Pub Date : 2024-07-15eCollection Date: 2024-06-01DOI: 10.1515/rir-2024-0010
Veronica Batani, Lorenzo Dagna, Giacomo De Luca
Primary heart involvement (pHI) is frequent in systemic sclerosis (SSc), even though often underdiagnosed. SSc-pHI has been recently defined as cardiac abnormalities that are predominantly attributable to SSc rather than other causes and/or complications. SSc-pHI represents a major determinant of mortality in SSc, accounting alone for about 12% of disease-related deaths; its early recognition and promptly therapeutic interventions are therefore crucial. Both perfusion defects and myocardial inflammation contribute to the occurrence of myocardial fibrosis that precipitates myocardial remodeling, potentially leading to heart failure and arrhythmic complications. To date, clear evidence and guidelines for effectively managing SSc pHI are not established yet, resulting in a lack of a defined therapeutic algorithm. In this review we summarize the most recent scientific literature on the prevailing therapeutic strategies and interventions to manage SSc-pHI, with particular focus on therapeutic strategies to counteract the 3 major pathogenic events of the disease, i.e. microvascular damage, myocardial inflammation and myocardial fibrosis.
{"title":"Therapeutic strategies for primary heart involvement in systemic sclerosis.","authors":"Veronica Batani, Lorenzo Dagna, Giacomo De Luca","doi":"10.1515/rir-2024-0010","DOIUrl":"10.1515/rir-2024-0010","url":null,"abstract":"<p><p>Primary heart involvement (pHI) is frequent in systemic sclerosis (SSc), even though often underdiagnosed. SSc-pHI has been recently defined as cardiac abnormalities that are predominantly attributable to SSc rather than other causes and/or complications. SSc-pHI represents a major determinant of mortality in SSc, accounting alone for about 12% of disease-related deaths; its early recognition and promptly therapeutic interventions are therefore crucial. Both perfusion defects and myocardial inflammation contribute to the occurrence of myocardial fibrosis that precipitates myocardial remodeling, potentially leading to heart failure and arrhythmic complications. To date, clear evidence and guidelines for effectively managing SSc pHI are not established yet, resulting in a lack of a defined therapeutic algorithm. In this review we summarize the most recent scientific literature on the prevailing therapeutic strategies and interventions to manage SSc-pHI, with particular focus on therapeutic strategies to counteract the 3 major pathogenic events of the disease, <i>i.e</i>. microvascular damage, myocardial inflammation and myocardial fibrosis.</p>","PeriodicalId":74736,"journal":{"name":"Rheumatology and immunology research","volume":"5 2","pages":"72-82"},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11248560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629483","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}
Pub Date : 2024-07-15eCollection Date: 2024-06-01DOI: 10.1515/rir-2024-0017
Zhi Li, Mengying Zhang, Lanlan Jia, Chuanmiao Zhu, Junyuan Wang
{"title":"Heart in a stone house: Systemic sclerosis with pericardial calcinosis.","authors":"Zhi Li, Mengying Zhang, Lanlan Jia, Chuanmiao Zhu, Junyuan Wang","doi":"10.1515/rir-2024-0017","DOIUrl":"10.1515/rir-2024-0017","url":null,"abstract":"","PeriodicalId":74736,"journal":{"name":"Rheumatology and immunology research","volume":"5 2","pages":"130-132"},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11248905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629481","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}
Background and objectives: The clinical course, the outcomes of myocarditis, and the imaging progression of cardiac magnetic resonance imaging (MRI) in systemic sclerosis (SSc) are still unknown. We aimed at defining changes in cardiac MRI findings, the clinical course, and the outcomes of SSc patients previously defined as having myocarditis by cardiac MRI. Methods: This prospective cohort study included SSc patients, who had previously been diagnosed with myocarditis through cardiac MRI at the Scleroderma Clinic of Khon Kaen University, between 2018 and 2020 and had had annual follow-ups of cardiac MRI for at least 3 years. Data on demographics, clinical characteristics, cardiac MRI findings, treatment regimens, and outcomes were collected. Serial cardiac MRI on a yearly basis was analyzed to assess changes in myocardial involvement over the 3-year period.
Results: Ten SSc patients diagnosed with myocarditis via cardiac MRI were included. Most belonged to the diffuse cutaneous subset with a mean age of 58.3±8.6 years and were mildly symptomatic. Initial cardiac MRI findings showed myocardial edema and hyperemia in all patients and eight patients had had pre-existing myocardial scars, suggesting disease chronicity. Treatment for concomitant interstitial lung disease involved steroids with either cyclophosphamide or mycophenolate mofetil in 6 patients. Outcomes of myocarditis were stable, improving, and worsening in 4, 4, and 2 patients, respectively. There was no complete resolution of the cardiac MRI indices for myocarditis, and none had had major cardiac events.
Conclusion: Although SSc myocarditis on cardiac MRI may improve or show stability, the changes remained persistent. Among patients with SSc and mildly symptomatic myocarditis, the efficacy of steroids and immunosuppressive therapy is inconclusive. Over a 3-year follow-up, the prognosis had been acceptably good with no cardiac events.
{"title":"Outcomes of myocarditis in systemic sclerosis: A 3-year follow-up.","authors":"Ajanee Mahakkanukrauh, Chingching Foocharoen, Narumol Chaosuwannakit, Siraphop Suwannaroj, Patnarin Pongkulkiat, Tippawan Onchan, Burabha Pussadhamma","doi":"10.1515/rir-2024-0015","DOIUrl":"10.1515/rir-2024-0015","url":null,"abstract":"<p><strong>Background and objectives: </strong>The clinical course, the outcomes of myocarditis, and the imaging progression of cardiac magnetic resonance imaging (MRI) in systemic sclerosis (SSc) are still unknown. We aimed at defining changes in cardiac MRI findings, the clinical course, and the outcomes of SSc patients previously defined as having myocarditis by cardiac MRI. Methods: This prospective cohort study included SSc patients, who had previously been diagnosed with myocarditis through cardiac MRI at the Scleroderma Clinic of Khon Kaen University, between 2018 and 2020 and had had annual follow-ups of cardiac MRI for at least 3 years. Data on demographics, clinical characteristics, cardiac MRI findings, treatment regimens, and outcomes were collected. Serial cardiac MRI on a yearly basis was analyzed to assess changes in myocardial involvement over the 3-year period.</p><p><strong>Results: </strong>Ten SSc patients diagnosed with myocarditis via cardiac MRI were included. Most belonged to the diffuse cutaneous subset with a mean age of 58.3±8.6 years and were mildly symptomatic. Initial cardiac MRI findings showed myocardial edema and hyperemia in all patients and eight patients had had pre-existing myocardial scars, suggesting disease chronicity. Treatment for concomitant interstitial lung disease involved steroids with either cyclophosphamide or mycophenolate mofetil in 6 patients. Outcomes of myocarditis were stable, improving, and worsening in 4, 4, and 2 patients, respectively. There was no complete resolution of the cardiac MRI indices for myocarditis, and none had had major cardiac events.</p><p><strong>Conclusion: </strong>Although SSc myocarditis on cardiac MRI may improve or show stability, the changes remained persistent. Among patients with SSc and mildly symptomatic myocarditis, the efficacy of steroids and immunosuppressive therapy is inconclusive. Over a 3-year follow-up, the prognosis had been acceptably good with no cardiac events.</p>","PeriodicalId":74736,"journal":{"name":"Rheumatology and immunology research","volume":"5 2","pages":"117-125"},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11248554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629482","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}
Pub Date : 2024-03-31eCollection Date: 2024-03-01DOI: 10.1515/rir-2024-0006
Marco Matucci-Cerinic, Francesco Ciccia, Rosario Foti, Alessandro Giunta, Francesco Loconsole, Francesca Prignano, Rossana Scrivo, Giampiero Girolomoni
Background and objectives: Psoriasis (PsO) and psoriatic arthritis (PsA) are often undertreated and require a multidisciplinary approach. In recent years, patent expiration has allowed the introduction of tumor necrosis factor inhibitor (anti-TNF) biosimilars, which have stimulated a significant increase in the use of biological therapies. This article reports the findings of a multidisciplinary approach to achieve a consensus on the use of adalimumab in patients with PsO or PsA.
Methods: A voting panel of 36 Italian dermatologists and rheumatologists were chosen by eight Italian clinicians (the Board), to provide a consensus on the real-world management of PsO and PsA with adalimumab using the Delphi Method, comprising three survey rounds. Twelve statements were defined by the Board and submitted to the panel (rating scale 1-7).
Results: Clinicians reached a wide consensus on the effectiveness (score 6-7: 67%) and long-term efficacy (6-7: 100%) of adalimumab in all clinical forms of PsO and PsA, including pediatric patients (6-7: 85%). Considering cost-effectiveness and safety, adalimumab is suggested as a first-line treatment in patients with enthesitis, predominant peripheral arthritis, axial involvement or associated inflammatory bowel disease (IBD) or uveitis. Adalimumab can be also considered after failure of etanercept (6-7: 94%).
Conclusion: Results from this Delphi study clearly show an overall consensus on the use of adalimumab in the management of PsO and PsA, particularly as first-choice for specific subpopulations (uveitis, IBD, hidradenitis suppurativa). Considering the cost-effectiveness of biosimilars within Italy, adalimumab may represent an effective and safe first-line treatment for patients with moderate-to-severe PsO or PsA, and a valid choice for switching after failure.
{"title":"Adalimumab in the management of psoriasis and psoriatic arthritis: Results from a Delphi investigation.","authors":"Marco Matucci-Cerinic, Francesco Ciccia, Rosario Foti, Alessandro Giunta, Francesco Loconsole, Francesca Prignano, Rossana Scrivo, Giampiero Girolomoni","doi":"10.1515/rir-2024-0006","DOIUrl":"https://doi.org/10.1515/rir-2024-0006","url":null,"abstract":"<p><strong>Background and objectives: </strong>Psoriasis (PsO) and psoriatic arthritis (PsA) are often undertreated and require a multidisciplinary approach. In recent years, patent expiration has allowed the introduction of tumor necrosis factor inhibitor (anti-TNF) biosimilars, which have stimulated a significant increase in the use of biological therapies. This article reports the findings of a multidisciplinary approach to achieve a consensus on the use of adalimumab in patients with PsO or PsA.</p><p><strong>Methods: </strong>A voting panel of 36 Italian dermatologists and rheumatologists were chosen by eight Italian clinicians (the Board), to provide a consensus on the real-world management of PsO and PsA with adalimumab using the Delphi Method, comprising three survey rounds. Twelve statements were defined by the Board and submitted to the panel (rating scale 1-7).</p><p><strong>Results: </strong>Clinicians reached a wide consensus on the effectiveness (score 6-7: 67%) and long-term efficacy (6-7: 100%) of adalimumab in all clinical forms of PsO and PsA, including pediatric patients (6-7: 85%). Considering cost-effectiveness and safety, adalimumab is suggested as a first-line treatment in patients with enthesitis, predominant peripheral arthritis, axial involvement or associated inflammatory bowel disease (IBD) or uveitis. Adalimumab can be also considered after failure of etanercept (6-7: 94%).</p><p><strong>Conclusion: </strong>Results from this Delphi study clearly show an overall consensus on the use of adalimumab in the management of PsO and PsA, particularly as first-choice for specific subpopulations (uveitis, IBD, hidradenitis suppurativa). Considering the cost-effectiveness of biosimilars within Italy, adalimumab may represent an effective and safe first-line treatment for patients with moderate-to-severe PsO or PsA, and a valid choice for switching after failure.</p>","PeriodicalId":74736,"journal":{"name":"Rheumatology and immunology research","volume":"5 1","pages":"49-56"},"PeriodicalIF":0.0,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10985702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861231","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}
Pub Date : 2024-03-31eCollection Date: 2024-03-01DOI: 10.1515/rir-2024-0009
Ana Rubim Correia, Inês Clara, Sara Raquel Martins, Tomás Fonseca
{"title":"Not all geriatric cachexia is cancer - The difficult lateonset rheumatoid arthritis.","authors":"Ana Rubim Correia, Inês Clara, Sara Raquel Martins, Tomás Fonseca","doi":"10.1515/rir-2024-0009","DOIUrl":"https://doi.org/10.1515/rir-2024-0009","url":null,"abstract":"","PeriodicalId":74736,"journal":{"name":"Rheumatology and immunology research","volume":"5 1","pages":"68-71"},"PeriodicalIF":0.0,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10985713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867869","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}
Pub Date : 2024-03-31eCollection Date: 2024-03-01DOI: 10.1515/rir-2024-0005
Saika Sharmeen, Lisa Christopher-Stine, Joann N Salvemini, Peter Gorevic, Richard Clark, Qingping Yao
Systemic autoinflammatory diseases (SAIDs) are distinct from autoimmune diseases. The former primarily results from abnormal innate immune response and genetic testing is crucial for disease diagnosis. Similar cutaneous involvement is a main feature for both SAID and dermatomyositis (DM), so they can be confused with each other. A literature search of PubMed and MEDLINE was conducted for relevant articles. The similarities and differences between these two types of diseases were analyzed. We found phenotypic similarities between these two types of disorders. Accumulating data supports a major role of the innate immune system and a similar cytokine profile. Molecular testing using an autoinflammatory disease gene panel may help identify SAID patients from the DM population and may offer therapeutic benefit using interleukin-1 (IL-1) inhibitors. A subset of DM, notably amyopathic dermatomyositis in the absence of autoantibodies may be on the spectrum of autoinflammatory disease.
系统性自身炎症疾病(SAIDs)有别于自身免疫性疾病。前者主要是先天性免疫反应异常所致,基因检测是疾病诊断的关键。类似的皮肤受累是 SAID 和皮肌炎(DM)的主要特征,因此两者容易混淆。我们对 PubMed 和 MEDLINE 上的相关文章进行了文献检索。分析了这两种疾病的异同。我们发现这两类疾病在表型上有相似之处。不断积累的数据支持先天性免疫系统的主要作用和相似的细胞因子谱。使用自身炎症性疾病基因面板进行的分子检测可能有助于从 DM 群体中识别出 SAID 患者,使用白细胞介素-1(IL-1)抑制剂可能会给治疗带来益处。DM 的一个亚群,尤其是无自身抗体的肌病性皮肌炎,可能属于自身炎症性疾病的范畴。
{"title":"Amyopathic dermatomyositis may be on the spectrum of autoinflammatory disease: A clinical review.","authors":"Saika Sharmeen, Lisa Christopher-Stine, Joann N Salvemini, Peter Gorevic, Richard Clark, Qingping Yao","doi":"10.1515/rir-2024-0005","DOIUrl":"https://doi.org/10.1515/rir-2024-0005","url":null,"abstract":"<p><p>Systemic autoinflammatory diseases (SAIDs) are distinct from autoimmune diseases. The former primarily results from abnormal innate immune response and genetic testing is crucial for disease diagnosis. Similar cutaneous involvement is a main feature for both SAID and dermatomyositis (DM), so they can be confused with each other. A literature search of PubMed and MEDLINE was conducted for relevant articles. The similarities and differences between these two types of diseases were analyzed. We found phenotypic similarities between these two types of disorders. Accumulating data supports a major role of the innate immune system and a similar cytokine profile. Molecular testing using an autoinflammatory disease gene panel may help identify SAID patients from the DM population and may offer therapeutic benefit using interleukin-1 (IL-1) inhibitors. A subset of DM, notably amyopathic dermatomyositis in the absence of autoantibodies may be on the spectrum of autoinflammatory disease.</p>","PeriodicalId":74736,"journal":{"name":"Rheumatology and immunology research","volume":"5 1","pages":"42-48"},"PeriodicalIF":0.0,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10985708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863829","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}
Pub Date : 2024-03-31eCollection Date: 2024-03-01DOI: 10.1515/rir-2024-0001
Xinping Tian, Xiaofeng Zeng
{"title":"Early diagnosis and standardized treatment are critical to improve the prognosis of patients with Takayasu's arteritis.","authors":"Xinping Tian, Xiaofeng Zeng","doi":"10.1515/rir-2024-0001","DOIUrl":"https://doi.org/10.1515/rir-2024-0001","url":null,"abstract":"","PeriodicalId":74736,"journal":{"name":"Rheumatology and immunology research","volume":"5 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10985710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861232","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}
Pub Date : 2024-03-31eCollection Date: 2024-03-01DOI: 10.1515/rir-2024-0003
Francesco Ciccia, Nikolas Konstantine Dussias, Saviana Gandolfo, Fernando Rizzello, Paolo Gionchetti
Spondyloarthritis (SpA), rheumatoid arthritis (RA), and inflammatory bowel diseases (IBD) are chronic inflammatory autoimmune diseases that are associated with alterations in the composition of the intestinal microbiota (i.e., dysbiosis). For SpA and RA, a gut-joint-enthesis axis is hypothesized and recent data suggests that dysbiosis may contribute directly to initiating and perpetuating joint and spine inflammation. Biologic drugs targeting tumor necrosis factor (TNF) are effective in treating these diseases and have been shown to partially restore the disrupted microbiome. Hence, drugs that affect both the intestinal and joint components of these diseases, such as anti-TNF drugs, may act on the intestinal microbiome. However, despite the remarkable efficacy of anti-TNF-α treatments, non-responders are frequent, and predictors of patient outcomes have not been identified. In this narrative review, we summarize recent research on the downstream effects of anti-TNF drugs on the intestinal microbiota in SpA, RA, and IBD. We also discuss whether these changes could have a role as predictive biomarkers of anti-TNF response.
{"title":"The effect of anti-TNF drugs on the intestinal microbiota in patients with spondyloarthritis, rheumatoid arthritis, and inflammatory bowel diseases.","authors":"Francesco Ciccia, Nikolas Konstantine Dussias, Saviana Gandolfo, Fernando Rizzello, Paolo Gionchetti","doi":"10.1515/rir-2024-0003","DOIUrl":"https://doi.org/10.1515/rir-2024-0003","url":null,"abstract":"<p><p>Spondyloarthritis (SpA), rheumatoid arthritis (RA), and inflammatory bowel diseases (IBD) are chronic inflammatory autoimmune diseases that are associated with alterations in the composition of the intestinal microbiota (<i>i.e</i>., dysbiosis). For SpA and RA, a gut-joint-enthesis axis is hypothesized and recent data suggests that dysbiosis may contribute directly to initiating and perpetuating joint and spine inflammation. Biologic drugs targeting tumor necrosis factor (TNF) are effective in treating these diseases and have been shown to partially restore the disrupted microbiome. Hence, drugs that affect both the intestinal and joint components of these diseases, such as anti-TNF drugs, may act on the intestinal microbiome. However, despite the remarkable efficacy of anti-TNF-α treatments, non-responders are frequent, and predictors of patient outcomes have not been identified. In this narrative review, we summarize recent research on the downstream effects of anti-TNF drugs on the intestinal microbiota in SpA, RA, and IBD. We also discuss whether these changes could have a role as predictive biomarkers of anti-TNF response.</p>","PeriodicalId":74736,"journal":{"name":"Rheumatology and immunology research","volume":"5 1","pages":"27-33"},"PeriodicalIF":0.0,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10985709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857433","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}
Pub Date : 2024-03-31eCollection Date: 2024-03-01DOI: 10.1515/rir-2024-0007
Nevin Hammam, Passant N El-Husseiny, Suzan S Al-Adle, Nermeen Samy, Nora Y Elsaid, Dina F El-Essawi, Eman F Mohamed, Samar M Fawzy, Samah A El Bakry, Maha Nassr, Samah I Nasef, Hanan M El-Saadany, Shereen Elwan, Nada M Gamal, Abdelhfeez Moshrif, Osman Hammam, Rawhya R El Shereef, Faten Ismail, Samar Tharwat, Doaa Mosad Mosa, Mervat I Abd Elazeem, Enas A Abdelaleem, Tamer A Gheita
Background and objectives: Rheumatoid factor (RF) and anti-cyclic citrullinated protein (anti-CCP) have been used to improve the diagnosis and prognosis of rheumatoid arthritis (RA). However, their association with RA disease phenotypes, individually and in combination, is not well studied. The aim of the study was to compare patients' and disease characteristics, activity and severity in double seronegative (DNRA), single seropositive RF, single seropositive anti-CCP and double seropositive (DPRA) patients.
Methods: Adults subjects with RA from Egyptian College of Rheumatology (ECR) database who had RF and anti-CCP results available were included. Demographic, clinical features, disease activity score 28 (DAS28), Health Assessment Questionnaire (HAQ) and laboratory data were collected and compared among different RA groups.
Results: 5268 RA patients with mean age of 44.9±11.6 years, and 4477 (85%) were females. 2900 (55%) had DPRA, 892 (16.9%) had single positive RF, 597 (11.3%) had single positive anti-CCP while 879 (16.7%) had DNRA. Patients with DPRA had significantly high percentage of metabolic syndrome (19.3%, P < 0.001), and functional impairment using HAQ (P = 0.01). Older age (RRR [relative risk ratio]: 1.03, 95%CI: 1.0, 1.0, P = 0.029), greater DAS28 (RRR: 1.51, 95%CI: 1.2, 1.9, P < 0.001), higher steroid use (RRR: 2.4, 95%CI: 1.36, 4.25, P = 0.002) were at higher risk of DPRA while longer disease duration (RRR: 1.08, 95%CI: 1.01, 1.16, P = 0.017) and fibromyalgia syndrome (RRR: 2.54, 95%CI: 1.10, 5.88, P = 0.028) were associated with higher odds of single positive RF status.
Conclusion: Dual antibody-positive status has higher disease activity and severity, and higher chance of development of metabolic syndrome; highlighting the implicated role of inflammation, atherogenesis and cardiovascular disease risk in RA.
背景和目的:类风湿因子(RF)和抗环瓜氨酸蛋白(anti-CCP)已被用于改善类风湿性关节炎(RA)的诊断和预后。然而,对它们单独或联合使用与 RA 疾病表型的关系研究不多。本研究旨在比较双血清阴性(DNRA)、单血清阳性 RF、单血清阳性抗CCP 和双血清阳性(DPRA)患者的病情特征、活动性和严重程度:方法:纳入埃及风湿病学会(ECR)数据库中具有RF和抗CCP结果的成人RA患者。收集人口统计学、临床特征、疾病活动度评分 28(DAS28)、健康评估问卷(HAQ)和实验室数据,并对不同 RA 组别进行比较:结果:5268 名 RA 患者,平均年龄为(44.9±11.6)岁,其中 4477 名(85%)为女性。2900例(55%)为DPRA,892例(16.9%)为RF单项阳性,597例(11.3%)为抗CCP单项阳性,879例(16.7%)为DNRA。DPRA 患者患有代谢综合征(19.3%,P < 0.001)和 HAQ 功能障碍(P = 0.01)的比例明显较高。年龄越大(RRR [相对风险比]:1.03,95%CI:1.0,1.0,P = 0.029)、DAS28 越高(RRR:1.51,95%CI:1.2,1.9,P < 0.001)、使用类固醇越多(RRR:2.4,95%CI:1.36,4.25,P = 0.002)患 DPRA 的风险较高,而病程较长(RRR:1.08,95%CI:1.01,1.16,P = 0.017)和纤维肌痛综合征(RRR:2.54,95%CI:1.10,5.88,P = 0.028)与 RF 单项阳性状态的几率较高相关:结论:双重抗体阳性者的疾病活动度和严重程度较高,患代谢综合征的几率也较高;这突出表明了炎症、动脉粥样硬化和心血管疾病风险在RA中的作用。
{"title":"Clinical implications of seropositive and seronegative autoantibody status in rheumatoid arthritis patients: A comparative multicentre observational study.","authors":"Nevin Hammam, Passant N El-Husseiny, Suzan S Al-Adle, Nermeen Samy, Nora Y Elsaid, Dina F El-Essawi, Eman F Mohamed, Samar M Fawzy, Samah A El Bakry, Maha Nassr, Samah I Nasef, Hanan M El-Saadany, Shereen Elwan, Nada M Gamal, Abdelhfeez Moshrif, Osman Hammam, Rawhya R El Shereef, Faten Ismail, Samar Tharwat, Doaa Mosad Mosa, Mervat I Abd Elazeem, Enas A Abdelaleem, Tamer A Gheita","doi":"10.1515/rir-2024-0007","DOIUrl":"https://doi.org/10.1515/rir-2024-0007","url":null,"abstract":"<p><strong>Background and objectives: </strong>Rheumatoid factor (RF) and anti-cyclic citrullinated protein (anti-CCP) have been used to improve the diagnosis and prognosis of rheumatoid arthritis (RA). However, their association with RA disease phenotypes, individually and in combination, is not well studied. The aim of the study was to compare patients' and disease characteristics, activity and severity in double seronegative (DNRA), single seropositive RF, single seropositive anti-CCP and double seropositive (DPRA) patients.</p><p><strong>Methods: </strong>Adults subjects with RA from Egyptian College of Rheumatology (ECR) database who had RF and anti-CCP results available were included. Demographic, clinical features, disease activity score 28 (DAS28), Health Assessment Questionnaire (HAQ) and laboratory data were collected and compared among different RA groups.</p><p><strong>Results: </strong>5268 RA patients with mean age of 44.9±11.6 years, and 4477 (85%) were females. 2900 (55%) had DPRA, 892 (16.9%) had single positive RF, 597 (11.3%) had single positive anti-CCP while 879 (16.7%) had DNRA. Patients with DPRA had significantly high percentage of metabolic syndrome (19.3%, <i>P</i> < 0.001), and functional impairment using HAQ (<i>P</i> = 0.01). Older age (RRR [relative risk ratio]: 1.03, 95%CI: 1.0, 1.0, <i>P</i> = 0.029), greater DAS28 (RRR: 1.51, 95%CI: 1.2, 1.9, <i>P</i> < 0.001), higher steroid use (RRR: 2.4, 95%CI: 1.36, 4.25, <i>P</i> = 0.002) were at higher risk of DPRA while longer disease duration (RRR: 1.08, 95%CI: 1.01, 1.16, <i>P</i> = 0.017) and fibromyalgia syndrome (RRR: 2.54, 95%CI: 1.10, 5.88, <i>P</i> = 0.028) were associated with higher odds of single positive RF status.</p><p><strong>Conclusion: </strong>Dual antibody-positive status has higher disease activity and severity, and higher chance of development of metabolic syndrome; highlighting the implicated role of inflammation, atherogenesis and cardiovascular disease risk in RA.</p>","PeriodicalId":74736,"journal":{"name":"Rheumatology and immunology research","volume":"5 1","pages":"57-65"},"PeriodicalIF":0.0,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10985701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867865","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}