OR = 3.2 (1.2-8.7)). Musculoskeletal involvement and nephritis were associated with AIRE rs2075876 under the dominant (97.9% vs. 80.8%, p = 0.009, OR = 11 (1.3-89.2)) and recessive models (100% vs. 69.3%, p = 0.032), respectively; and both were linked to AIRE rs2075876 at the allelic level: 98.3% vs. 85%, p = 0.005, OR = 10.1 (1.3-76.6) and 82.8% vs. 68.6, p = 0.041, OR = 2.2 (1-4.7), respectively. Patients with AIRE rs2075876 A alleles had a higher damage index ( 1 ± 1.3 vs. 0.6 ± 1.1, p = 0.045) while the LSI was greater in patients with AIRE rs2075876 (8.5 ± 0.5 vs. 7.8 ± 1.3, p = 0.002) and rs760426 (8.6 ± 11 vs. 7.8 ± 1.2, p = 0.031) under the recessive models. Conclusion. AIRE rs760426 could share in SLE susceptibility while AIRE rs2075876 could influence the disease expression and burden in Egyptian patients.

背景:系统性红斑狼疮(SLE)是一种全身性自身免疫性疾病。自身免疫调节因子(AIRE)是自我耐受性发展的主要调节因子。AIRE突变导致自身免疫性多腺综合征1型的发展,而AIRE多态性与器官特异性自身免疫有关。该研究旨在探讨AIRE多态性rs2075876 (G > A)和rs760426 (A > G)与埃及患者SLE易感性和表达之间的关系。方法:纳入99例患者。分别对110例和123例对照进行rs2075876和rs760426基因分型。使用狼疮疾病严重程度指数和狼疮严重程度指数(LSI)评估狼疮严重程度。考虑系统性狼疮国际合作诊所(SLICC)/美国风湿病学会(ACR)损伤指数。采用StepOne Real-Time PCR进行基因分型。结果。AIRE rs760426 GG在基因型水平(14.1% vs. 4.9%, p = 0.032)和隐性模式(14.1% vs. 4.9%, p = 0.017, OR = 3.2(1.2 ~ 8.7))患者中发生率更高。在显性模型(97.9%比80.8%,p = 0.009, OR = 11(1.3-89.2))和隐性模型(100%比69.3%,p = 0.032)下,肌肉骨骼受累和肾炎分别与AIRE rs2075876相关;两者均与AIRE rs2075876等位基因水平相关:98.3% vs. 85%, p = 0.005, OR = 10.1 (1.3 ~ 76.6); 82.8% vs. 68.6, p = 0.041, OR = 2.2(1 ~ 4.7)。在隐性模型下,AIRE rs2075876 A等位基因患者的损伤指数更高(1±1.3比0.6±1.1,p = 0.045),而AIRE rs2075876(8.5±0.5比7.8±1.3,p = 0.002)和rs760426(8.6±11比7.8±1.2,p = 0.031)患者的LSI更高。结论。AIRE rs760426可能参与SLE易感,AIRE rs2075876可能影响埃及患者的疾病表达和负担。
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引用次数: 2
Tocilizumab Effect on Lipid Profile in Correlation to Cardiovascular Events: A Retrospective Cohort Study. 托珠单抗对心血管事件相关血脂的影响:一项回顾性队列研究。
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2021-08-12 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5535486
Toka Alsulaim, Noor Alhassan, Hala Khalil, Abdullah Almutlaq

Objective: To study the effect of tocilizumab initiation on the lipid profile, in correlation to a composite of any cardiovascular events.

Methods: A retrospective cohort study, using data from the King Faisal Specialist Hospital & Research Centre database, from January 2014 to December 2019. Patients with rheumatoid arthritis or juvenile idiopathic arthritis who were ≥18 years old, initiated either on tocilizumab or other biologic treatment (anti-TNFs or Rituximab), were included, with a follow-up interval duration at a minimum of 6-12 months up to 3-5 years. Any patient with established cardiovascular disease or aged <18 were excluded.

Results: Only one cardiovascular mortality was reported in the tocilizumab group. Fifty percent of patients reached high cholesterol levels ≥ 5.2 mmol/L and LDL ≥ 3.37 mmol/L in the tocilizumab group at 36 months in a shorter time period compared to controls (60 months), P 0.001. There were no significant differences between groups for statin use (27% vs. 28%) However, there was a significantly higher mean dose of atorvastatin in the tocilizumab group compared to controls (20.6 mg vs. 16.6 mg, P 0.03).

Conclusion: There was a lack of evidence of increased cardiovascular risk in correlation to hyperlipidemia secondary to tocilizumab treatment.

目的:研究托珠单抗起始对血脂的影响,与任何心血管事件的复合相关。方法:回顾性队列研究,使用2014年1月至2019年12月费萨尔国王专科医院和研究中心数据库的数据。纳入≥18岁的类风湿关节炎或青少年特发性关节炎患者,开始接受tocilizumab或其他生物治疗(抗tnf或利妥昔单抗),随访时间间隔至少为6-12个月至3-5年。结果:托珠单抗组仅报告1例心血管疾病死亡。与对照组(60个月)相比,tocilizumab组50%的患者在36个月内达到高胆固醇水平≥5.2 mmol/L和LDL≥3.37 mmol/L, P < 0.001。他汀类药物的使用在两组间无显著差异(27% vs 28%)。然而,托珠单抗组阿托伐他汀的平均剂量明显高于对照组(20.6 mg vs 16.6 mg, P 0.03)。结论:缺乏与托珠单抗治疗继发高脂血症相关的心血管风险增加的证据。
{"title":"Tocilizumab Effect on Lipid Profile in Correlation to Cardiovascular Events: A Retrospective Cohort Study.","authors":"Toka Alsulaim,&nbsp;Noor Alhassan,&nbsp;Hala Khalil,&nbsp;Abdullah Almutlaq","doi":"10.1155/2021/5535486","DOIUrl":"https://doi.org/10.1155/2021/5535486","url":null,"abstract":"<p><strong>Objective: </strong>To study the effect of tocilizumab initiation on the lipid profile, in correlation to a composite of any cardiovascular events.</p><p><strong>Methods: </strong>A retrospective cohort study, using data from the King Faisal Specialist Hospital & Research Centre database, from January 2014 to December 2019. Patients with rheumatoid arthritis or juvenile idiopathic arthritis who were ≥18 years old, initiated either on tocilizumab or other biologic treatment (anti-TNFs or Rituximab), were included, with a follow-up interval duration at a minimum of 6-12 months up to 3-5 years. Any patient with established cardiovascular disease or aged <18 were excluded.</p><p><strong>Results: </strong>Only one cardiovascular mortality was reported in the tocilizumab group. Fifty percent of patients reached high cholesterol levels ≥ 5.2 mmol/L and LDL ≥ 3.37 mmol/L in the tocilizumab group at 36 months in a shorter time period compared to controls (60 months), <i>P</i> 0.001. There were no significant differences between groups for statin use (27% vs. 28%) However, there was a significantly higher mean dose of atorvastatin in the tocilizumab group compared to controls (20.6 mg vs. 16.6 mg, <i>P</i> 0.03).</p><p><strong>Conclusion: </strong>There was a lack of evidence of increased cardiovascular risk in correlation to hyperlipidemia secondary to tocilizumab treatment.</p>","PeriodicalId":51715,"journal":{"name":"International Journal of Rheumatology","volume":"2021 ","pages":"5535486"},"PeriodicalIF":2.3,"publicationDate":"2021-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39334266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Cutaneous Manifestations of "Lupus": Systemic Lupus Erythematosus and Beyond. 狼疮 "的皮肤表现:系统性红斑狼疮及其他。
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2021-05-18 eCollection Date: 2021-01-01 DOI: 10.1155/2021/6610509
Elizabeth E Cooper, Catherine E Pisano, Samantha C Shapiro

Lupus, Latin for "wolf," is a term used to describe many dermatologic conditions, some of which are related to underlying systemic lupus erythematosus, while others are distinct disease processes. Cutaneous lupus erythematosus includes a wide array of visible skin manifestations and can progress to systemic lupus erythematosus in some cases. Cutaneous lupus can be subdivided into three main categories: acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus. Physical exam, laboratory studies, and histopathology enable differentiation of cutaneous lupus subtypes. This differentiation is paramount as the subtype of cutaneous lupus informs upon treatment, disease monitoring, and prognostication. This review outlines the different cutaneous manifestations of lupus erythematosus and provides an update on both topical and systemic treatment options for these patients. Other conditions that utilize the term "lupus" but are not cutaneous lupus erythematosus are also discussed.

红斑狼疮(Lupus)在拉丁语中意为 "狼",是一个用来描述多种皮肤病的术语,其中一些与潜在的系统性红斑狼疮有关,而另一些则是不同的疾病过程。皮肤红斑狼疮包括一系列可见的皮肤表现,在某些情况下还会发展为系统性红斑狼疮。皮肤红斑狼疮可细分为三大类:急性皮肤红斑狼疮、亚急性皮肤红斑狼疮和慢性皮肤红斑狼疮。通过体格检查、实验室检查和组织病理学检查可以区分皮肤红斑狼疮的亚型。由于皮肤狼疮的亚型对治疗、疾病监测和预后都有影响,因此这种区分至关重要。本综述概述了红斑狼疮的不同皮肤表现,并提供了针对这些患者的局部和全身治疗方案的最新信息。此外,还讨论了使用 "狼疮 "一词但不属于皮肤红斑狼疮的其他疾病。
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引用次数: 0
Update in the Management of ANCA-Associated Vasculitis: Recent Developments and Future Perspectives. ANCA相关性血管炎管理的最新进展:最新进展与未来展望》。
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2021-04-08 eCollection Date: 2021-01-01 DOI: 10.1155/2021/5534851
Karla N Samman, Carolyn Ross, Christian Pagnoux, Jean-Paul Makhzoum

Significant progress has been made in the treatment of ANCA-associated vasculitides (AAV), notably in granulomatosis with polyangiitis and microscopic polyangiitis. Over the past few years, many innovative studies have changed the way we now induce and maintain remission in AAV; achieving remission while limiting treatment toxicity is the key. This article provides an in-depth, up-to-date summary of recent trials and suggests treatment algorithms for induction and maintenance of remission based on the latest guidelines. Future possible therapies in AAV will also be discussed.

ANCA相关血管炎(AAV)的治疗取得了重大进展,尤其是在多血管炎肉芽肿病和显微镜下多血管炎方面。过去几年中,许多创新性研究改变了我们现在诱导和维持 AAV 缓解的方法;实现缓解的同时限制治疗毒性是关键所在。本文对最近的试验进行了深入、最新的总结,并根据最新指南提出了诱导和维持缓解的治疗算法。文章还将讨论未来可能的 AAV 治疗方法。
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引用次数: 0
Clinical Outcomes of Myocarditis after Moderate-Dose Steroid Therapy in Systemic Sclerosis: A Pilot Study. 系统性硬化症患者中剂量类固醇治疗后心肌炎的临床结局:一项初步研究。
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2020-12-19 eCollection Date: 2020-01-01 DOI: 10.1155/2020/8884442
Burabha Pussadhamma, Thapanee Tipparot, Naruemol Chaosuwannakit, Ajanee Mahakkanukrauh, Siraphop Suwannaroj, Ratanavadee Nanagara, Chingching Foocharoen

Background: Myocarditis is reported in systemic sclerosis (SSc); however, treatment options and outcomes are limited. Our objective was to define cardiac outcomes after moderate-dose steroid therapy in SSc patients with myocarditis.

Method: An open-label study was conducted among SSc patients with myocarditis-as defined by cardiovascular magnetic resonance (CMR), disease onset <5 years, and a NYHA functional class ≥II. All enrolled patients received prednisolone (30 mg/d) which would be tapered off by week 24, and CMR was followed up at the end of treatment.

Results: A total of 20 SSc patients were enrolled which 12 patients completed the study. At week 24, 8 of the 12 cases experienced improvement of myocarditis. Compared to those with no improvement, these 8 patients had significantly longer disease duration (p = 0.03), higher heart rate at baseline (p = 0.049) and week 24 (p = 0.04), lower left ventricular (LV) and right ventricular (RV) stroke volume at baseline (p = 0.002 and p = 0.01) and week 24 (p = 0.01 and p = 0.02), and lower LV and RV cardiac output at week 24 (p = 0.01 and p = 0.01). Four cases died during follow-up (3 due to cardiac complications, 1 due to renal crisis). The two who died from heart failure had very high NT-prohormone-brain natriuretic peptide (NT-proBNP) and impaired LV ejection fraction (LVEF), and the one who died from arrhythmia had very high sensitivity of cardiac Troponin-T (hs-cTnT).

Conclusions: Moderate-dose steroid therapy may improve myocarditis in SSc. A proportion of patients died due to cardiac complications during treatment, particularly those with high hs-cTnT, high NT-proBNP, and impaired LVEF. This trial is registered with NCT03607071.

背景:系统性硬化症(SSc)中有心肌炎的报道;然而,治疗选择和结果是有限的。我们的目的是确定SSc合并心肌炎患者中剂量类固醇治疗后的心脏预后。方法:对伴有心血管磁共振(CMR)定义的SSc心肌炎患者进行开放标签研究。结果:共纳入20例SSc患者,其中12例患者完成了研究。24周时,12例患者中有8例心肌炎好转。与无改善的患者相比,这8例患者的病程明显延长(p = 0.03),基线心率(p = 0.049)和第24周心率(p = 0.04)明显提高,基线左心室(LV)和右心室(RV)搏量降低(p = 0.002和p = 0.01)和第24周(p = 0.01和p = 0.02),第24周左心室和右心室心输出量降低(p = 0.01和p = 0.01)。随访期间死亡4例,其中心脏并发症3例,肾危象1例。死于心力衰竭的2例患者有非常高的nt -原激素-脑钠肽(NT-proBNP)和左室射血分数(LVEF),而死于心律失常的1例患者有非常高的心肌肌钙蛋白- t (hs-cTnT)敏感性。结论:中等剂量类固醇治疗可改善SSc心肌炎。一部分患者在治疗期间死于心脏并发症,特别是那些高hs-cTnT、高NT-proBNP和LVEF受损的患者。本试验注册号为NCT03607071。
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引用次数: 8
Intracytoplasmic Expression of IL-6 and IL-17A in Circulating CD4+ T Cells Are Strongly Associated with and Predict Disease Activity in Rheumatoid Arthritis: A Case-Control Study in Ghana. 循环CD4+ T细胞中IL-6和IL-17A的胞浆内表达与类风湿关节炎的疾病活动密切相关并预测疾病活动:加纳的一项病例对照研究
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2020-10-08 eCollection Date: 2020-01-01 DOI: 10.1155/2020/2808413
Samuel Asamoah Sakyi, Tonnies Abeku Buckman, Daniel Antwi-Berko, Kwame Yeboah-Mensah, Dzifa Dey, Eddie-Williams Owiredu, Benjamin Amoani, Richard Mantey

Background: T cell cytokines play important roles in the development and progression of rheumatoid arthritis (RA). Loss of Th1/Th2 and Th17/Treg balance has been reported in several inflammatory autoimmune diseases. However, their role in RA within hitherto rare Ghanaian context has not been explored. Here, we evaluated the intracytoplasmic CD4+ T cell cytokine patterns in rheumatoid arthritis patients in Ghana and determined their relationship with disease activity.

Methods: This case-control study included 48 newly diagnosed RA patients and 30 apparent healthy controls from two major hospitals in Ghana. Validated structured questionnaires were administered to obtain demographic data; blood samples were collected and processed for flow cytometric analysis.

Results: IFN-γ, TNF-α, IL-4, IL-6, IL-10, IL-17A, IL-6/IL-4, and IL-17/IL-10 expressions were significantly higher in RA cases compared to the healthy controls. The expression of IL-6 (0.00 (0.00-0.98) vs. 0.82 (0.34-1.10) vs. 1.56 (1.39-1.68), p < 0.0001), IL-17A (0.00 (0.00-0.02) vs. 0.19 (0.09-0.30) vs. 0.99 (0.64-1.25), p < 0.0001), and IL-17A/IL-10 (0.00 (0.00-0.39) vs. 0.15 (0.09-0.26) vs. 0.88 (0.41-1.47), p < 0.0001) increased significantly from the healthy controls through RA patients with low DAS scores to RA patients with moderate DAS scores. IL-6 (β = 0.681, r 2 = 0.527, p < 0.0001), IL-17A (β = 0.770, r 2 = 0.593, p < 0.0001), and IL-17A/IL-10 (β = 0.677, r 2 = 0.452, p < 0.0001) expressions were significantly directly associated with DAS28 scores. IL-6 (cutoff = 1.32, sensitivity = 100.0%, specificity = 100.0%, accuracy = 100.0%, and AUC = 1.000) and IL-17A (cutoff = 0.58, sensitivity = 100.0%, specificity = 100.0%, accuracy = 100.0%, and AUC = 1.000) presented with the best discriminatory power in predicting moderate DAS scores from low DAS scores.

Conclusion: Th1- and Th17-related cytokines predominate in the pathophysiology of RA, with IL-6 and IL-17 being principally and differentially expressed based on the severity of the disease. IL-6 and IL-17A could serve as useful prognostic and disease-monitoring markers in RA in the African context.

背景:T细胞因子在类风湿关节炎(RA)的发生发展中起重要作用。Th1/Th2和Th17/Treg平衡的丧失已在几种炎症性自身免疫性疾病中报道。然而,在迄今罕见的加纳背景下,它们在RA中的作用尚未得到探讨。在这里,我们评估了加纳类风湿性关节炎患者的胞浆内CD4+ T细胞细胞因子模式,并确定了它们与疾病活动性的关系。方法:本病例对照研究包括48名新诊断的RA患者和30名表面健康对照者,来自加纳两家主要医院。使用经过验证的结构化问卷来获取人口统计数据;采集血样进行流式细胞术分析。结果:RA患者中IFN-γ、TNF-α、IL-4、IL-6、IL-10、IL-17A、IL-6/IL-4、IL-17/IL-10的表达均显著高于健康对照组。IL-6 (0.00 (0.00-0.98) vs. 0.82 (0.34-1.10) vs. 1.56 (1.39-1.68), p < 0.0001)、IL-17A (0.00 (0.00-0.02) vs. 0.19 (0.09-0.30) vs. 0.99 (0.64-1.25), p < 0.0001)、IL-17A/IL-10 (0.00 (0.00-0.39) vs. 0.15 (0.09-0.26) vs. 0.88 (0.41-1.47), p < 0.0001)的表达水平从健康对照组到DAS评分较低的RA患者到DAS评分中等的RA患者均显著升高。IL-6 (β = 0.681, r 2 = 0.527, p < 0.0001)、IL-17A (β = 0.770, r 2 = 0.593, p < 0.0001)、IL-17A/IL-10 (β = 0.677, r 2 = 0.452, p < 0.0001)的表达与DAS28评分直接相关。IL-6(截止值= 1.32,灵敏度= 100.0%,特异度= 100.0%,准确度= 100.0%,AUC = 1.000)和IL-17A(截止值= 0.58,灵敏度= 100.0%,特异度= 100.0%,准确度= 100.0%,AUC = 1.000)在预测DAS中低评分方面具有最佳的区分能力。结论:Th1-和th17相关的细胞因子在RA的病理生理中起主导作用,IL-6和IL-17根据病情的严重程度主要表达,并有差异表达。在非洲地区,IL-6和IL-17A可作为有用的RA预后和疾病监测标志物。
{"title":"Intracytoplasmic Expression of IL-6 and IL-17A in Circulating CD4+ T Cells Are Strongly Associated with and Predict Disease Activity in Rheumatoid Arthritis: A Case-Control Study in Ghana.","authors":"Samuel Asamoah Sakyi,&nbsp;Tonnies Abeku Buckman,&nbsp;Daniel Antwi-Berko,&nbsp;Kwame Yeboah-Mensah,&nbsp;Dzifa Dey,&nbsp;Eddie-Williams Owiredu,&nbsp;Benjamin Amoani,&nbsp;Richard Mantey","doi":"10.1155/2020/2808413","DOIUrl":"https://doi.org/10.1155/2020/2808413","url":null,"abstract":"<p><strong>Background: </strong>T cell cytokines play important roles in the development and progression of rheumatoid arthritis (RA). Loss of Th1/Th2 and Th17/Treg balance has been reported in several inflammatory autoimmune diseases. However, their role in RA within hitherto rare Ghanaian context has not been explored. Here, we evaluated the intracytoplasmic CD4+ T cell cytokine patterns in rheumatoid arthritis patients in Ghana and determined their relationship with disease activity.</p><p><strong>Methods: </strong>This case-control study included 48 newly diagnosed RA patients and 30 apparent healthy controls from two major hospitals in Ghana. Validated structured questionnaires were administered to obtain demographic data; blood samples were collected and processed for flow cytometric analysis.</p><p><strong>Results: </strong>IFN-<i>γ</i>, TNF-<i>α</i>, IL-4, IL-6, IL-10, IL-17A, IL-6/IL-4, and IL-17/IL-10 expressions were significantly higher in RA cases compared to the healthy controls. The expression of IL-6 (0.00 (0.00-0.98) vs. 0.82 (0.34-1.10) vs. 1.56 (1.39-1.68), <i>p</i> < 0.0001), IL-17A (0.00 (0.00-0.02) vs. 0.19 (0.09-0.30) vs. 0.99 (0.64-1.25), <i>p</i> < 0.0001), and IL-17A/IL-10 (0.00 (0.00-0.39) vs. 0.15 (0.09-0.26) vs. 0.88 (0.41-1.47), <i>p</i> < 0.0001) increased significantly from the healthy controls through RA patients with low DAS scores to RA patients with moderate DAS scores. IL-6 (<i>β</i> = 0.681, <i>r</i> <sup>2</sup> = 0.527, <i>p</i> < 0.0001), IL-17A (<i>β</i> = 0.770, <i>r</i> <sup>2</sup> = 0.593, <i>p</i> < 0.0001), and IL-17A/IL-10 (<i>β</i> = 0.677, <i>r</i> <sup>2</sup> = 0.452, <i>p</i> < 0.0001) expressions were significantly directly associated with DAS28 scores. IL-6 (cutoff = 1.32, sensitivity = 100.0%, specificity = 100.0%, accuracy = 100.0%, and AUC = 1.000) and IL-17A (cutoff = 0.58, sensitivity = 100.0%, specificity = 100.0%, accuracy = 100.0%, and AUC = 1.000) presented with the best discriminatory power in predicting moderate DAS scores from low DAS scores.</p><p><strong>Conclusion: </strong>Th1- and Th17-related cytokines predominate in the pathophysiology of RA, with IL-6 and IL-17 being principally and differentially expressed based on the severity of the disease. IL-6 and IL-17A could serve as useful prognostic and disease-monitoring markers in RA in the African context.</p>","PeriodicalId":51715,"journal":{"name":"International Journal of Rheumatology","volume":"2020 ","pages":"2808413"},"PeriodicalIF":2.3,"publicationDate":"2020-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/2808413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38532798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 6
Direct Healthcare Costs Associated with Oligoarticular Juvenile Idiopathic Arthritis at a Single Center. 单个中心与青少年少关节特发性关节炎相关的直接医疗费用
IF 2.3 Q2 RHEUMATOLOGY Pub Date : 2020-09-01 eCollection Date: 2020-01-01 DOI: 10.1155/2020/5640425
Amit Thakral, Daniel Pinto, Michael Miller, Megan L Curran, Marisa Klein-Gitelman, Dustin D French

Oligoarticular juvenile idiopathic arthritis (JIA) is a common disease in pediatric rheumatology. The management of oligoarticular JIA can result in a considerable economic burden. This study is a four-year, retrospective cost identification analysis performed to determine the annual direct cost of care for patients with oligoarticular JIA and possible predictive clinical factors. Direct healthcare costs were defined as those associated with office visits, laboratory studies, hospital admissions, joint injections, medications, infusions, radiology tests, and emergency room visits. Disease characteristics and patient information included ANA status, gender, age at diagnosis, duration from diagnosis to initial visit during the study period, and whether uveitis had been diagnosed. We identified 97 patients with oligoarticular JIA eligible for the study. The median age of diagnosis was 4.3 years. Positive ANA were noted in 75% of patients. 34% of patients received at least one intra-articular steroid injection. 32% of patients were prescribed a biologic during the study period, predominantly with other medications, while 23% of patients received only NSAIDs. 20% of patients were prescribed oral steroids. The average total direct medical cost in this study per year for an oligoarticular JIA patient was $3929 ± 6985. Medications accounted for 85% of annual direct medical costs. Clinic visits and laboratory testing accounted for 8% and 5%, respectively. Patient characteristics and demographics were tested for association with direct medical costs by the Wilcoxon rank sum test and Kruskal-Wallis test. Patients who were ANA positive had increased annual costs compared to patients who are ANA negative. ANA-positive patients were found to have statistically significant costs, particularly, in laboratory tests, procedural costs, radiology costs, and medication costs. The results reported here provide information when allocating healthcare resources and a better understanding of the economic impact oligoarticular JIA has on the United States healthcare system.

少关节幼年特发性关节炎(JIA)是小儿风湿病的常见病。寡关节JIA的治疗会造成相当大的经济负担。本研究是一项为期四年的回顾性成本识别分析,旨在确定少关节JIA患者的年度直接护理成本和可能的预测性临床因素。直接医疗保健费用被定义为与办公室就诊、实验室研究、住院、联合注射、药物、输液、放射检查和急诊室就诊相关的费用。疾病特征和患者信息包括ANA状态、性别、诊断时年龄、研究期间从诊断到初次就诊的持续时间以及是否诊断出葡萄膜炎。我们确定了97例符合研究条件的少关节性JIA患者。中位诊断年龄为4.3岁。75%的患者出现ANA阳性。34%的患者接受了至少一次关节内类固醇注射。在研究期间,32%的患者服用了生物制剂,主要是其他药物,而23%的患者只服用非甾体抗炎药。20%的患者服用口服类固醇。在本研究中,少关节JIA患者每年的平均总直接医疗费用为3929±6985美元。药品费用占年度直接医疗费用的85%。门诊就诊和实验室检测分别占8%和5%。采用Wilcoxon秩和检验和Kruskal-Wallis检验检验患者特征和人口统计学与直接医疗费用的关系。与ANA阴性患者相比,ANA阳性患者的年费用增加。研究发现,ana阳性患者的费用在统计上具有显著意义,特别是在实验室检查、手术费用、放射学费用和药物费用方面。本文报告的结果提供了分配医疗资源时的信息,并更好地了解寡关节JIA对美国医疗保健系统的经济影响。
{"title":"Direct Healthcare Costs Associated with Oligoarticular Juvenile Idiopathic Arthritis at a Single Center.","authors":"Amit Thakral,&nbsp;Daniel Pinto,&nbsp;Michael Miller,&nbsp;Megan L Curran,&nbsp;Marisa Klein-Gitelman,&nbsp;Dustin D French","doi":"10.1155/2020/5640425","DOIUrl":"https://doi.org/10.1155/2020/5640425","url":null,"abstract":"<p><p>Oligoarticular juvenile idiopathic arthritis (JIA) is a common disease in pediatric rheumatology. The management of oligoarticular JIA can result in a considerable economic burden. This study is a four-year, retrospective cost identification analysis performed to determine the annual direct cost of care for patients with oligoarticular JIA and possible predictive clinical factors. Direct healthcare costs were defined as those associated with office visits, laboratory studies, hospital admissions, joint injections, medications, infusions, radiology tests, and emergency room visits. Disease characteristics and patient information included ANA status, gender, age at diagnosis, duration from diagnosis to initial visit during the study period, and whether uveitis had been diagnosed. We identified 97 patients with oligoarticular JIA eligible for the study. The median age of diagnosis was 4.3 years. Positive ANA were noted in 75% of patients. 34% of patients received at least one intra-articular steroid injection. 32% of patients were prescribed a biologic during the study period, predominantly with other medications, while 23% of patients received only NSAIDs. 20% of patients were prescribed oral steroids. The average total direct medical cost in this study per year for an oligoarticular JIA patient was $3929 ± 6985. Medications accounted for 85% of annual direct medical costs. Clinic visits and laboratory testing accounted for 8% and 5%, respectively. Patient characteristics and demographics were tested for association with direct medical costs by the Wilcoxon rank sum test and Kruskal-Wallis test. Patients who were ANA positive had increased annual costs compared to patients who are ANA negative. ANA-positive patients were found to have statistically significant costs, particularly, in laboratory tests, procedural costs, radiology costs, and medication costs. The results reported here provide information when allocating healthcare resources and a better understanding of the economic impact oligoarticular JIA has on the United States healthcare system.</p>","PeriodicalId":51715,"journal":{"name":"International Journal of Rheumatology","volume":"2020 ","pages":"5640425"},"PeriodicalIF":2.3,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/5640425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38496638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
期刊
International Journal of Rheumatology
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