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The lung is a common site of involvement both in TB and rheumatoid arthritis (RA) disease, caused by disease itself or therapy. After completion of antiTB treatment, post TB lung disease (PTLD) residual changes persist and affect heath, survival and quality of life, mainly in patients with associated collagen diseases, as RA. Bronchiectasis are described in both RA and PTLD. The purpose of this prevalence study of bronchiectasis, performed among 92 RA hospitalized patients, from June 2017 to June 2019, consists in a pictorial assessment of the lung involvement changes, noticed on chest radiography and/or computed tomography, described in relation with TB sequelae, severity and duration of RA disease. Results. A high prevalence of imagistic abnormalities was found in 77.2% of cases (n=71/92). Bronchiectasis was a frequent imagistic chest finding (24/71; 33.8%), having a lower frequency among all study group patients (n=24/92; 26%), mostly older nonsmoker females. Conclusions. In a high TB burden, as Romania, the prevalence of bronchiectasis is related with advanced RA disease, being strongly correlated with persistent respiratory symptoms (p=0.009), and coexisting PTLD calcified nodular lung sequelae (p=0.001). [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to investigate extraarticular manifestations (EAMs) in patients with juvenile idiopathic arthritis (JIA) and assess their impact on health-related quality of life (HRQoL) among these patients. Methods: This cross-sectional analytic study was carried out on 117 patients with JIA. EAMs were identified clinically by history and examination. Sicca symptoms, peripheral neuropathy, enthesitis, and skin lesions were picked up during clinical examination. Pulmonary involvement was evaluated by high-resolution CT chest. Patients were assessed by abdominal ultrasonography to assess the size of liver and spleen. Atlantoaxial subluxation was evaluated by cervical spine x-rays. Patients were evaluated by Pediatric Quality of Life Inventory-4 (PedsQL-4) and PedsQL-3 arthritis module. Results: The median age of patients was 14 years with a median disease duration 4 years, 82.9% were females. Of the studied 117 JIA patients, 85 patients (72.6%) had at least one EAM. Persistent fatigue (51.3%) was the most prevalent EAM, followed by recurrent skin rash (16.2%), enthesitis (15.4%), recurrent fever (13.7%), and uveitis (12%). Patients with EAMs scored significantly lower in physical functioning (p = 0.001), emotional functioning (p < 0.001), social functioning (p = 0.005), and school functioning (p = 0.001). Regarding PedsQL arthritis module, patients with EAM had also significantly lower scores than did patients without EAM on the domains of pain and hurt (p < 0.001), daily activities (p = 0.008), and worry (p = 0.001). Results: EAMs are prevalent among JIA patients and have a negative impact on their HRQoL. So, early identification and treatment are highly recommended. Key Points • A large percentage of JIA patients experienced at least one extraarticular manifestation (EAM). • Persistent fatigue and recurrent skin rash are the most prevalent EAMs in JIA patients. • JIA patients with EAMs have worse scores in almost all domains of HRQoL. [ABSTRACT FROM AUTHOR]

Introduction: The therapeutic armamentarium for spondyloarthritis has expanded considerably in recent years, and there is growing evidence to support the increasing use of IL-17 inhibitors (IL-17i) in axial spondyloarthritis (axSpA)., Areas Covered: This literature review provides an update on the role of IL-17 in the pathogenesis of axSpA, efficacy and safety from clinical trials and real-life studies on the use of IL17i in axSpA. We also review the impact of extra-musculoskeletal manifestations on the decision to treat with IL17i and the efficacy of IL17i on structural progression., Expert Opinion: There are still some unanswered questions concerning the use of IL-17i in axSpA in clinical practice such as their respective place in the management of axSpA compared to TNFα inhibitors (TNFi). Their main differences rely on their specific efficacy in extra-articular manifestations such as psoriasis, uveitis, and inflammatory bowel diseases leading to the choice of the best treatment in a given patient. Regarding their real impact on structural progression, the rate of progression under IL-17i appears to be low and presumably similar to TNFi. One final question is the advantage of blocking the two IL-17 isoforms A and F compared to the single inhibition of IL-17A.

Spondylatrhritis is a multifaceted disease, primary involving the axial skeleton. But sometimes, the patient present either with articular involvement plus other organ invelovement, or with only extraarticular involvement. As the most frequent, uveitis is the main extraarticular manifestation (EAM) of spondylarthritis. This EAM is very important because it can be the first manifestation of SpA, so it may bring the patient to the doctor, be it an ophthalmologist or a rheumatologist. Diagnosing uveitis in the context of SpA, is of paramount importance also because anterior uveitis is an emergency, because it can lead to blindness. So, knowing the clinical appearance and the treatment of uveitis in the context of SpA is crucial for providing the best care for SpA patients.

Spondylatrhritis is a multifaceted disease, primary involving the axial skeleton. But sometimes, the patient present either with articular involvement plus other organ invelovement, or with only extraarticular involvement. As the most frequent, uveitis is the main extraarticular manifestation (EAM) of spondylarthritis. This EAM is very important because it can be the first manifestation of SpA, so it may bring the patient to the doctor, be it an ophthalmologist or a rheumatologist. Diagnosing uveitis in the context of SpA, is of paramount importance also because anterior uveitis is an emergency, because it can lead to blindness. So, knowing the clinical appearance and the treatment of uveitis in the context of SpA is crucial for providing the best care for SpA patients. [ABSTRACT FROM AUTHOR]

The research goal is to present the clinical observation that shows possibility of combination of low clinical and laboratory activity of psoriatic arthritis with 1) a large amount of exrtaarticular manifestations; 2) severe lesion of internal organs; 3) development of nephritis and hepatitis; 4) cardiovascular system pathology. The possibilities of different diagnostic and therapeutic methods have been considered in the article

The aim of our study was to investigate extraarticular manifestations (EAMs) in Turkish patients with rheumatoid arthritis (RA) and also assess the impact of EAMs on various health-related quality of life (HRQoL) domains, including physical, social, emotional, mental functioning, and bodily pain. A total of 150 patients were included in the study. EAMs were identified clinically. Pulmonary involvement was confirmed by using pulmonary function tests (PFT) and high-resolution computed tomography (HRCT), atlantoaxial subluxation by cervical spine X-rays. Peripheral neuropathy, rheumatoid nodules, and Sicca symptoms were picked up on clinical examination. Peripheral neuropathy was also confirmed by electroneurophysiologic studies. Patients were evaluated by Rheumatoid Arthritis Quality of Life (RAQoL), and Short form-36 (SF36). The quadrivariate Disease Activity Score- 28 (DAS28) was used for measuring disease activity. Functional status was evaluated by using the Stanford Health Assessment Questionnaire (HAQ). The severity of pain was documented by using 10-cm Visual Analog Scale-Pain (VAS-pain). EAMs were observed in 50 patients (33.3%). These were pulmonary involvement (28.7%), rheumatoid nodules (14.7%), Sicca Syndrome (8%), peripheral neuropathy (2.7%), and atlantoaxial subluxation (0.7%), respectively. It was not recorded any statistically significant difference in HAQ, DAS28, VAS-pain, and RAQoL scores between the patient groups with and without EAMs. Patients with EAMs scored significantly lower in physical functioning, role-physical, and role-emotional subgroups of SF36 ( P < 0.01). Presence of EAMs is not directly associated with disease activity and functional status, but influences negatively HRQoL including physical and emotional functioning. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis and ankylosing spondylitis are chronic inflammatory rheumatic diseases manifesting mainly by pain of joints and spine. Extraarticular manifestations such as involvement of entheses, skin, gut, eye, and others can be an important part of the disease. Systemic manifestations such as amyloidosis, vasculitis, more frequent occurrence of osteoporosis and accelerated development of atherosclerosis can occur simultaneously with the extraarticular manifestations. It was found that anti-TNFα therapy successfully affects the incidence of enthesitis, skin manifestations, uveitis and intestinal involvement in patients with ankylosing spondylitis, in both fully expressed and subclinical form of idiopathic inflammatory bowel disease. Patients treated with anti-TNFα antibodies were shown to have decreased incidence of uveitis compared to patients treated with etanercept. Treatment with infliximab or adalimumab is also indicated in patients with spondylarthritis with concomitant intestinal involvement. Anti-TNFα therapy in rheumatoid arthritis and ankylosing spondylitis has a beneficial effect on the increase of bone density compared to placebo treated individuals. The results from some studies and national registries imply that this therapy could reduce the incidence of cardiovascular events in comparison with untreated individuals. However, biological therapy may paradoxically cause development of autoimmune diseases, namely both organ specific and systemic diseases. [ABSTRACT FROM AUTHOR]

In search of a noninvasive diagnostic test for rheumatoid vasculitis (RV), this study addressed the questions whether changes in capillary blood cell velocity (CBV) detected by laser Doppler anemometry in patients with rheumatoid arthritis (RA) were correlated with the levels of soluble adhesion molecules and whether cutaneous flow abnormalities may reflect extraarticular manifestations in RA. In 31 RA patients and 20 patients with osteoarthritis (OA), CBV was measured in the skin above the left ring finger at rest and after 3-min arterial occlusion. Serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin), and soluble P-selectin (sP-selectin) were assessed by enzyme linked immunosorbent assay. Peak CBV was reduced in RA patients compared to OA patients (0.42 ± 0.07 mm/s vs. 0.70 ± 0.13 mm/s; P = 0.013). Both CBV during rest and reactive hyperemia were not correlated with the levels of soluble adhesion molecules. There were no significant differences in resting or peak CBV between RA patients with or without extraarticular manifestations. The lack of an inverse correlation between the levels of soluble adhesion molecules and CBV during rest and reactive hyperemia contradicts the assumption that inflammatory vascular damage indicated by increased levels of soluble adhesion molecules was the main reason for the impairment of microcirculation. The present results do not suggest that cutaneous flow abnormalities may reflect extraarticular manifestations in RA. [ABSTRACT FROM AUTHOR]

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Objective: The aims of this study were to evaluate whether treatment with tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA) affects the risk of developing severe extraarticular rheumatoid arthritis (ExRA) manifestations and to investigate potential predictors for developing ExRA., Methods: A dynamic community-based cohort of patients with RA was studied (n = 1977). Clinical records were reviewed and cases of severe ExRA were identified. Information on exposure to TNF inhibitors was obtained from a regional register. Exposure to TNF inhibitors was analyzed in a time-dependent fashion and the incidence of severe ExRA in exposed patients was compared with the incidence in unexposed patients. Cox regression models were used to assess potential predictors of severe ExRA., Results: During treatment with TNF inhibitors, there were 17 patients with new onset of severe ExRA in 2400 person-years at risk (PY; 0.71/100 PY, 95% CI 0.41-1.13) compared with 104 in 15,599 PY (0.67/100 PY, 95% CI 0.54-0.81) in patients without TNF inhibitors. This corresponded to an incidence rate ratio of 1.06 (95% CI 0.60-1.78). The age- and sex-adjusted HR for ExRA in anti-TNF-treated patients was 1.21 (95% CI 1.02-1.43), with similar findings in models adjusted for time-dependent Health Assessment Questionnaire and propensity for anti-TNF treatment. Male sex, positive rheumatoid factor (RF), long disease duration, and greater disability were predictors for ExRA., Conclusion: This study suggests that patients treated with TNF inhibitors are at a slightly increased risk of developing severe ExRA. RF-positive patients with disabling disease of long duration were more likely to develop severe ExRA.

Objective: To assess the evolution of preexisting extraarticular manifestations of rheumatoid arthritis (EA-RA) in patients treated with anti-tumor necrosis factor-α (TNF-α), as well as the development of new EA-RA., Methods: We assessed EA-RA in 152 patients receiving anti-TNF-α treatment., Results: In 22 cases, a new EA-RA developed. In 5 cases, there was evidence of progression of preexisting EA-RA. Regression was found in 4 cases. Some patients were in disease remission when they developed EA-RA, whereas some patients had moderate/high disease activity., Conclusion: EA-RA are still present in patients treated with anti-TNF-α. Development of new severe EA-RA is rare in patients receiving anti-TNF therapy.

Objective: An inconsistent association has been reported between the serum anticitrullinated protein antibodies (ACPA) level and rheumatoid arthritis (RA)-related pulmonary disease risk. We conducted a metaanalysis to reveal the association between them., Methods: An electronic search was performed in PubMed, ScienceDirect, and SpringerLink databases for studies published up to August 2013. The distributions of the serum ACPA level in cases and controls were obtained from eligible studies. The risk of RA-related pulmonary disease associated with serum ACPA positivity was estimated by OR and 95% CI. According to the heterogeneity results, a fixed-effects model or a random-effects model was used to calculate the pooled OR. Publication bias and sensitivity analyses were conducted., Results: Overall, 243 patients with RA-related pulmonary disease and 1442 RA controls were included in the metaanalysis. The results showed that the pooled OR was 2.621 (95% CI, 1.561-4.403, p < 0.001) for the increased risk of RA-related pulmonary disease due to the serum ACPA positivity. In the white population subgroup, an increased OR was 3.453 (95% CI 1.798-6.630, p < 0.001), whereas no association was found in the Asian population subgroup. Additionally, we further revealed that serum ACPA positivity indicated a higher risk for interstitial lung disease (ILD) and interstitial pulmonary fibrosis (IPF) among patients with RA (OR 4.679, 95% CI 2.071-10.572, p < 0.001). The heterogeneity, publication bias, and sensitivity analyses had no statistical significance in any group., Conclusion: To our knowledge, this is the first metaanalysis to reveal that serum ACPA positivity is highly associated with the risk of RA-related pulmonary disease, particularly in RA-related ILD and IPF.

Objective: To investigate biomarker patterns in rheumatoid arthritis (RA) with extraarticular manifestations., Methods: Cartilage oligomeric matrix protein (COMP), COMP-C3b, and soluble terminal complement complexes (sTCC) were measured by ELISA., Results: COMP-C3b levels were higher in patients with RA than in healthy controls and lower in extraarticular RA (ExRA) than in RA controls. In patients with ExRA, sTCC levels were higher than in RA controls, and correlated inversely with serum COMP-C3b levels in the ExRA group., Conclusion: Patients with ExRA had lower levels of COMP-C3b. This may be a consequence of complement consumption or a lower potential for COMP from these patients to activate complement.