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Background and aims: Thyroid function abnormalities and thyroid autoantibodies have previously been described in rheumatoid arthirits (RA) with limited data. In some studies, a relationship was found between thyroid autoantibodies and RA disease activity. However, there are not strong studies in the literature indicating the relationship between thyroid diseases and RA. The aim of this study was to determine the frequency of hypothyroidism and to investigate the relationship between thyroid hormone levels, autoantibodies and disease activity in patients with rheumatoid arthritis (RA).

Many patients diagnosed with rheumatoid arthritis (RA) report relief of symptoms after consuming certain foods. Diet plays a vital role in rheumatoid arthritis-related inflammation regulation. This study investigates the relationship between dietary inflammation index (DII) scores and RA disease activity. Forty-one RA patients were enrolled in the study. The general inflammatory index of the diet was analyzed by recording the 24-h food consumption of the patients, and the nutrients were analyzed using the Nutrition Information Systems Package Program. Dietary inflammatory indices were calculated for each patient using the patients' macro and micronutrient intake levels. RA disease activity was assessed using the Disease Activity Score-28 (DAS-28). The DAS-28 score was lower in the anti-inflammatory diet group compared to the pro-inflammatory diet group (p = 0.163). A weak but significant relationship was found between diet inflammation index score and DAS-28 (r = 0.3468, p = 0.0263). The effect of the dietary inflammatory index on the DAS-28 was 12.02%. Dietary iron, vitamin C, niacin, and magnesium intakes were statistically significantly higher in the quartile group that received an anti-inflammatory diet than in the quartile group that received a pro-inflammatory diet. The intake of some micronutrients, such as iron, zinc, magnesium, and folic acid, was significantly lower than the recommended values in all RA quartile groups. Our results suggest that reducing inflammation through the diet may have a weak but significant effect in controlling disease activity in RA patients. [ABSTRACT FROM AUTHOR]

Abstract Background Tumor necrosis factor inhibitors (TNFi) have emerged as an efficient therapeutic modality for rheumatoid arthritis (RA). A ratio of patients does not give a response despite therapy. It remains a challenge to predict which patients will respond. Our study aims to investigate early predictors of primary TNFi failure in RA patients. Patients were categorized into two groups based on TNFi therapy (responder/non-responder) and then compared to detect the most significant predictors of treatment failure. Results This study included 87 RA patients treated with TNFi for the first time after conventional disease-modifying anti-rheumatic drugs (DMARDs) failed. This study showed that compared to those with successful treatment, patients with overall primary failure were significantly higher in older age, females, smokers, obese, younger age at the onset of the disease, or those with deformity. In addition, the drug failure was significantly related to erythrocyte sedimentation rate (ESR) (100 vs 68 mm/h), C-reactive protein (CRP) (48 vs 12 mg/dl), rheumatoid factor (RF) positivity (29% vs 16%), anti-cyclic citrullinated peptide (anti-CCP) positivity (39% vs 23%), and non-methotrexate (MTX) concomitant use (33% vs 40%). Conclusion The increased age, being a smoker, earlier age at onset, presence of a deformity, and positive anti-CCP at baseline were predictors of overall failure. At the same time, concomitant MTX intake increased the success rate by 9.6%.

Background: Tumor necrosis factor inhibitors (TNFi) have emerged as an efficient therapeutic modality for rheumatoid arthritis (RA). A ratio of patients does not give a response despite therapy. It remains a challenge to predict which patients will respond. Our study aims to investigate early predictors of primary TNFi failure in RA patients. Patients were categorized into two groups based on TNFi therapy (responder/non-responder) and then compared to detect the most significant predictors of treatment failure. Results: This study included 87 RA patients treated with TNFi for the first time after conventional disease-modifying anti-rheumatic drugs (DMARDs) failed. This study showed that compared to those with successful treatment, patients with overall primary failure were significantly higher in older age, females, smokers, obese, younger age at the onset of the disease, or those with deformity. In addition, the drug failure was significantly related to erythrocyte sedimentation rate (ESR) (100 vs 68 mm/h), C-reactive protein (CRP) (48 vs 12 mg/dl), rheumatoid factor (RF) positivity (29% vs 16%), anti-cyclic citrullinated peptide (anti-CCP) positivity (39% vs 23%), and non-methotrexate (MTX) concomitant use (33% vs 40%). Conclusion: The increased age, being a smoker, earlier age at onset, presence of a deformity, and positive anti-CCP at baseline were predictors of overall failure. At the same time, concomitant MTX intake increased the success rate by 9.6%. Highlights: • The increased age, being a smoker, earlier age of disease onset, and the presence of a deformity were predictors of overall TNFi primary failure. • The overall primary failure of TNFi treatment was significantly related to ESR, CRP, RF positivity, anti-CCP positivity. • The regression analysis showed that these combined factors predict 70.1% of the TNFi failure rate. • Concomitant MTX intake increased the success rate by 9.6%. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a multisystem inflammatory disorder predominantly affecting joint structures leading to joint erosions, destruction of cartilage and frank deformities if not treated. However disease not confined to joint but also involves other organ systems. Objective. To determine the correlation between neutrophil-to-lymphocyte ratio and disease activity score using SDAI in established rheumatoid arthritis patients. Material and methods. This was an observational cross-sectional study, done at the Rheumatology Clinic/Medicine OPD of DOW University Hospital. Patients with ages between 18 to 70 years old, of any gender, diagnosed with rheumatoid arthritis according to American College of Rheumatology criteria were included. Data of all patients who met the inclusion criteria were recorded in predesigned questionnaire, after informed consent. Data were analyzed by calculating median and mode for quantitative variables, frequency and percentages for qualitative variables. Correlations were tested using Pearson correlation test. P values <0.05 were considered significant throughout the study. Outcome. The sample included 64 patients, seven males and 57 females. Mean age was 43.22±11.58. Fifty eight patients (90.6%) were sero-positives while six were negative (9.4%). The Pearson r for the correlation between NLR and SDAI was 0.105 and sig (2 tailed) value was 0.409. The Pearson r was close to 0, meaning a weak relationship between NLR and SDAI. Cross tabulation of NLR and SDAI of patients, using Chi Square yield, proved to have statistically insignificant results (p value = 0.181). Conclusion. The study results revealed a weak correlation between neutrophil-to-lymphocyte ratio and disease activity score using SDAI in established rheumatoid arthritis patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to perform a meta-analysis to ascertain the efficacy and safety of Cannabis in treating ulcerative colitis (UC). Material and Methods: A meta-analysis of randomized controlled trials (RCTs) included in three databases (PubMed, Google Scholar and Science Direct) was performed; from inception till 31st July 2023, so as to ascertain the efficacy and safety of Cannabis in UC. Primary outcomes included: disease activity and endoscopic indices, and quality of life (QOL). The risk of bias in the studies was assessed via the RoB2 tool. Results: In total 1,928 records identified; of which four were eligible for inclusion. The risk of bias in the included studies was moderate. The patients were randomized to the cannabinoid group had significantly improved disease activity indices (standardized mean difference (SMD) -1.78; 95% confidence interval (CI) (-2.89 to 0.67); I2=74%) and QOL (SMD -1.70; 95% CI (0.24 to 3.17); I2=75%) than those in the placebo group. However, cannabinoids did not have a significant impact on endoscopic indices (SMD -0.40; 95% CI (-0.92 to 0.11); I2=0%) nor C-reactive protein (CRP) levels (SMD -0.49; 95% CI (-0.87 to 1.85); I2=85%) of UC patients. Conclusion: Cannabinoids show potential in improving disease activity and QOL; however, their impact on endoscopic indices and CRP levels remains inconclusive.

Objective. The indices to measure disease activity of chronic arthritis in adulthood and childhood are different. Therefore, assessing the status of the disease in young patients with juvenile idiopathic arthritis (JIA) can be tricky, especially when the transition to adult care is ongoing. The aim of our study was to assess the level of correlation between adult and juvenile scores in the measurement of disease activity in JIA patients during transitional care. Methods. We estimated the disease activity by using the Juvenile Arthritis Disease Activity Score 71 (JADAS71), clinical JADAS, adult Disease Activity Score (DAS28), Simplified Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI) in JIA patients in transitional care. We enrolled patients older than 16 years at the time of the first transition visit, and disease activity was assessed at baseline and 12 months. Regression analyses were carried out to estimate the level of agreement among the different indices. Results. We recruited 26 patients with JIA; 11 patients were polyarticular (42.3%) and 15 patients were oligoarticular (53.1%). The mean age at diagnosis was 7.7±3.9 years and the age at the first evaluation was 20.9±3.7 years. The correlation between JADAS71 and DAS28 was r2=0.69, r2=0.86 between JADAS71 and SDAI, and r2=0.81 between JADAS71 and CDAI. Conclusions. SDAI and JADAS71 showed the best correlation, but a few patients were not captured at the same level of disease activity. New prospective studies with a larger number of patients will be needed in this field.

Background: Musculoskeletal ultrasound can aid in assessing disease activity and deciding to taper off disease-modifying antirheumatic drugs in patients of rheumatoid arthritis (RA). With this background, we conducted a study to compare Clinical Disease Activity Score 28 C-reactive protein (DAS28 CRP) with Ultrasound Disease Activity Score 28 CRP (USDAS28 CRP) and its correlation with disease parameters in RA patients. Materials and Methods: Forty-eight RA patients were subjected to clinical and ultrasound assessment of disease activity after subjecting them to history, clinical, and laboratory investigations. The clinical assessment was done by DAS28 CRP and the US assessment was done by USDAS28 CRP score. The swollen joint count and the tender joint count were replaced by GSUS (grayscale ultrasound) score and power Doppler ultrasound score, respectively, in USDAS28 CRP score. Results: The mean age of the patients was 46.31 ± 13.90 years, with a mean duration of illness being 98.3 months. Nineteen patients had inactive disease and 29 patients had active disease on clinical examination. Six out of 19 (31.6%) patients with the inactive disease on clinical assessment had activity (subclinical synovitis) on US assessment. Two out of 29 (6.89%) patients with the active disease on clinical assessment had inactive disease on US assessment. Patients with subclinical synovitis had a longer disease duration (154 ± 114.2 vs. 73.38 ± 54.9 months, P = 0.05) and higher erythrocyte sedimentation rate (28.5[23] vs. 15[5] mm/H, P = 0.017) as compared to RA patients with the inactive disease on US assessment. Correlations between clinical scales and ultrasound scales were good (Pearson's r = 0.832, P = 0.01). Conclusion: US scoring for disease assessment is a plausible method to assess subclinical activity in RA patients with inactive disease. [ABSTRACT FROM AUTHOR]

Abstract Introduction Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone-disease of unknown origin. The National Pediatric Rheumatologic Database (NPRD) collects long-term data of children and adolescents with rheumatic diseases including CNO. Objective To assess characteristics, courses, and outcomes of CNO with onset in childhood and adolescence and to identify outcome predictors. Methods From 2015 to 2021 patients with a confirmed diagnosis of CNO, who were registered in the NPRD during their first year of disease and at least one follow-up visit, were included in this analysis and observed for up to 4 years. Results Four hundred patients with recent diagnosis of CNO were enrolled in the NRPD during the study period. After 4 years, patient data documentation was sufficient to be analyzed in 81 patients. A significant decline of clinical and radiological lesions is reported: at inclusion in the registry, the mean number of clinical lesions was 2.0 and 3.0 MRI lesions per patient. A significant decrease of manifestations during 4 years of follow-up (mean clinical lesions 0.5, p = 4. Predictors associated with a severe disease course include the site of inflammation (pelvis, lower extremity, clavicle), increased erythrocyte sedimentation rate, and multifocal disease at first documentation. The previously published composite PedCNO disease activity score was analyzed revealing a PedCNO70 in 55% of the patients at 4YFU. Conclusion An improvement of physician global disease activity (PGDA), patient reported overall well-being and imaging-defined disease activity measures was documented, suggesting that inactivity of CNO disease can be reached. PedCNO score and especially PGDA, MRI-defined lesions and in a number of patients also the C-HAQ seem to be reliable parameters for describing disease activity. The identification of risk factors at the beginning of the disease might influence treatment decision in the future.

ObjectiveTakayasu artery (TAK) is a chronic inflammatory disease that mainly affects the aorta and its major branches and is rarely reported in infants. We aimed to summarize the clinical features of infant TA (I-TA) in a tertiary care center.MethodsWe performed a retrospective study involving 10 infants diagnosed with TAK. A comprehensive evaluation of clinical, laboratory, radiographic features, disease activity, treatment and outcomes was carried out.ResultsA consecutive cohort was composed of 8 girls and 2 boys, with an age at diagnosis of 11.1 (1.7–36) months. The median time to diagnosis and the average time to follow-up were 9.5 days (2–235 days) and 10.9 (1–21) months, respectively. The most common initial manifestations were malaise (80%), fever (70%), hypertension (50%) and rash (30%). The mean Pediatric Vasculitis Activity Score (PVAS), Takayasu Clinical Activity Score (ITAS-2010) and ITAS-A scores were 2.8/63, 2.6/51, and 5.6/54, respectively. All patients had aberrant laboratory parameters. The most common lesions were in the thoracic aorta (60%) and abdominal aorta (60%). Corticosteroids combined with cyclophosphamide followed by long-term mycophenolate mofetil were initiated in most cases (70%). Biologics were attempted in 5 cases. Mortality was 40%.ConclusionsIt is challenging to diagnose TAK in infants in a timely manner. Considering the more vessels involved, more severe inflammation and higher mortality, aggressive treatment is warranted in infants. GCs and CYC treatment seem to be effective.

Background and aim of work: Rheumatoid arthritis (RA) patients with concomitant hepatitis C virus (HCV) infection tend to have higher disease activity than patients with no HCV. This study aimed to explore the potential outcome of elimination of HCV on RA disease activity in the patients with comorbidity of RA and HCV infection. Methods: This is a retrospective study. The medical records of 55 RA patients with concomitant HCV infection were reviewed. RA clinical and laboratory parameters of RA activity and disease activity score-28 (DAS28) were obtained from the medical records before the initiation of the anti-viral treatment and 12-weeks after completing antiviral therapy for HCV. Results: After treatment, the sustained virological response 12-weeks (SVR12) was achieved in 83.6% of the patients. Good and moderate response based on EULAR response criteria was achieved in 76% of the RA patients. In RA patients achieved SVR12, there was a significant post-treatment decline in the RA activity measures including morning stiffness duration (p <0.001), presence of subcutaneous nodules (p <0.001), C - reactive protein (CRP) level (p<0.001) and erythrocyte sedimentation rate (ESR) level (p <0.001) as compared to pretreatment values. The DAS28-ESR was significantly decreased from 4.15 ±1.31 at the pretreatment to 3.08 ±1.28 after achieving SVR12 (P=0.004). The pretreatment viral load and attainment of SVR12 were the only factors that could predict improvement of RA activity in regression analysis. Conclusion: Elimination of HCV is associated with significant improvement in RA activity in chronic HCV infection patients with concomitant RA. [ABSTRACT FROM AUTHOR]

IntroductionThis study aims to examine the potential effectiveness of intravenous neridronate (IVNer) on axial involvement in patients with spondyloarthritis (SpA) refractory to non-steroidal anti-inflammatory drugs (NSAIDs) but not eligible for biological disease-modifying antirheumatic drugs (bDMARDs).MethodPatients with active SpA (BASDAI score ≥ 4) and active sacroiliitis (SI) on MRI (according to ASAS MRI definition), who were NSAID-insufficient responder/intolerant but not eligible for bDMARDs, were retrospectively recruited in a tertiary rheumatology centre between September 2015 and December 2021. IVNer (100 mg) was administered to the patients on days 1, 4, 7, and 10. Responses were evaluated 60 days after the last infusion as the median changes from the baseline of BASDAI and Visual Analogue Scale (VAS) pain and there are improvements on MRI signs.ResultsA total of 38 patients (26 axial SpA, 3 enteropathic arthritis, and 9 axial psoriatic arthritis) were included [66% women, mean age ± SD: 38.0 ± 14.1 years, mean disease duration: 30.5 ± 49.5 months (range 1.0–298), 47% HLAB27+]. The reason for bDMARD ineligibility was concurrent solid tumors (n = 6) or hematological (n = 1) malignancy, comorbidities (n = 11), or patient preference (n = 20). Both median BASDAI [5.83 (4.2–8.33) versus 3.66 (1.1–6.85), p

Background: T cell receptors play important roles in the development and progression of rheumatoid arthritis (RA). Their involvement has been reported in inflammatory autoimmune diseases. However, their role in predicting RA is still under exploration. This study evaluated the expression of CD183 (CXCR3) receptors on T‐cells and other relevant biomarkers for detecting RA and determine their relationship with disease activity. Methods: This unmatched case–control study included 48 newly diagnosed RA patients and 30 apparent healthy controls from the orthopedic units of Komfo Anokye Teaching Hospital (KATH), Kumasi and Korle‐Bu Teaching Hospital (KBTH), Accra, Ghana. Sociodemographic data was obtained, and blood samples were also collected and processed for flow cytometric analysis. Statistical analyses were done using SPSS version 26.0 and R programming language. p <.05 was considered statistically significant. Results: This study found a significant difference in age group (p <.0001), marital status (p =.0210), occupation (p =.0140), educational level (p =.0210) and religion (p =.0100) between RA patients and healthy controls. Moreover, hemoglobin level (p =.0010), waist circumference (p <.0001) and hip circumference (p =.0040) were significantly different between RA patients and controls. RA patients had significantly lower levels of CD4+CD183+ compared with the control group (p <.001), and was positively correlated with DAS score (r =.0397, p =.789). In Receiver Operator Characteristics analysis, CD4+CD183+ could significantly detect RA with a high area under the curve (AUC = 0.687, p =.018). At a cut‐off of 0.082, CD4+CD183+ was the best receptor biomarker for detecting RA with a sensitivity of 90.0%, specificity of 25.9%, a positive predictive value of 69.2%, and a negative predictive value of 58.3%. Conclusion: CD4+CD183+ best predict RA and is positively correlated with disease activity. CD4+CD183+ could serve as diagnostics and disease‐monitoring biomarker for RA; however, it demonstrates low specificity. Future studies should be directed on CD4+CD183+ and other biomarkers to augment their diagnostics performances and routine management in RA. [ABSTRACT FROM AUTHOR]

Chemotherapy with cytarabine, vincristine (VCR), and prednisolone has achieved low mortality rates in pediatric patients with Langerhans cell histiocytosis (LCH). However, relapse rates remain high, making event-free survival (EFS) rates unsatisfactory. A nationwide clinical trial, LCH-12, tested a modified protocol in which the early maintenance phase was intensified with increasing dosages of VCR. Patients newly diagnosed with multifocal bone (MFB) or multisystem (MS) LCH and aged < 20 years at diagnosis were enrolled between June 2012 and November 2017. Of the 150 eligible patients, 43 with MFB were treated for 30 weeks and 107 with MS LCH were treated for 54 weeks. One patient with MS LCH died of sepsis during the induction phase. The 3-year EFS rates among patients with MFB LCH, risk organ (RO)-negative MS LCH, and RO-positive MS LCH were 66.7% (95% confidential interval [CI], 56.5–77.0%), 66.1% (95% CI 52.9–76.4%), and 51.1% (95% CI 35.8–64.5%), respectively, similar to previously observed rates. EFS rates were significantly lower in patients with disease activity scores > 6 than in those with scores ≤ 6. The strategy that included more intense treatment with VCR was not effective. Other strategies are required to improve outcomes in patients with pediatric LCH. [ABSTRACT FROM AUTHOR]

Introduction Depression and anxiety share similar symptoms with rheumatoid arthritis (RA) and these conditions are often not diagnosed or overlooked in RA. This study aimed to determine the prevalence of depression/anxiety in RA and their correlation with RA activity. Material and methods Rheumatoid arthritis patients who presented at a rheumatology clinic were selected consecutively. The diagnosis of RA was confirmed by the ACR/EULAR criteria, disease activity was assessed by Dis-ease Activity Score based on the 28-joint count (DAS28) and patients with DAS28 > 2.6 were consid-ered to have active RA. The diagnosis of depression and anxiety was made by the Hospital Anxiety and Depression Scale (HADS). The Pearson test was used to determine the correlation between DAS28 and HADS scores. Results Two-hundred patients (female, 82%) with a mean age of 53.5 ±10.1 years and mean disease dura-tion of 6.6 ±6.8 years were studied. Depression was diagnosed in 27 (13.5%) patients and anxiety in 38 (19%) patients. The DAS28 score correlated positively with depression ( r = 0.173, p = 0.014) and anxiety score ( r = 0.229, p = 0.001). In multiple logistic regression analysis after adjustment for all covariates, age < 40 years and female sex were independently associated with RA activity in patients with depression, with OR = 4.21 ( p = 0.002) and OR = 3.56 ( p = 0.028) respectively. Conclusions These findings indicate that depression and anxiety are prevalent in RA and correlate positively with active disease in particular in depressive female patients aged < 40 years.

Objective: To validate the Juvenile Spondyloarthritis Disease Activity (JSpADA) index, and modified versions thereof, in a North American cohort of patients with enthesitis-related arthritis (ERA).Methods: We utilized the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry database ERA cohort to validate the JSpADA and its modifications (JSpADA6-no Schober, no CRP/ESR; JSpADA7- no Schober; and JSpADA7- no CRP/ESR) using OMERACT principles of face validity, discriminative validity, and responsiveness to change.Results: There were 51 subjects (64 visits) with complete JSpADA data with a mean age of 13.7 years and disease duration of 30.9 months. Subjects were predominantly white (84.3%) with half of them, male (56.9%), and HLA-B27 positive (50%). The JSpADA showed high correlation with the cJADAS-10 (r=0.81), moderate-to-high correlation with physician global (r=0.69), and low-to-fair correlation with CHAQ (0.22). The modifications of JSpADA (JSpADA7- no Schober, JSpADA7-no CRP/ESR, and JSpADA6 - no Schober, no CRP/ESR) performed similarly with high correlation with cJADAS-10 (r=0.81, 0.79, and 0.80, respectively), moderateto- high correlation with physician global (r=0.65, 0.67, 0.64), and low-to-fair correlation with CHAQ (r= 0.35, 0.34, 0.39). All modified versions of JSpADA had good responsiveness to change. All versions of JSpADA had excellent discriminative validity.Conclusion: We propose the term "modified JSpADA" for the modification of JSpADA with 6 elements (JSpADA6 - no Schober, no CRP/ESR). This shorter disease activity index may improve implementation of JSpADA in both clinical practice and research trials. [ABSTRACT FROM AUTHOR]

Introduction: Depression and anxiety share similar symptoms with rheumatoid arthritis (RA) and these conditions are often not diagnosed or overlooked in RA. This study aimed to determine the prevalence of depression/anxiety in RA and their correlation with RA activity. Material and methods: Rheumatoid arthritis patients who presented at a rheumatology clinic were selected consecutively. The diagnosis of RA was confirmed by the ACR/EULAR criteria, disease activity was assessed by Disease Activity Score based on the 28-joint count (DAS28) and patients with DAS28 > 2.6 were considered to have active RA. The diagnosis of depression and anxiety was made by the Hospital Anxiety and Depression Scale (HADS). The Pearson test was used to determine the correlation between DAS28 and HADS scores. Results: Two-hundred patients (female, 82%) with a mean age of 53.5 ±10.1 years and mean disease duration of 6.6 ±6.8 years were studied. Depression was diagnosed in 27 (13.5%) patients and anxiety in 38 (19%) patients. The DAS28 score correlated positively with depression (r = 0.173, p = 0.014) and anxiety score (r = 0.229, p = 0.001). In multiple logistic regression analysis after adjustment for all covariates, age < 40 years and female sex were independently associated with RA activity in patients with depression, with OR = 4.21 (p = 0.002) and OR = 3.56 (p = 0.028) respectively. Conclusions: These findings indicate that depression and anxiety are prevalent in RA and correlate positively with active disease in particular in depressive female patients aged < 40 years. [ABSTRACT FROM AUTHOR]

Abstract Background T cell receptors play important roles in the development and progression of rheumatoid arthritis (RA). Their involvement has been reported in inflammatory autoimmune diseases. However, their role in predicting RA is still under exploration. This study evaluated the expression of CD183 (CXCR3) receptors on T‐cells and other relevant biomarkers for detecting RA and determine their relationship with disease activity. Methods This unmatched case–control study included 48 newly diagnosed RA patients and 30 apparent healthy controls from the orthopedic units of Komfo Anokye Teaching Hospital (KATH), Kumasi and Korle‐Bu Teaching Hospital (KBTH), Accra, Ghana. Sociodemographic data was obtained, and blood samples were also collected and processed for flow cytometric analysis. Statistical analyses were done using SPSS version 26.0 and R programming language. p

Abstract Background Diet plays an important role in regulating inflammation, which is a hallmark of rheumatoid arthritis (RA). Our aim was to investigate the association between the Dietary Inflammatory Index (DII) scores and RA activity. Methods This cross-sectional study was conducted on 184 patients with RA in rheumatology clinic in Kermanshah city, Iran, in 2020. RA was diagnosed according to the criteria of the 2010 American College of Rheumatology/ European League against Rheumatism. The overall inflammatory potential of the diet was extracted from a validated 168-item food frequency questioner (FFQ) using the DII. RA disease activity was assessed using Disease Activity Score 28 (DAS-28) scores. Logistic regression and one-way ANOVA/ ANCOVA were conducted. Results Individuals in the highest DII quartile had the significantly higher odds of positive C-reactive protein than those in the lowest quartile of the DII scores (OR 4.5, 95% CI 1.16 – 17.41, P = 0.029). A statistically significant downward linear trend in fat-free mass and weight were observed with increasing the DII quartiles (P = 0.003, P = 0.019, respectively). Patients in the highest DII quartile had higher DAS-28 scores than those in the first quartile (Mean difference: 1.16, 95% CI 0.51 – 1.81, P

Background: Rheumatoid arthritis [RA] is a type of progressive disease characterised by inflammation in the synovial tissues resulting in deformity and functional impairment. Fibromyalgia [FM] is a well-known comorbidity in RA which may change the physical evaluation and incorrectly affect the degree of RA treatment. The Aim of the work: To evaluate FM in patients with RA and its impact on disease activity, functional, and psychological status.Patients and methods: The study included 1200 patients with RA. Individuals were divided based on their FM status. All patients were assessed clinically and evaluated by the Health Assessment Questionnaire for pain [HAQ-pain], the Multidimensional Assessment of Fatigue [MAF], the Pittsburgh Sleep Quality Index [PSQI], the Beck Depression Inventory-II [BDI-II], and the Modified Health Assessment Questionnaire for functional disability [MHAQ]. The Disease Activity Score with ESR [DAS28-ESR] was used to assess RA disease activity in 28 joints. FM and RA were diagnosed using the criteria of the American College of Rheumatology [ACR].Results: Among our patients with RA, the prevalence of FM was 37%. Patients with FM had an increased proportion of females, were older, had a more prolonged disease duration, and had more protracted morning stiffness than patients without FM. Scores of DAS28 were considerably higher in RA patients with FM in comparison to those with only RA [5.70 ±1.19, 4.48 ± 1.26; P < 0.001] respectively. Concurrent FM also had worse HAQ-pain, MHAQ, fatigue, and depression scores, as well as more frequent sleep problems.Conclusion: In patients with RA, coexisting FM was associated with greater activity of the disease and impairments in functional level. FM was linked to higher rates of depression and fatigue, as well as an increased prevalence of sleep problems. The recognition and evaluation of such psychiatric disorders may help patients with RA achieve therapeutic improvement or remission.

Background: Rheumatoid Arthritis (RA), having a striking clinical resemblance to amavata in traditional Indian medicine (Ayurveda) presents an opportunity to look at disease from two different healthcare perspectives. This differential information may potentially supplement one system with the knowledge of the other for optimal application. This study is the first of its kind, where Ayurvedic concepts of amavata have been adopted to enhance the knowledge about RA where optimal care is still beyond the common reach. Objective: The study was conducted to develop and validate a novel ama score based upon constitutional features of ama as depicted in ayurvedic literature as a disease activity indicator in RA. Material and methods: The study was conducted in two parts comprising development and textual validation of the ama assessment instrument (AAI) followed by its clinical testing. AAI comprising ten items, was developed where each item was provided with a range of scores to offer the assessment close to the patient's observations. The score obtained through AAI was clinically and statistically tested on 79 RA/amavata patients randomly selected for validity and reliability. The score obtained through AAI was tested for its correlation with the DAS-28 score and ESR. Results: Ama Assessment Instrument could find a slight correlation with acute phase reactant ESR (r-value between ESR and AMA at baseline is 0.287, and at 1st, 2nd, and 3rd follow-up is 0.276, 0.276 and 0.160 respectively) and DAS-28 (The r value between DAS and AMA at baseline is 0.231, and at 1st, 2nd and 3rd follow up is 0.218, 0.201 and 0.247 respectively). It however emerged as an independent disease status marker since it could mark the changes in the study population on a time scale more precisely as compared to DAS -28 or ESR. When the ama values at different follow-ups were compared, a significant difference was observed consistent with disease activity marker catching constitutional and GI related domain of the patients. When reducing values of ama score were compared to overall improvements as reported by the patients, a similar trend was observed showing that a change in ama score is reflective of a change in disease status and the impact of the disease on the patient. Conclusion: This study provided a quantitative measure for the abstract concept of ama which could be used to mark the disease activity in amavata or RA. The change in ama based scores can be used to assess disease status and the intervention related benefits. The observations prompt for the possible inclusion of AAI in RA composite score to make it more dynamic in terms of disease activity identification in RA.

Purpose: To determine the efficacy of probiotics in the treatment of rheumatoid arthritis (RA). Methods: Clinical trials were searched from online medicine databases. Outcomes such as changes in inflammatory cytokines and disability parameters such as American College of Rheumatology 20 % (ACR20) response, were analyzed. Results: Nine trials were eligible, and 385 patients were included. Meta-analysis showed that probiotic consumption significantly improved 28-joint disease activity (DAS28) score and decreased levels of high-sensitivity CRP (95 % CI = -3.23, -0.80; p = 0.001), tumor necrosis factor-α (95 % CI = -1.40, -0.67; p < 0.00001), interleukin (IL)-1β (95 % CI = -11.37, -0.84; p = 0.02) and IL-12 (95 % CI = -94.91, -53.58; p < 0.00001) in RA patients when compared with placebo. However, probiotics did not affect ACR20 response, erythrocyte sedimentation rate, IL-6, and IL-10, when compared with placebo. Conclusion: The effects of probiotic consumption on RA are very beneficial and have some reference significance for formulating treatment guidelines for RA. However, more trials are needed to confirm the influence of probiotics on RA patients. Furthermore, more clinical trials with larger sample sizes are needed to affirm the effectiveness of probiotics in mitigating disability and inflammatory status in RA patients. [ABSTRACT FROM AUTHOR]

Biologics have emerged as an effective treatment of rheumatoid arthritis (RA). However, there is a significant proportion of patients who fail to respond to biologics. Identifying the predictors that affect the response to biologics remains challenging. A comprehensive literature search of PubMed, Embase, and Web of Science databases was conducted through May 1, 2022. We included all studies that used a multivariate model to assess for the predictors of remission in RA patients treated with biologics. We calculated pooled odds ratios (OR) with 95% confidence intervals (CI) for risk factors reported in ≥ 3 studies using a random-effects model. A total of 16,934 patients with RA who were treated with biologics were included in twenty-one studies. Our study showed that old age (OR 0.98 (0.97, 0.99), P < 0.00001), female gender (OR 0.66 (0.56, 0.77), P < 0.00001), smoking history (OR 0.86 (0.75, 0.99), P 0.04), obesity (OR 0.95 (0.91, 0.99), P 0.02), poor functional status (OR 0.62 (0.48, 1.27), P < 0.00001), high disease activity (OR 0.90 (0.85, 0.96), P 0.0005), and elevated erythrocyte sedimentation rate (OR 0.99 (0.98, 1.00), P 0.009) were poor predictors of remission. On the other hand, positive anti-citrullinated protein antibodies (OR 2.52 (1.53, 4.12), P 0.0003) was associated with high remission rate. Old age, female gender, obesity, smoking history, poor functional status, high disease activity, and elevated ESR at the time of diagnosis have been associated with poor response to biologics. Our findings could help establish a risk stratification model for predicting the remission rate in RA patients receiving biologics. [ABSTRACT FROM AUTHOR]

Background: In recent years, the involvement of the soluble urokinase Plasminogen Activator Receptor (suPAR) in the pathophysiological modulation of Rheumatoid Arthritis (RA) has been documented, resulting in the activation of several intracellular inflammatory pathways. Methods: We investigated the correlation of urokinase Plasminogen Activator (uPA)/urokinase Plasminogen Activator Receptor (uPAR) expression and suPAR with inflammation and joint damage in RA, evaluating their potential role in a precision medicine context. Results: Currently, suPAR has been shown to be a potential biomarker for the monitoring of Systemic Chronic Inflammation (SCI) and COVID-19. However, the effects due to suPAR interaction in immune cells are also involved in both RA onset and progression. To date, the literature data on suPAR in RA endorse its potential application as a biomarker of inflammation and subsequent joint damage. Conclusion: Available evidence about suPAR utility in the RA field is promising, and future research should further investigate its use in clinical practice, resulting in a big step forward for precision medicine. As it is elevated in different types of inflammation, suPAR could potentially work as an adjunctive tool for the screening of RA patients. In addition, a suPAR system has been shown to be involved in RA pathogenesis, so new data about the therapeutic response to Jak inhibitors can represent a possible way to develop further studies. [ABSTRACT FROM AUTHOR]

Abstract Background Rheumatoid arthritis (RA) is an autoimmune inflammatory disease. It is characterized by an inflammatory polyarthritis that preferentially affects the small joints leading to joint damage and eventual deformity and disability, and can also present with extra-articular manifestations. Micro RNA (miRNA) is a class of non-coding RNAs which negatively regulate messenger RNA (mRNA) expression. Several studies had shown that miRNA-23b has a close relationship with inflammation and autoimmune diseases. An increasing evidence has suggested that miRNA-23b is closely associated with many inflammatory and autoimmune diseases. The current study aimed to evaluate the plasma expression of miRNA-23b in rheumatoid arthritis (RA) patients and to explore its potential association with diseases activity. Results RA patients had a significantly higher plasma miRNA-23b expression than controls (P < 0.001). The miRNA-23b plasma expression was significantly associated with the clinical and laboratory indices of RA activity as well as with the DAS28-ESR score (P = 0.009) and grades (P < 0.001). The miRNA-23b plasma expression was significantly correlated with the radiological severity of RA (P = 0.002). Conclusions Plasma expression of miRNA-23b is significantly increased in patients with RA than controls. In RA patients, plasma expression of miRNA-23b was significantly correlated with the activity and radiological severity of RA. miRNA-23b may represent a potential therapeutic target that can retard progression of RA.

Factors influencing prognosis after administration of the last biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) to patients with difficult-to-treat rheumatoid arthritis (D2T_RA) were evaluated in a clinical setting. RA patients who met the EULAR definition of D2T_RA were recruited. These patients were grouped according to success/failure. Success was defined as sustained within light disease activity or discontinued after clinical remission, and all of the following were met, including glucocorticoid (GCS) < 7.5 mg/day, no rapid radiographic progression, and improved quality of life from the beginning of the b/tsDMARD (baseline). Failure was defined as any other condition from success. The primary endpoint of the study was success or failure at 12 months after baseline. Factors influencing success/failure were statistically evaluated. A total of 71 D2T_RA patients were selected, 22 were in the success group and 49 in the failure group. For patients taking GCS and methotrexate (MTX) ≤ 8.6 mg/week, only one was included in the success group and the other 24 were included in the failure group (p < 0.001). Of the 18 patients without GCS and with MTX ≥ 8.7 mg, 12 patients whose 28-joint disease activity score ≤ 1.90 at 3 months or ≤ 2.54 at 6 months were in the success group (p < 0.01). D2T_RA patients with GCS or MTX ≤ 8.6 mg at baseline are considered to be at high risk of repeat D2T_RA. Patients with no GCS and MTX ≥ 8.7 mg are more likely to withdraw from D2T_RA if their disease activity is tightly controlled. [ABSTRACT FROM AUTHOR]

Abstract Background Clinical trials show intensive treatment to induce remission is effective in patients with highly active rheumatoid arthritis (RA). The TITRATE trial showed that the benefits of intensive treatment also extend to moderately active RA. However, many patients failed to achieve remission or show improvements in pain and fatigue. We investigated whether baseline predictors could identify treatment non-responders. Methods The impact of obesity, depression, anxiety and illness perception on RA outcomes, including disease activity, remission, pain and fatigue were determined using a pre-planned secondary analysis of the TITRATE trial data. Results Body mass index was associated with disease activity levels and remission: obese patients had a higher overall disease activity and fewer obese patients achieved remission. Intensive management was not associated with increased remission in these patients. Obesity was also associated with increased overall pain and fatigue. Anxiety, depression and health perceptions had no discernible impact on disease activity but were associated with high levels of pain and fatigue. There was a strong association between anxiety and high pain scores; and between depression and high fatigue scores; and health perception was strongly related to both. None of the predictors had an important impact on pain and fatigue reduction in cross-sectional analysis. Conclusions Disease activity is higher in obese patients and they have fewer remissions over 12 months. Anxiety, depression and health perceptions were associated with higher pain and fatigue scores. Intensive management strategies need to account for these baseline features as they impact significantly on clinical and psychological outcomes. Trial registration ISRCTN 70160382 ; date registered 16 January 2014

Objective: We aimed to reveal whether there is nasal involvement by examining the Nasal Mucociliary Clearance (NMC) and the relationship between this activity and disease severity in Rheumatoid Arthritis (RA) patients. Methods: In this prospective study, NMC time, disease activity (Disease Activity Score 28) and blood parameters of RA patients (n = 87) were investigated and compared with the healthy control group (n = 50). In addition, the relationship between DAS 28 and NMC was investigated. Results: The mean NMC of the RA group was 9.51 ± 3.54 min, the mean NMC of the control group was 8.69 ± 2.85 min, and there was no significant difference between the two groups. There was no correlation between NMC and disease duration, and DAS 28. The mean NMC of the RA patients with Anti Cyclic Citrulled Peptide (Anti-CCP) positive was significantly higher than the negative ones. Conclusion: Although there was no significant difference in NMC values between the RA and control group, the NMC of the Anti-CCP positive patients was higher. Level of evidence: Level 2.

Background: Diet plays an important role in regulating inflammation, which is a hallmark of rheumatoid arthritis (RA). Our aim was to investigate the association between the Dietary Inflammatory Index (DII) scores and RA activity.Methods: This cross-sectional study was conducted on 184 patients with RA in rheumatology clinic in Kermanshah city, Iran, in 2020. RA was diagnosed according to the criteria of the 2010 American College of Rheumatology/ European League against Rheumatism. The overall inflammatory potential of the diet was extracted from a validated 168-item food frequency questioner (FFQ) using the DII. RA disease activity was assessed using Disease Activity Score 28 (DAS-28) scores. Logistic regression and one-way ANOVA/ ANCOVA were conducted.Results: Individuals in the highest DII quartile had the significantly higher odds of positive C-reactive protein than those in the lowest quartile of the DII scores (OR 4.5, 95% CI 1.16 - 17.41, P = 0.029). A statistically significant downward linear trend in fat-free mass and weight were observed with increasing the DII quartiles (P = 0.003, P = 0.019, respectively). Patients in the highest DII quartile had higher DAS-28 scores than those in the first quartile (Mean difference: 1.16, 95% CI 0.51 - 1.81, P < 0.001) and second quartile of the DII scores (Mean difference: 1.0, 95% CI 0.34 - 1.65, P < 0.001).Conclusion: Our results indicated that reducing inflammation through diet might be one of the therapeutic strategies to control and reduce the disease activity in RA patients. [ABSTRACT FROM AUTHOR]

Low‐dose methotrexate can be challenging to treat rheumatoid arthritis due to side effects, lack of adherence and risk of medication errors. The aim of this study was to explore the safety and efficacy of low‐dose methotrexate administered daily or weekly in patients with rheumatoid arthritis. Patients were randomized according to a total oral dose of 12.5 mg of methotrexate administered: (A) divided in 5 days/week and (B) once per week. Patients were assessed along 24 weeks after starting treatment. Polyglutamates of methotrexate were quantified by ultrahigh‐performance liquid chromatography coupled to tandem mass spectrometer. Patients from groups A and B showed a good response to methotrexate treatment in 29% and 25.5%, respectively, and a global frequency of adverse events of 37%. Methotrexate polyglutamate 3 concentrations were higher in normal weight (body mass index 18.5–24.9 kg/m2) than in obese (body mass index 30 kg/m2) patients with a median (interquartile range) of 28 (17.95–45.15) and 10.35 (5.22–30.88) nM without differences between dosage groups. Daily dosage regimen represents a therapeutic alternative without compromising the efficacy and safety of methotrexate treatment and with similar adherence patterns than weekly dosage regimen; further, methotrexate polyglutamate 3 concentrations could be a useful tool for therapeutic drug monitoring purposes. [ABSTRACT FROM AUTHOR]

Abstract Background Behçet’s disease (BD) is also referred to as vascular BD when it frequently involves the heart and vessels. This study aimed to describe the cardiovascular manifestations in patients with BD and its correlation to disease activity. We conducted a cross-sectional study on 40 patients diagnosed with BD according to the International Criteria for Behçet’s Disease 2014. All the patients were subjected to detailed history taking, full clinical examination, lab investigations, resting electrocardiogram, trans-thoracic echocardiography, and carotid artery duplex for measuring intimal thickness, peripheral arterial and venous duplex, computed tomography pulmonary angiography, and full ophthalmological examination. Regarding the activity of the disease, it was assessed according to the score of Behçet’s Disease Current Activity Form (BDCAF). Results The most common cardiac manifestation was valvular lesion (67.5%) where the most frequently affected valve was the tricuspid valve (27.5%). Although 25% of patients had left ventricular diastolic dysfunction, only 5% had intracardiac masses. Approximately 52.5% of patients had vascular lesion (deep venous thrombosis 45%, arterial involvement 7.5% [as pulmonary artery thrombosis 5% and aneurysm 2.5%]). Increase in intima media thickness (IMT) was observed in 7.5% of patients, while 60% had abnormal lipid profiles. Hypercholesterolemia was the most common lipid abnormality (50%). BDCAF score range was 4–12, which was significantly correlated to multiple cardiovascular parameters as a mitral, tricuspid valve, and vascular venous involvement (p < 0.05), while not significantly correlated to lipid profile (p > 0.05). Conclusion Cardiovascular complications are frequent among patients with BD, even those who are asymptomatic; therefore, these complications must be screened for early detection and proper management.

Aim. To evaluate the status of vitamin D in women with rheumatoid arthritis (RA) and establish its associations with comorbidity, disease activity, and body composition components. Materials and methods. 86 women with RA (average age 58.18.5 years) were enrolled in the study. We analyzed the relationship of vitamin D levels with clinical and laboratory parameters and with the results of two-energy x-ray absorptiometry. MannWhitney or KruskalWallis, 2 and Spearman tests were performed using Statistica for Windows 10.0 (StatSoft Inc., USA). Results. Vitamin D level was 22.4 [17.8; 27.3] ng/ml: deficiency was detected in 33%, and insufficiency in 46% of women with RA. Only 41% of patients with low vitamin D levels received supplements of cholecalciferol, while only 9% in a sufficient dose. 25(OH)D level was significantly lower in RA patients with sarcopenia, obesity, high activity according to DAS28 and in those who did not receive vitamin D supplements. There werent differences in 25(OH)D levels among subgroups of patient according to age, fertility, BMD status, comorbidity index, RA duration, ESR and CRP levels, medical therapy performed. Conclusion. 79% of patients with RA had low levels of vitamin D, while less than half of them received additional cholecalciferol supplements. Low vitamin D levels in RA patients were associated with high disease activity, sarcopenia, and obesity.

Objective: Treat to target (T2T) is a strategy of adjusting treatment until a target is reached. An international task force recommended T2T for juvenile idiopathic arthritis (JIA) treatment. Implementing T2T in a standard and reliable way in clinical practice requires agreement on critical elements of (1) target setting, (2) T2T strategy, (3) identifying barriers to implementation, and (4) patient eligibility. A consensus conference was held among Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) stakeholders to inform a statement of understanding regarding the PR-COIN approach to T2T.Methods: PR-COIN stakeholders including 16 healthcare providers and 4 parents were invited to form a voting panel. Using the nominal group technique, 2 rounds of voting were held to address the above 4 areas to select the top 10 responses by rank order.Results: Incorporation of patient goals ranked most important when setting a treatment target. Shared decision making (SDM), tracking measurable outcomes, and adjusting treatment to achieve goals were voted as the top elements of a T2T strategy. Workflow considerations, and provider buy-in were identified as key barriers to T2T implementation. Patients with JIA who had poor prognostic factors and were at risk for high disease burden were leading candidates for a T2T approach.Conclusion: This consensus conference identified the importance of incorporating patient goals as part of target setting and of the influence of patient stakeholder involvement in drafting treatment recommendations. The network approach to T2T will be modified to address the above findings, including solicitation of patient goals, optimizing SDM, and better workflow integration. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate whether shoulder ultrasound (US) findings were associated with disease activity and pain level in rheumatoid arthritis (RA) patients. Patients and methods: Between April 2019 and November 2019, a total of 60 shoulders of 30 female patients with RA (mean age: 53.8±12.0 years; range, 30 to 65 years) were included. The patients were questioned about shoulder pain and their Disease Activity Score-28 (DAS28) was estimated. After clinical examination with shoulder impingement tests, both shoulders were evaluated by US. Results: Of 60 shoulders examined by shoulder US, the most common shoulder pathology was supraspinatus tendinopathy (n=33, 55%). The prevalence of subdeltoid bursitis on US was significantly higher in the group with moderate disease activity, compared to the group with low disease activity (p<0.05). There were no significant differences in the physical examination findings of patients with low and moderate disease activity. In terms of US findings, subscapularis tendinopathy, glenohumeral joint and acromioclavicular joint degeneration, and subacromial bursitis were more common in shoulders with a history of pain, compared to non-painful shoulders. Conclusion: Shoulder US may be useful for demonstrating shoulder involvement in patients with RA, independent of the presence of shoulder pain. [ABSTRACT FROM AUTHOR]

Objective: To investigate concurrent validity and discrimination of the Disease Activity Index for Psoriatic Arthritis (DAPSA) score, Psoriatic Arthritis Disease Activity Score (PASDAS), and Ankylosing Spondylitis Disease Activity Score (ASDAS) in peripheral spondyloarthritis (pSpA) in clinical practice.Methods: Data from a Dutch registry for SpA (SpA-Net) were used. Predefined hypotheses on concurrent validity of the composite measures with 15 other outcome measures of disease activity, physical function, and health-related quality of life were tested. Concurrent validity was considered acceptable if ≥ 75% of the hypotheses were confirmed. Discrimination was assessed by stratifying patients in DAPSA, PASDAS, and ASDAS predefined disease activity states and studying mean differences in health outcomes by 1-way ANOVA. Further, the concordance in disease activity states was determined. All analyses were repeated in subgroups with and without psoriasis (PsO).Results: DAPSA, PASDAS, and ASDAS scores were available for 191, 139, and 279 patients with pSpA, respectively. The concurrent validity and discrimination of all composite measures were acceptable, as the strength of correlations were as hypothesized in ≥ 75% of the studied correlations. With increasing disease activity states, scores in nearly all outcome measures worsened significantly. The DAPSA, PASDAS, and ASDAS classified 22%, 56%, and 48% of the patients, respectively, in the 2 highest disease activity states. Stratified analyses for concomitant PsO revealed no relevant subgroup differences.Conclusion: The performance of DAPSA, PASDAS, and ASDAS in pSpA was acceptable, and independent of concomitant PsO. Due to discrepancy in classification, the validity of existing thresholds for disease activity states warrants further study in pSpA. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease. Complications of RA can cause low quality of life and disabilities. Nowadays, despite all the medical developments, etiology of RA is unclear. Both soft and hard tissue damages occur in RA and periodontitis due to chronic inflammation and also since tissue damage presentation and pathogenesis of RA and periodontitis are the same, this study was done for evaluating the relationship between clinical and laboratory findings in RA patients with their oral status and disease activity. Methods: This case-control study was performed on 236 patients; 118 RA patients and 118 cases of normal people. Gingivitis, dental caries and plaques, oral hygiene and severity of periodontitis were measured based on gingival index, plaque index, clinical attachment level, Decayed Missing Filled index and oral hygiene index-simplified. Disease activity was assessed according to Diseases Activity Score-28. Blood samples were taken to evaluate the level of anti-CCP, RF, ESR, CRP, and CBC. Data were analyzed by t-test and chi-square. Results: RA patients are more susceptible to periodontitis, plaque formation and dental caries. There is a relationship among RA disease and periodontitis, oral hygiene, gingivitis. There is also a reverse relationship between RF level and periodontitis severity likewise dental caries. There is no significant relationship between other laboratory findings and the oral status of patients. Conclusion: This is more likely for RA patients to experience periodontitis which can destruct alveoli bone and it can also cause early tooth loss. Regular examination and early treatment are highly recommended.

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory peripheral polyarthritis with unclear etiology. RA usually leads to joint deformity and cartilage destruction in joints of RA patients. The aim of this study was to determine the effect of Islamic fasting on RA (rheumatoid arthritis) severity. Methods: A total number of 28 RA patients in an observational study were randomly divided into two groups. The duration of the study was from 2 weeks prior to start of Ramadan month in 2015 until one month after end of Ramadan. One group followed Islamic fasting during the Ramadan month and another group did not fast. The two groups were visited twice: first before Ramadan and the second time after Ramadan. The number of tender and swollen joints, DAS-28 score, patient-VAS, physician-VAS, and ESR and CRP values were recorded. Results: Mean (±SD) number of tender joints decreased from 1.36 (±1.94) to 0.42 (±0.85) in fasting group (P= 0.02). Mean (±SD) number of swollen joints decreased from 0.79 (±1.05) to 0.07 (±0.26) in fasting group (P= 0.02). DAS-28 and physician-VAS also showed significant decrease in fasting group only. Patient-VAS did not show significant decrease in either group. Mean (±SD) DAS-28 score decreased from 2.74 (±1.06) to 2.18 (±0.64) (P= 0.003) in fasting group. In contrast, mean (SD) DAS-28 score decreased from 2.71 (±0.8) to 2.27 (±1.01) (P= 0.24) in non-fasting group. Conclusion: Islamic fasting during the holy month of Ramadan was effective in decreasing RA severity, but further evidence is required to recommend this type of dietary intervention for RA patients.

Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease which leads to significant morbidity. Formal quantitative swollen and tender joint count and indices like disease activity score 28 (DAS28) and clinical disease activity index (CDAI) are very specific for measuring disease activity. Routine assessment of patient index data 3 (RAPID3) is a patient-reported outcome measure used for the assessment and follow-up of RA which can be completed in 10 s. We aimed to determine the effects of patient educational status and comorbidity on RAPID3 and its correlation with DAS28 and CDAI. Methods: A total of 246 RA patients (80.1% female; mean age: 53.2 years) followed up for 3 years were asked to fill out RAPID3 questionnaires, and DAS28 and CDAI were calculated. Patients were subdivided according to disease severity as Group A (remission-minimal disease activity) and Group B (moderate–severe disease activity). The duration of disease, medications, educational status, comorbidity, and medical history were recorded. Results: The mean duration of disease was 8.44 years. Of the patients, 27.2% were illiterate and the mean education time was 4.9 years. The 47.6% of the patients had a comorbid disease. The correlation of RAPID3 with DAS28 and CDAI scores was statistically significant (P < 0.001). Similarly, educational status and the presence of comorbidity did not affect this correlation (P < 0.001). The kappa analysis showing compliance of RAPID3 with DAS28 and CDAI scores was also significant (P < 0.001). Conclusion: RAPID3 is an index which shows a perfect correlation with DAS28/CDAI and can be used routinely for follow-up of RA patients and for decision-making for treatment. It can provide quantitative data with DAS28/CDAI in busy outpatient clinics not only in patients with different educational levels but also in patients with comorbid diseases.

Background: A disease activity score obtained by using systemic lupus erythematosus disease activity index (SLEDAI) has traditionally been a reliable method to assess the SLE status of patients. More recently, a buccal micronucleus cytome assay (BMCA) has been developed for use as a biomarker of DNA damage in patients with SLE. There has been a very limited number of studies pertaining to the oral lesions in Arab population suffering from SLE in Asir region. Hence, it became utmost important to study epidemiological data of oral mucosal lesions in SLE patients. Distribution of oral lesions in SLE patients could also be helpful in better management of oral complications. Aim: The aim of this study was to determine the existence of a correlation between SLEDAI score and the degree of micronuclei (MN) formation using BMCA. Materials and Methods: After thorough oral examination of adult Saudi SLE patients of Asir hospital and that of healthy control subjects, the subjects underwent BMCA from normal unaffected bilateral buccal mucosae. Results: Pearson's correlation test showed that MN count did not significantly correlate with either disease activity or duration of SLE. Conclusions: Controlled state SLE does not lead to a significant increase in MN formation. Thus, the occurrence of premalignant lesions in the oral cavity could be minimized using proper management protocols.

Objectives Environmental air pollution has been linked to the pathogenesis of RA. Nevertheless, evidence linking higher concentrations of air pollutants with the risk of RA reactivations is missing. The objective of the present study was to determine the association between RA flares and air pollution. Methods We collected longitudinal data of patients affected by RA and of the daily concentration of air pollutants in the Verona area. We designed a case-crossover study. We compared the exposure to pollutants in the 30‐day and 60-day periods preceding an arthritic flare referent to the 30‐day and 60-day preceding a low-disease activity visit. Results The study included 888 patients with RA with 3396 follow-up visits; 13 636 daily air pollution records were retrieved. We found an exposure–response relationship between the concentration of air pollutants and the risk of having abnormal CRP levels. Patients exposed to greater concentrations of air pollutants were at higher risk of having CRP levels ≥5 mg/l. Concentrations of CO, NO, NO2, NOx, PM10, PM2.5 and O3 were higher in the 60-day period preceding a flare. Conclusions We found a striking association between air pollution and RA disease severity and reactivations in a cohort of patients followed over a 5-year period. The exposure to high levels of air pollutants was associated with increased CRP levels and a higher risk of experiencing a flare of arthritis. This excessive risk was evident at very low levels of exposure. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic auto-immune disease that causes pain, swelling and inflammation in the joints. Joint swelling results in deformity and reducing patient mobility, limiting joint motions. Discovering novel biomarkers with critical roles in various phases of development remains an issue of interest for RA. As a result, biomarkers are needed to facilitate early diagnosis and predict prognosis in rheumatoid arthritis. A cross sectional study was conducted to assess the serum levels of soluble programmed death protein 1 (sPD-1) and evaluate relationship with the activity or severity of rheumatoid arthritis. A blood sample was collected from 90 individuals with rheumatoid arthritis. Enzyme-linked immunosorbent assay (ELISA) was used to assess serum sPD-1. RA severity was estimated by DAS28-ESR and CDAI. Also, immune parameters such Anti-CCP, ESR, RF and CRP were analyzed. The current study showed a non-significant difference between sPD-1 levels in serum of RA patients with DAS-28ESR (p = 0.3). Also, the study showed a weak negative correlation (r = -0.04) between sPD-1 and DAS28-ESR. In conclusion, the serum level of sPD-1 was non significantly related to disease activity score (DAS28-ESR) among patients with rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) exhibited differences between women and men.Methods: We systematically searched MEDLINE, Embase, Web of Science, and other sources in English or Spanish from January 1, 1995, to July 31, 2020, to assess the differences according to sex in BASDAI and ASDAS. We performed a comparative analysis by sex using t test and mean difference by sex metaanalyses for BASDAI and ASDAS, as well as a random-effects model using the inverse-variance method.Results: Forty-one studies included BASDAI (6785 women, 12,929 men) and 16 of them included ASDAS (2046 women, 4403 men). Disease activity detected using BASDAI was significantly higher in women than in men (mean 4.9 vs 4.2, P = 0.02), whereas ASDAS did not detect differences between sexes (mean 2.8 women vs 2.8 men). In the metaanalyses, BASDAI detected significant differences between women and men (mean difference = 0.55 [95% CI 0.46-0.65], P < 0.00001), but ASDAS did not identify significant mean difference between sexes (0.04, 95% CI -0.05 to 0.12], P = 0.38).Conclusion: The 2 most widely used indices of disease activity in spondyloarthritis (SpA) discriminate differently according to sex by their different evaluations of peripheral disease. The different components and weights in BASDAI and ASDAS influence their values. BASDAI may be affected by fatigue, and in predominantly peripheral manifestations such as enthesitis, ASDAS may not be sensitive enough to detect activity. This may represent a sex bias unfavorable to women, because peripheral SpA is more common in women than in men. [ABSTRACT FROM AUTHOR]

Objective: The Childhood Health Assessment Questionnaire (CHAQ), though widely used for assessments in pediatric rheumatology, has drawbacks, including low correlation to disease activity and ceiling effects. We sought to determine if any tools from the Patient Reported Outcomes Measurement Information System (PROMIS) improve on these shortcomings and/or are preferred by patients.Methods: Patients 5-17 years of age with juvenile idiopathic arthritis (JIA) or juvenile dermatomyositis (JDM) were recruited from the rheumatology clinics at a Canadian children's hospital. Participants completed the CHAQ, 3 PROMIS measures (pain interference, mobility, and physical activity), and underwent a standard clinical assessment.Results: Fifty-two patients participated, 25 with JIA and 27 with JDM. None of the PROMIS measures suffered from ceiling effects, whereas the CHAQ Disability Index (DI) and pain visual analog scales both did, with 50% and 20% of patients achieving the best possible scores, respectively. The PROMIS mobility was moderately correlated to the CHAQ-DI (rs -0.60, 95% CI -0.75 to -0.40), and the PROMIS pain interference was strongly correlated to the CHAQ pain score (rs 0.65, 95% CI 0.43-0.80). No measures correlated with disease activity. Patients preferred the PROMIS to the CHAQ.Conclusion: The PROMIS pain interference, mobility, and physical activity measures improve in some areas where the CHAQ is weak: they do not suffer from ceiling effects, and patients prefer the PROMIS tools. More work is needed to determine the correlation and responsiveness of the PROMIS tools to changes in disease activity over time before they should be widely adopted for clinical use. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to evaluate the relative efficacy of targeted immune modulators (TIMs) in TIM-naïve/mixed populations (≤ 20% TIM-experienced) and TIM-experienced (> 20% TIM-experienced) adults with moderate-to-severe rheumatoid arthritis with an inadequate response to or intolerance of conventional disease-modifying antirheumatic drugs (cDMARDs). Methods: A fixed-effects Bayesian network meta-analysis (NMA) was performed using published study-level data from 41 randomized controlled trials (RCTs) identified from two recent systematic literature reviews conducted by the Institute for Clinical and Economic Review, and two additional phase III trials for filgotinib (FINCH-1, FINCH-2). RCTs that compared TIMs with each other, cDMARD therapy, or placebo were included. Treatments included Janus kinase (JAK) inhibitors, tumor necrosis factor α inhibitors (TNFi), and other non-TNFi therapies. Efficacy was defined as achieving remission with a DAS28 score < 2.6 at 12 and 24 weeks. Results: In the 12-week analysis for the TIM-naïve/mixed population, all TIMs combined with cDMARD therapy were significantly more likely to achieve remission compared with a cDMARD alone, with intravenous tocilizumab showing a substantially greater magnitude of effect (odds ratio 19.36; 95% credible interval 11.01–38.16). Similarly, in the 24-week analysis, intravenous and subcutaneous tocilizumab showed the highest odds ratio of achieving DAS28 remission compared with cDMARD therapy. Similar trends were observed for the analyses on monotherapy or TIM-experienced population. Conclusions: This NMA demonstrated that tocilizumab is associated with a greater likelihood of remission (DAS28 < 2.6) at 12 and 24 weeks compared with most other TIMs, including new JAK inhibitors, when used in combination with a cDMARD or as monotherapy among TIM-naïve/mixed or TIM-experienced populations. [ABSTRACT FROM AUTHOR]

Background: Neutrophil–lymphocyte ratio (NLR) is reported to be increased in various inflammatory conditions, but its significance in RA remains unclear. The aim of this study was to evaluate whether NLR can be used as a simple tool for disease activity assessment in rheumatoid arthritis (RA). Aim: The aim was to assess the NLR in RA patients and compare between active cases and those in remission. Materials and Methods: The study enrolled 150 diagnosed RA patients. Disease activity was determined with the Disease Activity Score (DAS-28), and the correlation of NLR with disease activity was analyzed. Results: NLR, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were found to be significantly high in RA patients. Further, NLR correlated positively with CRP, ESR, and worsening DAS score. Conclusion: Our study concludes that NLR can become a readily available and cost-effective tool for disease assessment in RA in future.

Background Quality of life (QOL) is a multidimensional concept that is used to describe the individuals’ perceptions, satisfaction, and evaluation of different areas of their own lives, such as physical health and functioning, psychological and emotional well-being, social roles, and relationships. Few studies have addressed the effect of rheumatoid disease on the QOL in the Egyptian community. Results Functional disability based on health assessment questionnaire disability index was significantly increased with the increase in disease activity based on disease activity score-28, where all patients on remission and 56% of those with low disease activity had mild functional disability. Approximately 89% of patients with low disease activity had mild anxiety based on Hamilton anxiety scale, and the majority (75%) of those patients with moderate disease activity and 83.3% of patients on remission had mild anxiety. The majority (85.7%) of those with high disease activity were depressed based on Zung self-rating depression score. Disease activity score-28 score had a positive significant correlation with health assessment questionnaire disability index (P=0.01, r=0.40), Hamilton anxiety scale-A (P=0.01, r=0.46), Zung score (P=0.01, r=0.46), and rheumatoid arthritis QOL (r=0.70, P=0.00), and negative correlation with female sexual index (r=−0.80, P=0.00), all domains of SF-36, and all five domains of WHOQOL. Conclusion This study confirms that rheumatoid arthritis causes impairment of all aspects of QOL (limitation of physical function, physical disability, and pain), mental health disorders (anxiety and depression), and social, environmental, and also sexual dysfunction.