Archives of rheumatology最新文献

Objectives: This study aims to the prevalence of antinuclear antibody (ANA)-negative systemic lupus erythematosus (SLE) and their clinical characteristics in a large single-center SLE inception cohort to provide guidance for early diagnosis.

Patients and methods: Between December 2012 and March 2021, the medical records of a total of 617 firstly diagnosed SLE patients (83 males, 534 females; median age [IQR]: 33+22.46 years) who fulfilled the selection criteria were retrospectively analyzed. The patients were divided into groups with ANA-negative SLE and ANA-positive SLE, or with prolonged use of glucocorticoids or immunosuppressants (SLE-1) and without (SLE-0). Demographic, clinical characteristics, and laboratory features were collected.

Results: The total prevalence of ANA-negative SLE patients was 2.11% (13/617). The prevalence of ANA-negative SLE in SLE-1 (7.46%) was significantly higher than that in SLE-0 (1.48%) (p<0.01). The ANA-negative SLE patients had a higher prevalence of thrombocytopenia (84.62%) than ANA-positive SLE patients (34.27%). As with ANA-positive SLE, ANA-negative SLE also had a high prevalence of low complement (92.31%) and anti-double-stranded deoxyribonucleic acid (anti-dsDNA) positivity (69.23%). The prevalence of medium-high titer anti-cardiolipin antibody (aCL) IgG (50.00%) and anti-ß2 glycoprotein I (anti-ß2GPI) (50.00%) of ANA-negative SLE was significantly higher than that of ANA-positive SLE (11.22% and 14.93%, respectively).

Conclusion: The prevalence of ANA-negative SLE is very low, but it exists, particularly under the influence of prolonged use of glucocorticoids or immunosuppressants. Thrombocytopenia, low complement, positive anti-dsDNA, and medium-high titer antiphospholipid antibody (aPL) are the main manifestations of ANA-negative SLE. It is necessary to identify complement, anti-dsDNA, and aPL in ANA-negative patients with rheumatic symptoms, particularly thrombocytopenia.

Objectives: In this study, we aimed to examine the efficacy of micro ribonucleic acid (miRNA)-23a-5p in gouty arthritis and to investigate its possible mechanism.

Materials and methods: Gouty arthritis in rat was established by intraarticular injection of 0.2 mL monosodium urate crystal (20 mg/mL) inside knee joint cavity. THP-1 cell was induced using lipopolysaccharides (LPS) for in vitro model.

Results: Serum miRNA-23a-5p expression levels were increased in rats of gouty arthritis. However, overexpression of miRNA-23a-5p promoted inflammation and induced myeloid differential protein-88 (MyD88)/nuclear factor-kappa B (NF-κB) pathway by induction toll-like receptor-2 (TLR2) in vitro. The inhibition of TLR2 attenuated the pro-inflammation effects of miRNA-23a-5p in inflammation in in vitro model of gouty arthritis.

Conclusion: Our findings demonstrate that miRNA-23a-5p is a biomarker for gouty arthritis and promotes inflammation in rats of gouty arthritis via MyD88/NF-κB pathway by targeting TLR2.

Objectives: To explore the ability to use urinary level of plasmin as an indicator for renal affection and activity in systemic lupus erythematosus (SLE) patients.

Patients and methods: Between April 2020 and October 2020, urine samples from 50 SLE patients (2 males, 48 females; mean age: 35.5±8.1 years; range, 22 to 39 years) and 20 age- and sex-matched healthy controls (2 males, 18 females; mean age: 34.1±6.5 years; range, 27 to 38 years) were collected. The patients were divided into two groups according to the presence or absence of renal manifestations as those with renal disease (n=28) and those without renal disease (n=22). The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), renal activity (rSLEDAI), and Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI) scores were calculated. Renal biopsy was performed to patients with active lupus nephritis (LN). The activity index (AI) and Chronicity Index (CI) were scored.

Results: There was a highly statistically significant difference in the mean urinary plasmin levels between SLE cases and the control group (88.9±42.6 ng/mL vs. 21.3±26.8 ng/mL, respectively; p<0.001). A significant elevation was observed (p<0.05) in patients with LN (97.9±46.6 ng/mL) than without (42.7±12.7 ng/mL), particularly in patients with active renal involvement (82.9±26.6 ng/mL) than patients with inactive renal disease (63.2±15.5 ng/mL). There were significant positive correlations between the mean urinary plasmin levels and inflammatory markers, SLEDAI, and rSLEDAI scores.

Conclusion: Urinary level of plasmin is significantly elevated among SLE cases, particularly in those with active LN. The remarkable association between urinary plasmin level and various activity status implies that urinary plasmin can be used as a beneficial marker to monitor lupus nephritis flare.

Objectives: The aim of this study was to translate and cross-culturally adapt the English version of the Cervical Radiculopathy Impact Scale (CRIS) and to investigate the validity and reliability of the Turkish version of the CRIS.

Patients and methods: Between October 2021 and February 2022, a total of 105 patients (48 males, 57 females; mean age: 45.4±11.8 years; range, 36.5 to 55.5 years) who were diagnosed with cervical radiculopathy due to disc herniation were included. Disability and quality of life were evaluated with the Neck Disability Index (NDI), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Short Form-12 (SF-12). Pain severity was evaluated using the Numerical Rating Scale (NRS) in three subscales (neck pain, pain radiating to the arm, and numbness in the finger, hand, or arm). The internal consistency for CRIS was assessed using the Cronbach alpha and test-retest reliability by intraclass correlation coefficients (ICCs). Explanatory factor analyses were performed for construct validity. To examine the content validity, the correlations among the three subgroup scores of CRIS and the other scale scores were analyzed.

Results: The internal consistency of CRIS was found to be high (α=0.937). A high reliability was obtained for test-retest reliability for the three subscales of CRIS (Symptoms, Energy and postures, Actions and activities) (ICC: 0.950, 0.941, 0.962, respectively; p<0.001). All three subscale scores of CRIS were correlated with the NDI, QuickDASH, SF-12 (physical and mental) and NRS scores (r=0.358-0.713, p<0.001). Factor analysis showed that the scale had five factors.

Conclusion: The CRIS is a valid and reliable instrument for Turkish patients with cervical radiculopathy due to disc herniation.

Objectives: In this study, we aimed to compare the efficacy of ultrasonography (US) and steroid phonophoresis (PH) treatments in patients with idiopathic carpal tunnel syndrome (CTS).

Patients and methods: Between January 2013 and May 2015, a total of 46 hands of 27 patients (5 males, 22 females; mean age: 47.3+13.7 years; range, 23 to 67 years) with idiopathic mild/moderate CTS without tenor atrophy or spontaneous activity in abductor pollicis brevis were included. The patients were randomly divided into three groups. The first group was ultrasound (US) group, the second group was PH group, and the third group was placebo US group. Continuous US with a frequency of 1 MHz, an intensity of 1.0 W/cm² was used in the US and the PH groups. The PH group received 0.1% dexamethasone. Placebo group received a frequency of 0 MHz, an intensity of 0 W/cm² US. Treatments were administered for five days a week, a total of 10 sessions. All patients also wore night splints during treatment. The Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire consisting of two parts, namely the Symptom Severity Scale and Functional Status Scale), grip strength, and electroneurophysiological evaluations were compared before the treatment, after the treatment, and three months later.

Results: All clinical parameters improved in all groups after treatment and at three months, except for the grip strength. Recovery in the sensory nerve conduction velocity between palm and wrist was seen in US group at three months after the treatment; however, recovery in the sensory nerve distal latency between the second finger and palm was seen in PH and placebo groups after treatment and at three months after the treatment.

Conclusion: The results of this study suggest that splinting therapy combined with steroid PH, placebo or continuous US is effective for both clinical and electroneurophysiological improvement; however, electroneurophysiological improvement is limited.

Objectives: This study aims to investigate the prevalence of low-density lipoprotein receptor (LDL-R) rs5925 genetic variants and to evaluate their relationship with plasma lipid and kidney functions in lupus nephritis patients.

Patients and methods: Between September 2020 and June 2021, a total of 100 lupus nephritis patients (8 males, 92 females; mean age: 31.1±1.1 years; range, 20 to 67 years) and a total of 100 age- and sex-matched healthy volunteers (10 males, 90 females; mean age: 35.8±2.8 years; range, 21 to 65 years) were included. The gene polymorphism rs5925 (LDLR) was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Lipid profile and kidney functions were measured.

Results: Regarding rs5925 (LDLR), C allele was significantly higher among lupus nephritis patients (60%) compared to the control group (45%). While T allele was significantly lower in lupus nephritis patients (40%), compared to the control group (p=0.003). The plasma level of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) were significantly lower in lupus nephritis patients with TT and CT genotypes, compared to those with CC genotype. Moreover, atherogenic index of plasma (AIP) and LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio were significantly lower in patients with TT genotype, compared to the patients with CC genotype. There was a strong and clear association between patients with renal biopsies grades III & IV & V and LDLR C allele (p=0.01, p=0.003, and p=0.004, respectively).

Conclusion: C allele is the significantly prevailed LDLR C1959T variant among lupus nephritis patients. Moreover, LDL-R genetic variant may be one of the non-immunological mechanisms implicated in the disturbed lipid profile among lupus nephritis patients. Profound dyslipidemia may partly underscore the deterioration of kidney function among lupus nephritis patients.

Objectives: This study aims to investigate the expression patterns of mitochondrially encoded cytochrome c oxidase 1 (MT-CO1) in different organs and tissues of MRL/lpr mice aged six and 18 weeks.

Materials and methods: Six-week-old female MRL/lpr mice (n=10) were considered young lupus model mice, and 18-week-old MRL/lpr mice (n=10) were considered old lupus model mice. Additionally, six-week-old (n=10) and 39-week-old (n=10) female Balb/c mice were used as the young and old controls, respectively. The messenger ribonucleic acid (mRNA) and protein expression levels of MT-CO1 in nine organs/tissues were detected via quantitative polymerase chain reaction (qPCR) and Western blot. Malondialdehyde (MDA) levels were determined with thiobarbituric acid colorimetry. The correlation coefficient of MT-CO1 mRNA levels and MDA levels in each organ/tissue at different ages was analyzed by Pearson correlation analysis.

Results: The results showed that most non-immune organs/tissues (heart, lung, liver, kidneys, and intestines) showed increased MT-CO1 expression levels in younger MRL/lpr mice (p<0.05) and decreased MT-CO1 expression in older mice (p<0.05). Expression of MT-CO1 in the lymph nodes was low in younger mice but high in older mice. In other immune organs (spleen and thymus), MT-CO1 expression was low in older MRL/lpr mice. Lower mRNA expression and higher MDA levels were observed in the brains of MRL/lpr mice. However, all MRL/lpr mice showed higher MDA levels than Balb/c mice in every organ no matter younger or older MRL/lpr mice.

Conclusion: Our study results suggest that lymphoid mitochondrial hyperfunction at organ level may be an important intrinsic pathogenesis in systemic lupus erythematosus activity, which may affect mitochondrial dysfunction in non-immune organs.

Objectives: This study aims to evaluate the presence and factors related to insulin resistance (IR) in untreated very early rheumatoid arthritis (RA) patients.

Patients and methods: Between June 2020 and July 2021, a total of 90 RA patients (29 males, 61 females; mean age: 49.3±10.2 years; range 24 to 68 years) and 90 age-, sex- and body mass index (BMI)-matched controls (35 males, 55 females; mean age: 48.3±5.1 years; range 38 to 62 years) were included. Homeostatic model assessment was applied to evaluate IR (HOMA-IR) and β-cell function (HOMA-β). Disease activity score 28 (DAS28) was used to estimate disease activity. Lipid profile, hemoglobin A1c (HbA1c), glucose, insulin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were measured. Logistic regression analysis was performed to investigate the relationship between the IR and clinical features of RA patients.

Results: The RA patients had higher HOMA-IR values (p<0.001) and adverse lipid profile. The IR was positively correlated with age (r=0.35, p<0.01), CRP (r=0.42, p<0.001), ESR (r=0.33, p<0.01), disease duration (r=0.28, p<0.01), and DAS28 (r=0.50, p<0.001). The DAS28, CRP and age, but not sex and menopausal status, were independently associated with IR.

Conclusion: Insulin resistance was present in untreated very early RA patients. The DAS28, CRP, and age were independent predictors for the presence of IR. Based on these findings, RA patients should be evaluated early for the presence of IR to reduce the risk of metabolic diseases.