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1. Predictors of quality of life, functional status, depression and fatigue in early arthritis: comparison between clinically suspect arthralgia, unclassified arthritis and rheumatoid arthritis.

Author

Torlinska, Barbara, Raza, Karim, Filer, Andrew, Jutley, Gurpreet, Sahbudin, Ilfita, Singh, Ruchir, de Pablo, Paola, Rankin, Elizabeth, Rhodes, Benjamin, Amft, Nicole, Justice, Elizabeth, McGrath, Catherine, Baskar, Sangeetha, Trickey, Jeanette, Calvert, Melanie, and Falahee, Marie

Subjects
RHEUMATOID arthritis, FATIGUE (Physiology), FUNCTIONAL status, JOINT pain, QUALITY of life
Abstract

Background: Rheumatoid arthritis (RA) is often preceded by symptomatic phases during which classification criteria are not fulfilled. The health burden of these "at-risk" stages is not well described. This study assessed health-related quality of life (HRQoL), function, fatigue and depression in newly presenting patients with clinically suspect arthralgia (CSA), unclassified arthritis (UA) or RA. Methods: Cross-sectional analysis of baseline Patient-Reported Outcome Measures (PROMs) was conducted in patients from the Birmingham Early Arthritis Cohort. HRQoL, function, depression and fatigue at presentation were assessed using EQ-5D, HAQ-DI, PHQ-9 and FACIT-F. PROMs were compared across CSA, UA and RA and with population averages from the HSE with descriptive statistics. Multivariate linear regression assessed associations between PROMs and clinical and sociodemographic variables. Results: Of 838 patients included in the analysis, 484 had RA, 200 had CSA and 154 had UA. Patients with RA reported worse outcomes for all PROMs than those with CSA or UA. However, "mean EQ-5D utilities were 0.65 (95%CI: 0.61 to 0.69) in CSA, 0.61 (0.56 to 0.66) in UA and 0.47 (0.44 to 0.50) in RA, which was lower than in general and older (≥ 65 years) background populations." In patients with CSA or UA, HRQoL was comparable to chronic conditions such as heart failure, severe COPD or mild angina. Higher BMI and older age (≥ 60 years) predicted worse depression (PHQ-9: -2.47 (-3.85 to -1.09), P < 0.001) and fatigue (FACIT-F: 5.05 (2.37 to 7.73), P < 0.001). Women were more likely to report worse function (HAQ-DI: 0.13 (0.03 to 0.21), P = 0.01) and fatigue (FACIT-F: -3.64 (-5.59 to -1.70), P < 0.001), and residents of more deprived areas experienced decreased function (HAQ-DI: 0.23 (0.10 to 0.36), P = 0.001), greater depression (PHQ-9: 1.89 (0.59 to 3.18), P = 0.004) and fatigue (FACIT-F: -2.60 (-5.11 to 0.09), P = 0.04). After adjustments for confounding factors, diagnostic category was not associated with PROMs, but disease activity and polypharmacy were associated with poorer performance across all PROMs. Conclusions: Patient-reported outcomes were associated with disease activity and sociodemographic characteristics. Patients presenting with RA reported a higher health burden than those with CSA or UA, however HRQoL in the pre-RA groups was significantly lower than population averages. Key messages: The development of RA is often preceded by symptomatic phases in which patients do not yet fulfil classification criteria for RA. This study confirms a significant negative impact of symptoms on patient functioning and health-related quality of life in those newly presenting with clinically suspect arthralgia, unclassified arthritis, and RA. Patient burden was associated with measures of disease activity and patient characteristics, and was comparable to serious conditions such as angina, chronic obstructive pulmonary disease and heart failure. Further studies are needed to establish if patients in symptomatic at risk of RA phases may benefit from pharmacological and non-pharmacological interventions to reduce symptom impact and improve quality of life. [ABSTRACT FROM AUTHOR]

Published
2024
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2. The epidemiology of musculoskeletal inflammation

Author

De Pablo, Paola

Subjects
616.7, RC Internal medicine
Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive joint destruction often resulting in functional disability and increased mortality. With appropriate therapies, it is possible to delay or even prevent evolution of patients into RA and/or induce remission. Thus the identification of individuals not only early in the disease course but at risk of developing RA is important. Following on this concept, we investigated the presence of systemic autoimmunity among individuals at risk of RA based on environmental exposures, and conducted a meta-analyses showing an early therapeutic window of opportunity associated with sustained benefit on disease progression and structural damage. Since time matters, we examined both the recent criteria performance and the role of musculoskeletal ultrasound as tools to identify RA early in the disease course. One of the therapeutic goals in RA is the prevention of radiologically evident joint destruction, thus we evaluated a novel scoring method to assess radiological disease progression. We also examined the impact of inflammation on RA-associated collateral damage, including cardiovascular disease and bone loss. We observed within the epidemiology of musculoskeletal involvement that chronic inflammation in any one tissue clearly impacts the overall health status and disease susceptibility of the whole body.

Published
2013

5. OA04 Association of clinical and demographic factors with quality of life, functional status, depression, and fatigue in patients presenting with, and at risk of, rheumatoid arthritis

Author

Torlinska, Barbara, primary, Raza, Karim, additional, Filer, Andrew, additional, Jutley, Gurpreet, additional, Sahbudin, Ilfita, additional, Singh, Ruchir, additional, de Pablo, Paola, additional, Rankin, Elizabeth, additional, Rhodes, Benjamin, additional, Amft, Nicole, additional, Justice, Elizabeth, additional, McGrath, Catherine, additional, Baskar, Sangeetha, additional, Trickey, Jeanette, additional, Calvert, Melanie, additional, and Falahee, Marie, additional

Published
2023
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9. Osteoarthritis

Author

de Pablo, Paola, McAlindon, Timothy E., Bales, Connie W., editor, and Ritchie, Christine S., editor

Published
2009
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10. Outcomes of periodontal therapy in rheumatoid arthritis: The OPERA feasibility randomized trial.

Author

de Pablo, Paola, Serban, Stefan, Lopez‐Oliva, Isabel, Rooney, Joanna, Hill, Kirsty, Raza, Karim, Filer, Andrew, Chapple, Iain, and Dietrich, Thomas

Subjects
*PERIODONTITIS treatment, *RHEUMATOID arthritis treatment, *BIOTHERAPY, *PILOT projects, *C-reactive protein, *ORAL hygiene, *ANTIRHEUMATIC agents, *TREATMENT effectiveness, *RANDOMIZED controlled trials, *SEVERITY of illness index, *PRE-tests & post-tests, *RHEUMATOID arthritis, *DESCRIPTIVE statistics, *RESEARCH funding, *DOPPLER ultrasonography, *STATISTICAL sampling, *CONTROL groups, *DENTAL hygiene, *LONGITUDINAL method, *EVALUATION
Abstract

Aim: Periodontitis is independently associated with rheumatoid arthritis (RA); however, there is limited data on whether periodontal treatment improves overall RA disease activity. We conducted a pilot feasibility randomized controlled clinical trial to test whether intensive periodontal therapy reduces RA disease activity in patients with active RA and periodontitis. Materials and Methods: The following inclusion criteria were applied: patients with RA and periodontitis, aged 18+, stable on treatment with disease‐modifying anti‐rheumatic drugs for ≥3 months, disease activity score (DAS28) ≥3.2, and DAS28 >5.1 only if patient unwilling to take biologics. Participants meeting the inclusion criteria were randomized to immediate intensive periodontal therapy or to delayed therapy (control group) administered by a dental hygienist in a secondary care setting. Data were collected at baseline and at 3 and 6 months of follow‐up. Participants randomized to the control group (delayed therapy) received the standard of care for the duration of the trial, including oral hygiene instructions delivered by a dental hygienist, and the same periodontal therapy as the intervention group after study completion (i.e., 6 months after randomization). The periodontal inflammation surface area was calculated using clinical attachment loss (CAL), periodontal probing pocket depth, and bleeding on probing. Cumulative probing depth was also measured. We examined the effect of periodontal therapy on periodontal outcomes and on clinical markers of disease activity in RA, as measured by the DAS28‐C‐reactive protein score as well as musculo‐skeletal ultrasound grey scale and power Doppler scores. Results: A total of 649 patients with RA were invited to participate in the study. Of these, 296 (46%) consented to participate in the screening visit. A sample of 201 patients was assessed for eligibility, of whom 41 (20%) did not meet the RA inclusion criteria and 100 (50%) did not meet the periodontal disease criteria. Among the 60 (30%) eligible participants, 30 were randomized to immediate periodontal therapy and 30 were allocated to the control group. The loss to follow‐up was 18% at the end of the trial. There were no major differences with regard to baseline characteristics between the groups. Periodontal therapy was associated with reduced periodontal inflamed surface area, cumulative probing depths, RA disease activity scores, and ultrasound scores over the course of the trial. There was no change in CAL. Conclusions: Overall, the trial was feasible and acceptable to the study participants. Recruitment to and satisfactory retention in a randomized controlled trial on the effect of periodontal treatment on RA patients is possible, albeit challenging. In this feasibility study of patients with RA and periodontitis, periodontal treatment resulted in significant improvements in periodontal disease outcomes and overall RA disease activity, although complete resolution of periodontal inflammation was difficult to achieve in some cases. [ABSTRACT FROM AUTHOR]

Published
2023
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11. The value of ultrasound-defined tenosynovitis and synovitis in the prediction of persistent arthritis

Author

Sahbudin, Ilfita, primary, Singh, Ruchir, additional, De Pablo, Paola, additional, Rankin, Elizabeth, additional, Rhodes, Benjamin, additional, Justice, Elizabeth, additional, Derrett-Smith, Emma, additional, Amft, Nicole, additional, Narayan, Nehal, additional, McGrath, Catherine, additional, Baskar, Sangeetha, additional, Trickey, Jeanette, additional, Maybury, Mark, additional, Raza, Karim, additional, and Filer, Andrew, additional

Published
2022
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13. Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data

Author

Zemedikun, Dawit T, primary, Chandan, Joht Singh, additional, Raindi, Devan, additional, Rajgor, Amarkumar Dhirajlal, additional, Gokhale, Krishna Margadhmane, additional, Thomas, Tom, additional, Falahee, Marie, additional, De Pablo, Paola, additional, Lord, Janet M, additional, Raza, Karim, additional, and Nirantharakumar, Krishnarajah, additional

Published
2021
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28. Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Author

Mehta, Puja, Holder, Susan, Fisher, Benjamin, Vincent, Tonia, Nadesalingam, Kavitha, Maciver, Helen, Shingler, Wendy, Bakshi, Jyoti, Hassan, Sadon, D'Cruz, David, Chan, Antoni, Litwic, Anna E., McCrae, Fiona, Seth, Rakhi, Nandagudi, Anupama, Jury, Elizabeth, Isenberg, David, Karjigi, Uma, Paul, Anupam, Rees, Frances, O'Dowd, Emma, Kinnear, William, Johnson, Simon, Lanyon, Peter, Stevens, Richard, Narayan, Nehal, Marguerie, Christopher, Robinson, Helena, Ffolkes, Lorrette, Worsnop, Fiona, Ostlere, Lucy, Kiely, Patrick, Dharmapalaiah, Chethana, Hassan, Nada, Bharadwaj, Anurag, Skibinska, Malgorzata, Gendi, Nagui, Davies, Emma J., Akil, Mohammed, Kilding, Rachael, Ramachandran Nair, Jagdish, Walsh, Maeve, Farrar, Wendy, Thompson, Robert N., Borukhson, Liubov, McFadyen, Charles, Singh, Deepwant, Rajagopal, Vivek, Chan, Angela Marie L., Wearn Koh, Li, Christie, Jennifer D., Croot, Lorraine, Gayed, Mary, Disney, Benjamin, Singhal, Saket, Grindulis, Karl, Reynolds, Timothy D., Conway, Katie, Williams, Debbie, Quin, John, Dean, Gillian, Churchill, Duncan, Walker-Bone, Karen E., Goff, Iain, Reynolds, Gary, Grove, Matthew, Patel, Priya, Lazarus, Mark N., Roncaroli, Frederico, Gabriel, Carolyn, Kinderlerer, Anne R., Nikiphorou, Elena, Hall, Frances C., Bruce, Ellen, Gray, Leanne, Krutikov, Maria, Wig, Surabhi, Bruce, Ian, D'Agostino, Maria A., Wakefield, Richard, Berner Hammer, Hilde, Vittecoq, Olivier, Galeazzi, Mauro, Balint, Peter, Filippucci, Emilio, Moller, Ingrid, Iagnocco, Annamaria, Naredo, Esperanza, Ostergaard, Mikkel, Gaillez, Corine, Kerselaers, Wendy, Van Holder, Karina, Le Bars, Manuela, Stone, Millicent A., Williams, Francis, Wolber, Lisa, Karppinen, Jaro, Maatta, Juhani, Thompson, Ben, Atchia, Ismael, Lorenzi, Alice, Raftery, Graham, Platt, Phil, Platt, Philip N., Pratt, Arthur, Turmezei, Thomas D., Treece, Graham M., Gee, Andrew H., Poole, Kenneth E., Chandratre, Priyanka N., Roddy, Edward, Clarson, Lorna, Richardson, Jane, Hider, Samantha, Mallen, Christian, Lieberman, Abigail, Prouse, Peter J., Mahendran, Prini, Samarawickrama, Amanda, Ottery, Faith D., Yood, Robert, Wolfson, Marsha, Ang, Andrea, Riches, Philip, Thomson, Janet, Nuki, George, Humphreys, Jennifer, Verstappen, Suzanne M., Chipping, Jacqueline, Hyrich, Kimme, Marshall, Tarnya, Symmons, Deborah P., Roy, Matthew, Kirwan, John R., Marshall, Robert W., Matcham, Faith, Scott, Ian C., Rayner, Lauren, Hotopf, Matthew, Kingsley, Gabrielle H., Scott, David L., Steer, Sophia, Ma, Margaret H., Dahanayake, Chanaka, Kingsley, Gabrielle, Cope, Andrew, Wernham, Aaron, Ward, Lorna, Carruthers, David, Deeming, Alison, Buckley, Christopher, Raza, Karim, De Pablo, Paola, Carpenter, Lewis, Jayakumar, Keeranur, Solymossy, Csilla, Dixey, Josh, Young, Adam, Singh, Animesh, Penn, Henry, Ellerby, Nicholas, Mattey, Derek L., Packham, Jonathan, Dawes, Peter, Hider, Samantha L., Ng, Nora, Humby, Frances, Bombardieri, Michele, Kelly, Stephen, Di Cicco, Maria, Dadoun, Sabrina, Hands, Rebecca, Rocher, Vidalba, Kidd, Bruce, Pyne, Dev, Pitzalis, Costantino, Poore, Sophie, Hutchinson, David, Low, Audrey, Lunt, Mark, Mercer, Louise, Galloway, James, Davies, Rebecca, Watson, Kath, Dixon, Will, Symmons, Deborah, Watson, Kath D., Dixon, William G., Hyrich, Kimme L., Malik, Saadia P., Kelly, Clive, Hamilton, Jennifer, Heycock, Carol, Saravanan, Vadivelu, Rynne, Martin, Harris, Helen E., Tweedie, Fiona, Skaparis, Yiannis, White, Marie, Scott, Nicola, Samson, Kay, Mercieca, Cecilia, Clarke, Shane, Warner, Alexander J., Verstappen, Suzanne, Chan, Esther, Woodhead, Felix A., Nisar, Mohamed, Arthanari, S., Dawson, Julie, Sathi, Nav, Ahmad, Yasmeen, Koduri, Gouri, Cumming, Jo, Stannett, Peter, Hull, Richard, Metsios, George, Stavropoulos Kalinoglou, Antonios, Veldhuijzen van Zanten, Jet J., Nightingale, Peter, Koutedakis, Yiannis, Kitas, George D., Williams, Peter, Walsh, David, Perry, Elizabeth, de-Soyza, Anthony, Moullaali, Thomas, Eggleton, Paul, Stavropoulos-Kalinoglou, Antonios, Sandoo, Aamer, de Pablo, Paola, Maggs, Fiona, Faizal, Abdul, Pugh, Mark, Jobanputra, Paresh, Kehoe, Oksana, Cartwright, Alison, Askari, Ayman, El Haj, Alicia, Middleton, Jim, Aynsley, Sarah, Hardy, Jacob, Veale, Douglas, Fearon, Ursula, Wilson, Gerry, Muthana, Munitta, Fossati, G., Healy, L., Nesbitt, A., Becerra, Elena, Leandro, Maria J., De La Torre, Inmaculada, Cambridge, Geraldine, Nelson, P. N., Roden, D., Shaw, M., Davari Ejtehadi, Hora, Nevill, A., Freimanis, G., Hooley, P., Bowman, S., Alavi, A., Axford, J., Veitch, A. M., Tugnet, N., Rylance, P. B., Hawtree, Sarah, Mark Wilkinson, J., Wilson, Anthony G., Woon Kam, Ngar, Filter, Andrew, Croft, Adam P., Naylor, Amy, Zimmermann, Birgit, Hardie, Debbie, Desanti, Guillaume, Jaurez, Maria, Muller-Ladner, Ulf, Filer, Andrew, Neumann, Elena, Movahedi, Mohammad, Ray, David W., Burmester, Gerd R., Matucci-Cerinic, Marco, Navarro-Blasco, Francisco, Kary, Sonja, Unnebrink, Kristina, Kupper, Hartmut, Mukherjee, Sandeep, Cornell, Patricia, Richards, Selwyn, Rahmeh, Fouz, Thompson, Paul W., Westlake, Sarah L., Javaid, Muhammad K., Batra, Rajbir, Chana, Jasroop, Round, Gemma, Judge, Andrew, Taylor, Peter, Patel, Sanjeev, Cooper, Cyrus, Ravindran, Vinod, Bingham, Clifton O., Weinblatt, Michael E., Mendelsohn, Alan, Kim, Lilianne, Mack, Michael, Lu, Jiandong, Baker, Daniel, Westhovens, Rene, Hewitt, Jamie, Han, Chenglong, Keystone, Edward C., Fleischmann, Roy, Smolen, Josef, Emery, Paul, Genovese, Mark, Doyle, Mittie, Hsia, Elizabeth C., Hart, Jennifer C., Harland, Dave, Gibbons, Carl, Pang, Hok, Huertas, Catherine, Diamantopoulos, Alex, Dejonckheere, Fred, Clowse, M., Wolf, D., Stach, C., Kosutic, G., Williams, S., Terpstra, I., Mahadevan, U., Ferraccioli, G., Samborski, W., Berenbaum, F., Davies, O., Koetse, W., Bennett, B., Burkhardt, H., Luijtens, K., van der Heijde, Desiree, Mariette, X., van Vollenhoven, Ronald F., Bykerk, V., de Longueville, M., Arendt, C., Cush, J., Khan, Afsha, Maclaren, Zoe, Dubash, Sayam, Chalam, Venkat C., Sheeran, Tom, Price, Tom, Baskar, Sangeetha, Mulherin, Diarmuid, Molloy, Cauline, Keay, Fiona, Heritage, Caroline, Douglas, Barbara, Schiff, Michael H., Khanna, Dinesh, Furst, Daniel E., Maldonado, Michael A., Li, Wanying, Sasso, Eric H., Emerling, Daniel, Cavet, Guy, Ford, Kerri, Mackenzie-Green, Bronwen, Collins, David, Price, Elizabeth, Williamson, Lyn, Golla, Janardhana, Vagadia, Vipul, Morrison, Elaine, Tierney, Ann, Wilson, Hilary, Hunter, John, Reddy, Venkat, Moore, Samantha, Ehrenstein, Michael, Benson, Claire, Wray, Maria, Cairns, Andrew, Wright, Gary, Pendleton, Adrian, McHenry, Michelle, Taggart, Allister, Bell, Aubrey, Bosworth, Ailsa, Cox, Maureen, Johnston, Graeme, Shah, Preeti, O'Brien, Anne, Jones, Peter, Sargeant, Ify, Bukhari, Marwan, Nusslein, Hubert, Alten, Rieke, Lorenz, Hannes M., Boumpas, Dimitrios, Nurmohamed, Michael T., Bensen, William, Peter, Hans-Hartmut, Rainer, Franz, Pavelka, Karel, Chartier, Melanie, Poncet, Coralie, Rauch, Christiane, Lempp, Heidi, Hofmann, Darija, Adu, Aderonke, Congreve, Carron, Dobson, Joanne, Rose, Diana, Simpson, Carol, Wykes, Til, Ibrahim, Fowzia, Schiff, Michael, Nash, Peter, Durez, Patrick, Kaine, Jeffrey, Delaet, Ingrid, Kelly, Sheila, Maldonado, Michael, Patel, Salil, Jones, Graeme, Sebba, Anthony, Lepley, Denise, Devenport, Jenny, Bernasconi, Corrado, Smart, Devi, Mpofu, Chiedzo, Gomez-Reino, Juan J., Verma, Inderjeet, Kaur, Jaspreet, Syngle, Ashit, Krishan, Pawan, Vohra, Kanchan, Kaur, Ladbans, Garg, Nidhi, Chhabara, Monica, Gibson, Kellie, Woodburn, James, Telfer, Scott, Buckley, Felicity, Finckh, Axel, Huizinga, Tom W., Jansen, Jeroen P., Rubbert-Roth, Andrea, Scali, Juan J., Kremer, Joel M., Pitts, Laura, Vernon, Emma, Sharif, Mohammed I., Das, Sudipto, Helliwell, Philip, Sokoll, Katharina, and Vital, Edward M.

Subjects
cardiovascular system
Abstract

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interest

Published
2017

30. The role of ultrasound-defined tenosynovitis and synovitis in the prediction of rheumatoid arthritis development

Author

Sahbudin, Ilfita, Pickup, Luke, Nightingale, Peter, Allen, Gina, Cader, Zaeem, Singh, Ruchir, de Pablo, Paola, Buckley, Christopher D, Raza, Karim, and Filer, Andrew

Subjects
rheumatoid arthritis, ultrasound, Clinical Science, synovitis, tenosynovitis
Abstract

Objectives Tenosynovitis (TS) is common in early arthritis. However, the value of US-defined TS in predicting RA development is unclear. We assessed the predictive utility of US-defined TS alongside US-defined synovitis and clinical and serological variables in a prospective cohort of early arthritis patients. Methods One hundred and seven patients with clinically apparent synovitis of one or more joint and symptom duration ⩽3 months underwent baseline clinical, laboratory and US assessment of 19 bilateral joint sites and 16 bilateral tendon compartments. Diagnostic outcome was determined after 18 months, applying the 2010 ACR/EULAR classification criteria for RA. The predictive values of US-defined TS for persistent RA were compared with those of US-defined synovitis, clinical and serological variables. Results A total of 4066 US joint sites and 3424 US tendon compartments were included in the analysis. Forty-six patients developed persistent RA, 17 patients developed non-RA persistent disease and 44 patients had resolving disease at follow-up. US-defined TS in at least one tendon compartment at baseline was common in all groups (RA 85%, non-RA persistent disease 71% and resolving 70%). On multi-variate analysis, US-defined digit flexor TS provided independent predictive data over and above the presence of ACPA and US-defined joint synovitis. Conclusion US-defined digit flexor TS provided independent predictive data for persistent RA development in patients with early arthritis. The predictive utility of this tendon site should be further assessed in a larger cohort; investigators designing imaging-based predictive algorithms for RA development should include this tendon component as a candidate variable.

Published
2018

31. Dysbiotic Subgingival Microbial Communities in Periodontally Healthy Patients With Rheumatoid Arthritis

Author

Lopez-Oliva, Isabel, primary, Paropkari, Akshay D., additional, Saraswat, Shweta, additional, Serban, Stefan, additional, Yonel, Zehra, additional, Sharma, Praveen, additional, de Pablo, Paola, additional, Raza, Karim, additional, Filer, Andrew, additional, Chapple, Iain, additional, Dietrich, Thomas, additional, Grant, Melissa M., additional, and Kumar, Purnima S., additional

Published
2018
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34. High erythrocyte levels of the n-6 polyunsaturated fatty acid linoleic acid are associated with lower risk of subsequent rheumatoid arthritis in a southern European nested case–control study

Author

de Pablo, Paola, primary, Romaguera, Dora, additional, Fisk, Helena L, additional, Calder, Philip C, additional, Quirke, Anne-Marie, additional, Cartwright, Alison J, additional, Panico, Salvatore, additional, Mattiello, Amalia, additional, Gavrila, Diana, additional, Navarro, Carman, additional, Sacerdote, Carlotta, additional, Vineis, Paolo, additional, Tumino, Rosario, additional, Ollier, William E, additional, Michaud, Dominique S, additional, Riboli, Elio, additional, Venables, Patrick J, additional, and Fisher, Benjamin A, additional

Published
2018
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35. Erratum to: Smoking, Porphyromonas gingivalis and the immune response to citrullinated autoantigens before the clinical onset of rheumatoid arthritis in a Southern European nested case–control study

Author

Fisher, Benjamin A., primary, Cartwright, Alison J., additional, Quirke, Anne-Marie, additional, de Pablo, Paola, additional, Romaguera, Dora, additional, Panico, Salvatore, additional, Mattiello, Amalia, additional, Gavrila, Diana, additional, Navarro, Carmen, additional, Sacerdote, Carlotta, additional, Vineis, Paolo, additional, Tumino, Rosario, additional, Lappin, David F., additional, Apatzidou, Danae, additional, Culshaw, Shauna, additional, Potempa, Jan, additional, Michaud, Dominique S., additional, Riboli, Elio, additional, and Venables, Patrick J., additional

Published
2016
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36. Smoking, Porphyromonas gingivalis and the immune response to citrullinated autoantigens before the clinical onset of rheumatoid arthritis in a Southern European nested case–control study

Author

Fisher, Benjamin A., primary, Cartwright, Alison J., additional, Quirke, Anne-Marie, additional, de Pablo, Paola, additional, Romaguera, Dora, additional, Panico, Salvatore, additional, Mattiello, Amalia, additional, Gavrila, Diana, additional, Navarro, Carmen, additional, Sacerdote, Carlotta, additional, Vineis, Paolo, additional, Tumino, Rosario, additional, Lappin, David F., additional, Apazidou, Danae, additional, Culshaw, Shauna, additional, Potempa, Jan, additional, Michaud, Dominique S., additional, Riboli, Elio, additional, and Venables, Patrick J., additional

Published
2015
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37. Response to: ‘The autoantibody repertoire in periodontitis: a role in the induction of autoimmunity to citrullinated proteins in rheumatoid arthritis? Antibodies against uncitrullinated peptides seem to occur prior to the antibodies to the corresponding citrullinated peptides’ by Brinket al

Author

de Pablo, Paola, primary, Dietrich, Thomas, additional, Chapple, Iain L C, additional, Milward, Michael, additional, Buckley, Christopher D, additional, and Venables, Patrick J, additional

Published
2014
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39. O19. Smoking Affects Immune Response to Citrullinated Autoantigens Before Clinical Onset of Rheumatoid Arthritis in a Southern European Cohort

Author

Cartwright, Alison J., primary, Quirke, Anne-Marie, additional, de Pablo, Paola, additional, Romaguera, Dora, additional, Panico, Salvatore, additional, Mattiello, Amalia, additional, Gavrila, Diana, additional, Sanchez, Carmen Navarro, additional, Sacerdote, Carlotta, additional, Vineis, Paolo, additional, Tumino, Rosario, additional, Michaud, Dominique, additional, Riboli, Elio, additional, Fisher, Benjamin A., additional, and Venables, Patrick J., additional

Published
2014
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40. A1.5 Smoking is a risk factor for ACPA prior to onset of symptoms of rheumatoid arthritis in a cohort from southern europe

Author

Cartwright, Alison J, primary, Quirke, Anne-Marie, additional, de Pablo, Paola, additional, Romaguera, Dora, additional, Panico, Salvatore, additional, Mattiello, Amalia, additional, Gavrila, Diana, additional, Navarro, Carmen, additional, Sacerdote, Carlotta, additional, Vineis, Paolo, additional, Tumino, Rosario, additional, Michaud, Dominique, additional, Riboli, Elio, additional, Fisher, Benjamin A, additional, and Venables, Patrick J, additional

Published
2014
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47. Association of Periodontal Disease and Tooth Loss with Rheumatoid Arthritis in the US Population

Author

de Pablo, Paola, Dietrich, Thomas, and McAlindon, Timothy

Abstract

OBJECTIVE: To test for an association of periodontitis and tooth loss with rheumatoid arthritis (RA). METHODS: The third National Health and Nutrition Examination Survey (NHANES III) is a nationally representative cross-sectional survey of noninstitutionalized civilians. We included participants aged ≥ 60 years who had undergone both musculoskeletal and dental examinations. RA was defined based on American College of Rheumatology criteria. Dental examinations quantified decayed and filled surfaces, missing teeth, and periodontitis. Periodontitis was defined as at least 1 site exhibiting both attachment loss and a probing depth of ≥ 4 mm. We classified dental health status as (1) no periodontitis, (2) periodontitis, or (3) edentulous (i.e., complete tooth loss). We performed multivariate multinomial logistic regression models with dental health status as the dependent and RA as the independent variables. RESULTS: The sample consisted of 4461 participants, of whom 103 were classified as having RA. Participants with RA had more missing teeth (20 vs 16 teeth; p < 0.001), but less decay (2% vs 4%; p < 0.001) than participants without RA. After adjusting for age, sex, race/ethnicity, and smoking, subjects with RA were more likely to be edentulous [odds ratio (OR) 2.27, 95% confidence interval (CI) 1.56 3.31] and have periodontitis (OR 1.82, 95% CI 1.04 3.20) compared with non-RA subjects. In participants with seropositive RA there was a stronger association with dental health status, in particular with edentulism (OR 4.5, 95% CI 1.2 17). CONCLUSION: RA may be associated with tooth loss and periodontitis.

Published
2008

48. Extent of Followup Care After Elective Total Hip Replacement

Author

de PABLO, PAOLA, LOSINA, ELENA, MAHOMED, NIZAR, WRIGHT, JOHN, FOSSEL, ANNE, BARRETT, JANE, and KATZ, JEFFREY

Abstract

OBJECTIVE: To estimate the extent of radiographic and orthopedic followup among recipients of total hip replacement (THR), and to identify patients who are less likely to have consistent followup over 6 years postoperatively. METHODS: We studied a population-based sample of 622 patients who received THR in 1995. We developed a multivariate ordinal regression model with the extent of radiographic followup as the dependent variable (none, early, and consistent), adjusting for demographic and preoperative clinical characteristics, and hospital and surgeon volume. RESULTS: Ninety-four (15%) patients indicated that they had no followup radiographs, 269 (43%) had early followup only, and 259 (42%) had consistent followup radiographs over 6 years. Ninety percent of those with consistent followup orthopedic visits also had consistent followup radiographs over 6 years. Multivariate analyses revealed that older patients were less likely to have radiographic followup than younger patients (OR 0.76, 95% CI 0.65, 0.89) per each 5-year increase in age. Subjects with no college education were less likely to have radiographic followup than those with more education (OR 0.58, 95% CI 0.41, 0.83), and those with lower income were less likely to have radiographic followup than those with a higher income (OR 0.50, 95% CI 0.27, 0.92). CONCLUSION: Only 42% of THR recipients reported consistent radiographic followup. Older patients, patients with lower income, and those with lower education level were less likely to have consistent radiographic followup over 6 years after THR. These population groups can serve as targets for interventions to improve followup after elective THR.

Published
2006

49. High erythrocyte levels of the n-6 polyunsaturated fatty acid linoleic acid are associated with lower risk of subsequent rheumatoid arthritis in a southern European nested case-control study

Author

William E R Ollier, Alison J Cartwright, Carlotta Sacerdote, Helena L. Fisk, Paola de Pablo, Salvatore Panico, Paolo Vineis, Philip C. Calder, Patrick J Venables, Diana Gavrila, Carman Navarro, Amalia Mattiello, Elio Riboli, Dora Romaguera, Rosario Tumino, Anne-Marie Quirke, Benjamin A Fisher, Dominique S. Michaud, de Pablo, Paola, Romaguera, Dora, Fisk, Helena L, Calder, Philip C, Quirke, Anne-Marie, Cartwright, Alison J, Panico, Salvatore, Mattiello, Amalia, Gavrila, Diana, Navarro, Carman, Sacerdote, Carlotta, Vineis, Paolo, Tumino, Rosario, Ollier, William E, Michaud, Dominique S, Riboli, Elio, Venables, Patrick J, Fisher, Benjamin A, and Imperial College Healthcare NHS Trust- BRC Funding

Subjects
Male, rheumatoid arthritis, Erythrocytes, early rheumatoid arthritis, Physiology, Severity of Illness Index, Arthritis, Rheumatoid, 0302 clinical medicine, Reference Values, Immunology and Allergy, Medicine, early rheumatoid arthriti, 030212 general & internal medicine, Prospective cohort study, chemistry.chemical_classification, education.field_of_study, Incidence, Confounding, Middle Aged, European Prospective Investigation into Cancer and Nutrition, Europe, 1117 Public Health And Health Services, Italy, 1107 Immunology, Cytokines, Female, epidemiology, Life Sciences & Biomedicine, Polyunsaturated fatty acid, Adult, Immunology, Population, Lower risk, Risk Assessment, General Biochemistry, Genetics and Molecular Biology, lipids, 03 medical and health sciences, Age Distribution, Rheumatology, lipid, Fatty Acids, Omega-6, Fatty Acids, Omega-3, Humans, Sex Distribution, education, Aged, 030203 arthritis & rheumatology, Science & Technology, business.industry, 1103 Clinical Sciences, Arthritis & Rheumatology, chemistry, Spain, Case-Control Studies, Nested case-control study, business, Body mass index, Biomarkers
Abstract

ObjectivesFindings relating to dietary intake of n-3 polyunsaturated fatty acids (PUFA) and risk of rheumatoid arthritis (RA) are mixed. Erythrocyte membrane PUFA is an accurate objective biomarker of PUFA status; however, there are little data on erythrocyte membrane PUFA and risk of RA. The objective was therefore to compare erythrocyte membrane PUFA between pre-RA individuals and matched controls from a population-based sample, and specifically to test the hypothesis that higher levels of longer chain n-3 PUFA are associated with lower risk of RA.MethodsThe European Prospective Investigation into Cancer and Nutrition (EPIC) is a large European prospective cohort study of apparently healthy populations. We undertook a nested case–control study by identifying RA cases with onset after enrolment (pre-RA) in four EPIC cohorts in Italy and Spain. Confirmed pre-RA cases were matched with controls by age, sex, centre, and date, time and fasting status at blood collection. Conditional logistic regression analysis was used to estimate associations of PUFA with the development of RA, adjusting for potential confounders including body mass index, waist circumference, education level, physical activity, smoking status and alcohol intake.ResultsThe study analysed samples from 96 pre-RA subjects and 258 matched controls. In this analysis, the median time to diagnosis (defined as time between date of blood sample and date of diagnosis) was 6.71 years (range 0.8–15). A significant inverse association was observed with n-6 PUFA linoleic acid (LA) levels and pre-RA in the fully adjusted model (highest tertile: OR 0.29; 95% CI 0.12 to 0.75; P for trend 0.01). No association was observed with any individual n-3 PUFA, total n-3 PUFA or total n-3:n-6 ratio.ConclusionsErythrocyte levels of the n-6 PUFA LA were inversely associated with risk of RA, whereas no associations were observed for other n-6 or n-3 PUFA. Further work is warranted to replicate these findings and to investigate if lower LA levels are a bystander or contributor to the process of RA development.

Published
2018

50. Erratum to: Smoking, Porphyromonas gingivalis and the immune response to citrullinated autoantigens before the clinical onset of rheumatoid arthritis in a Southern European nested case-control study

Author

Benjamin A. Fisher, Alison J. Cartwright, Anne-Marie Quirke, Paola de Pablo, Dora Romaguera, Salvatore Panico, Amalia Mattiello, Diana Gavrila, Carmen Navarro, Carlotta Sacerdote, Paolo Vineis, Rosario Tumino, David F. Lappin, Danae Apatzidou, Shauna Culshaw, Jan Potempa, Dominique S. Michaud, Elio Riboli, Patrick J. Venables, Fisher, Benjamin A, Cartwright, Alison J, Quirke, Anne Marie, de Pablo, Paola, Romaguera, Dora, Panico, Salvatore, Mattiello, Amalia, Gavrila, Diana, Navarro, Carmen, Sacerdote, Carlotta, Vineis, Paolo, Tumino, Rosario, Lappin, David F, Apatzidou, Danae, Culshaw, Shauna, Potempa, Jan, Michaud, Dominique S, Riboli, Elio, and Venables, Patrick J.

Subjects
Adult, Male, Hydrolases, Autoantigens, Peptides, Cyclic, Arthritis, Rheumatoid, Rheumatology, Humans, Orthopedics and Sports Medicine, Prospective Studies, Adhesins, Bacterial, Periodontitis, Science & Technology, Smoking, 1103 Clinical Sciences, Middle Aged, Europe, Cysteine Endopeptidases, Orthopedics, Case-Control Studies, Gingipain Cysteine Endopeptidases, Protein-Arginine Deiminases, Female, Erratum, Porphyromonas gingivalis, Life Sciences & Biomedicine
Abstract

Antibodies to citrullinated proteins (ACPA) occur years before RA diagnosis. Porphyromonas gingivalis expresses its own peptidylarginine deiminase (PPAD), and is a proposed aetiological factor for the ACPA response. Smoking is a risk factor for both ACPA-positive RA and periodontitis. We aimed to study the relation of these factors to the risk of RA in a prospective cohort.We performed a nested case-control study by identifying pre-RA cases in four populations from the European Prospective Investigation into Cancer and nutrition, matched with three controls. Data on smoking and other covariates were obtained from baseline questionnaires. Antibodies to CCP2 and citrullinated peptides from α-enolase, fibrinogen, vimentin and PPAD were measured. Antibodies to arginine gingipain (RgpB) were used as a marker for P.gingivalis infection and validated in a separate cohort of healthy controls and subjects with periodontitis.We studied 103 pre-RA cases. RA development was associated with several ACPA specificities, but not with antibodies to citrullinated PPAD peptides. Antibody levels to RgpB and PPAD peptides were higher in smokers but were not associated with risk of RA or with pre-RA autoimmunity. Former but not current smoking was associated with antibodies to α-enolase (OR 4.06; 95 % CI 1.02, 16.2 versus 0.54; 0.09-3.73) and fibrinogen peptides (OR 4.24; 95 % CI 1.2-14.96 versus 0.58; 0.13-2.70), and later development of RA (OR 2.48; 95 % CI 1.27-4.84 versus 1.57; 0.85-2.93), independent of smoking intensity.Smoking remains a risk factor for RA well before the clinical onset of disease. In this cohort, P.gingivalis is not associated with pre-RA autoimmunity or risk of RA in an early phase before disease-onset. Antibodies to PPAD peptides are not an early feature of ACPA ontogeny.

Published
2016

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