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Objective@#Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune disorder that impairs patients’ overall health-related quality of life (HRQOL). In this study, we evaluated the effect of adalimumab in Korean patients with active RA on HRQOL. @*Methods@#Patients included in the study had moderate to severe active RA that did not respond to conventional drugs with a Disease Activity Score of 28 joints ＞3.2 and were biologics-naïve. All patients received adalimumab 40 mg subcutaneously every other week and were followed for 24 weeks. The primary endpoint was the change in baseline Health Assessment Questionnaire Disability Index (HAQ-DI) score at week 24. Secondary endpoints were changes in the EuroQol 5-dimension 3-Level (EQ-5D-3L) baseline score and Short Form 36-Item Health Survey (SF-36) domain scores at weeks 12 and 24 and change in baseline HAQ-DI score at week 12. @*Results@#In total, 91 Korean patients were included. Ninety-three percent of patients were in high disease activity with a baseline mean DAS28 value of 6.1 within all patients. The mean change from baseline in HAQ-DI scores were −0.46 at week 12 and∼0.67 at week 24 (p＜0.0001). Additionally, EQ-5D-3L score at weeks 12 and 24 had significantly improved (p＜0.0001) compared to baseline. SF-36 at weeks 12 and 24 had significantly improved (p＜0.0001, p=0.0001) compared to baseline. @*Conclusion@#Treatment with adalimumab resulted in significant improvement in HAQ-DI, EQ-5D-3L, and SF-36 scores at 12 and 24 weeks in Korean RA patient.
ABSTRACT
Background@#There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. @*Methods@#Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. @*Results@#Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities,including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. @*Conclusion@#These QIs can be used to assess and improve the quality of health care for patients with RA.
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The coronavirus disease 2019 (COVID-19) pandemic has caused more than 100 million infections and 2 million deaths worldwide. In up to 20% of cases, COVID-19 infection can take a severe, life-threatening course. Therefore, preventive measures such as mask-wearing, hand hygiene, and social distancing are important. COVID-19 vaccines that use novel vaccine technology can prevent up to 95% of infections. However, the uncertainty regarding the efficacy and safety of vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), who are immunocompromised due to underlying immune dysfunction and concomitant immunosuppressive treatment, warrants clear guidance. A task force of the Korean College of Rheumatology formulated a set of vaccination guidance based on the currently available data and expert consensus. The currently available COVID-19 vaccines are considered to be safe and effective. Every patient with AIIRD should receive one of the available COVID-19 vaccines unless contraindicated for medical reasons such as prior allergy/anaphylaxis to the COVID-19 vaccine or its components. Patients should continue immunosuppressive treatment for their underlying AIIRD, including biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Corticosteroids should be reduced to the lowest dose possible without aggravating the AIIRD. To improve the vaccine response, methotrexate can be withheld for 1–2 weeks after each vaccination, and the timing of rituximab and abatacept infusion should be adjusted if clinically acceptable.Rheumatologists should play a leading role in educating and vaccinating patients with AIIRD.
ABSTRACT
Background@#There is increasing interest in the quality of health care and considerable efforts are being made to improve it. Rheumatoid arthritis (RA) is a disease that can result in favorable outcomes when appropriate diagnosis and treatment are provided. However, several studies have shown that RA is often managed inappropriately. Therefore, the Korean College of Rheumatology aimed to develop quality indicators (QIs) to evaluate and improve the health care of patients with RA. @*Methods@#Preliminary QIs were derived based on the existing guidelines and QIs for RA. The final QIs were determined through two separate consensus meetings of experts. The consensus was achieved through a panel of experts who voted using the modified Delphi method. @*Results@#Fourteen final QIs were selected among 70 preliminary QIs. These included early referral to and regular follow-up with a rheumatologist, radiographs of the hands and feet, early initiation and maintenance of disease-modifying anti-rheumatic drug (DMARD) therapy, periodic assessment of disease activity, screening for drug safety and comorbidities,including viral hepatitis and tuberculosis before biologic DMARD therapy, periodic laboratory testing, supplementation with folic acid, assessment of the risk for cervical spine instability before general anesthesia, patient education, and specialized nurse. @*Conclusion@#These QIs can be used to assess and improve the quality of health care for patients with RA.
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has caused more than 100 million infections and 2 million deaths worldwide. In up to 20% of cases, COVID-19 infection can take a severe, life-threatening course. Therefore, preventive measures such as mask-wearing, hand hygiene, and social distancing are important. COVID-19 vaccines that use novel vaccine technology can prevent up to 95% of infections. However, the uncertainty regarding the efficacy and safety of vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), who are immunocompromised due to underlying immune dysfunction and concomitant immunosuppressive treatment, warrants clear guidance. A task force of the Korean College of Rheumatology formulated a set of vaccination guidance based on the currently available data and expert consensus. The currently available COVID-19 vaccines are considered to be safe and effective. Every patient with AIIRD should receive one of the available COVID-19 vaccines unless contraindicated for medical reasons such as prior allergy/anaphylaxis to the COVID-19 vaccine or its components. Patients should continue immunosuppressive treatment for their underlying AIIRD, including biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). Corticosteroids should be reduced to the lowest dose possible without aggravating the AIIRD. To improve the vaccine response, methotrexate can be withheld for 1–2 weeks after each vaccination, and the timing of rituximab and abatacept infusion should be adjusted if clinically acceptable.Rheumatologists should play a leading role in educating and vaccinating patients with AIIRD.
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Patients with systemic rheumatic diseases (SRD) are vulnerable for coronavirus disease (COVID-19). The Korean College of Rheumatology recognized the urgent need to develop recommendations for rheumatologists and other physicians to manage patients with SRD during the COVID-19 pandemic. The working group was organized and was responsible for selecting key health questions, searching and reviewing the available literature, and formulating statements. The appropriateness of the statements was evaluated by voting panels using the modified Delphi method. Four general principles and thirteen individual recommendations were finalized through expert consensus based on the available evidence. The recommendations included preventive measures against COVID-19, medicinal treatment for stable or active SRD patients without COVID-19, medicinal treatment for SRD patients with COVID-19, and patient evaluation and monitoring. Medicinal treatments were categorized according to the status with respect to both COVID-19 and SRD. These recommendations should serve as a reference for individualized treatment for patients with SRD. As new evidence is emerging, an immediate update will be required.
ABSTRACT
Patients with systemic rheumatic diseases (SRD) are vulnerable for coronavirus disease (COVID-19). The Korean College of Rheumatology recognized the urgent need to develop recommendations for rheumatologists and other physicians to manage patients with SRD during the COVID-19 pandemic. The working group was organized and was responsible for selecting key health questions, searching and reviewing the available literature, and formulating statements. The appropriateness of the statements was evaluated by voting panels using the modified Delphi method. Four general principles and thirteen individual recommendations were finalized through expert consensus based on the available evidence. The recommendations included preventive measures against COVID-19, medicinal treatment for stable or active SRD patients without COVID-19, medicinal treatment for SRD patients with COVID-19, and patient evaluation and monitoring. Medicinal treatments were categorized according to the status with respect to both COVID-19 and SRD. These recommendations should serve as a reference for individualized treatment for patients with SRD. As new evidence is emerging, an immediate update will be required.
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OBJECTIVE: To evaluate the fate of abstracts presented at scientific meetings of the Korean College of Rheumatology (KCR). METHODS: This study examined the abstracts presented at annual meetings of the KCR from 2005 to 2014. Only original studies were selected, excluding case reports. A manual search was conducted using PubMed, KoreaMed, Cochrane Library, and Embase to track the published articles. The abstracts were considered to have been published if the authors, title, study design, and results were the same for a published article. In addition, they were considered published if the author and the study design matched, even if the results of the abstract and the results of the published articles were not identical. RESULTS: A total of 928 abstracts from 2005 to 2014 were analyzed. Of the 928 abstracts, 468 (50.43%) abstracts were published in a peer-reviewed journal and the mean time to publication was 19 months. Of the 468 abstracts, 414 were published in a science citation index extended (SCI[E]) journal, and 54 were published in non-SCI(E) journals. The proportion of SCI(E) articles increased annually. The average impact factor for the SCI(E) journals was 2.93. In subgroup analysis, the abstracts that were awarded the best oral or best poster presentation were more likely to be published as full-length articles with a higher impact factor than the abstracts not awarded. CONCLUSION: Half of the abstracts presented in the KCR annual meetings were published in a peer-reviewed journal. Approximately 90% of the articles were published in a SCI(E) journal.
Subject(s)
Awards and Prizes , Korea , Publications , RheumatologyABSTRACT
Posterior reversible encephalopathy syndrome (PRES) is a neurologic condition characterized by vasogenic edema on neuroimaging and is associated with the setting of severe hypertension, eclampsia, autoimmune disease, malignancy, and immunosuppressive drugs. We report on a 42 year-old female systemic lupus erythematous patient who presented altered consciousness, seizure, and visual disturbance after cyclophosphamide pulse therapy. Magnetic resonance imaging (MRI) showed multi-focal high signal intensity lesions in the parieto-occipital cortex bilaterally and in the subcortical white matter. Her condition was improved and her MRI lesions were resolved after aggressive blood pressure control and high-dose steroid treatment. It is possibly the first reported case of PRES in a patient with lupus, treated with cyclophosphamide pulse therapy during a nephritis flare in Korea.
Subject(s)
Female , Humans , Pregnancy , Autoimmune Diseases , Blood Pressure , Consciousness , Cyclophosphamide , Eclampsia , Edema , Hypertension , Korea , Lupus Erythematosus, Systemic , Lupus Nephritis , Magnetic Resonance Imaging , Nephritis , Neuroimaging , SeizuresABSTRACT
OBJECTIVE: The aim of this study was to assess the gender differences in the clinical presentation and treatment patterns between Korean women and men with ankylosing spondylitis (AS). METHODS: We retrospectively analyzed the data from extensive clinical assessments of 721 patients (162 women and 559 men) with AS, who were diagnosed at Seoul St. Mary's Hospital, between January 2000 and September 2009. Clinical data, regarding the disease onset, disease duration, clinical presentations, status of human leukocyte antigen (HLA)-B27, and bone mineral density, were determined using a dual-energy X-ray absorptiometry (DEXA). Finally, we analyzed the medical treatments prescribed for these patients. RESULTS: The ratio of men to women was 3.45:1. Compared to men, women were older at the time of diagnosis, had shorter disease durations, and were diagnosed in earlier stages of the disease. More women had a history of uveitis at diagnosis than men. Back pain was the main presenting symptom, and its prevalence was the same in both genders. Fewer women showed cervical and thoracic axial involvement than men. Initially, more women had wrist and hand pain than men; however, at some point, peripheral arthritis development was equally likely in both genders. Women experienced shoulder pain, during the disease course, more often thanmen. On the other hand, men presented with knee and hip pain more often than women. Sulfasalazine and anti-TNF agents were more often prescribed to women. CONCLUSION: The presentation and progression of AS showed a difference between women and men. Because of these differences, AS should be considered when a women presents with peripheral arthritis or uveitis in the early stage of the disease.
Subject(s)
Female , Humans , Male , Absorptiometry, Photon , Arthritis , Back Pain , Bone Density , Hand , Hip , Knee , Leukocytes , Prevalence , Retrospective Studies , Shoulder Pain , Spondylitis, Ankylosing , Sulfasalazine , Uveitis , WristABSTRACT
OBJECTIVES: Osteoclast differentiation and bone resorption are considered a potential therapeutic target to the treatment of erosive bone diseases, including osteoporosis and rheumatoid arthritis. Poria cocos Wolf (PCW), commonly used herbal medicine, has previously been reported to induce anti-inflammatory effect and anti-cancer effect, and to modulate immunologic responses. However, the effects of PCW on osteoclasts, and its detailed mechanisms are not proven. Therefore, we examined the inhibitory mechanism of PCW on osteoclast differentiation and bone resorption. MATERIALS AND METHODS: To analyze the effects of PCW on osteoclast differentiation, we examined osteoclast differentiation in bone marrow macrophages (BMMs) treated with or without of PCW by TRAP staining. The expression of c-Fos, NFATc1, TRAP and OSCAR mRNA was determined by RT-PCR and the protein levels of c-Fos, NFATc1, p38, ERK, JNK, Akt and IkappaB were assessed by western blot. Also, we evaluated the effect of PCW on bone resorption using hydroxyapatite plate. RESULTS: PCW significantly inhibited RANKL-mediated osteoclast differentiation without any evidence of cytotoxicity. We founded that PCW strongly inhibited RANKL-induced osteoclast formation when added during the early stage of cultures, suggesting that PCW acts on osteoclast precursors to inhibit RANKL/RANK signaling. Among the RANK signaling pathways, PCW inhibited the phosphorylation of p38 and JNK, also inhibited RANKL-induced expression of c-Fos, NFATc1, TRAP and OSCAR. In addition, PCW suppressed the bone resorption of mature osteoclasts. CONCLUSIONS: These findings suggest that PCW may be a potential novel drug for bone disorders by targeting the differentiation of osteoclasts as well as their functions.
Subject(s)
Arthritis, Rheumatoid , Blotting, Western , Bone Diseases , Bone Marrow , Bone Resorption , Cocos , Durapatite , Herbal Medicine , Macrophages , Osteoclasts , Osteoporosis , Phosphorylation , Poria , RNA, Messenger , WolvesABSTRACT
OBJECTIVE: The 2010 New American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for rheumatoid arthritis (RA) was raised to identify patients with early RA and replaced the 1987 ACR classification criteria. The aims of this study are to assess the availability of new classification criteria and to evaluate its potential limitation. METHODS: A total of 408 patients with newly diagnosed RA were included from 13 secondary or tertiary hospitals in South Korea. The symptom duration was less than 12 months before the diagnosis of RA. RA was defined as either 1987 ACR classification criteria or new 2010 ACR/EULAR criteria. We compared the full details of both classification criteria. RESULTS: The mean symptom duration was 5.1 months. The majority (76.2%) of the patients were female. Two hundred and seventy three patients (66.9%) fulfilled both of the 2010 and 1987 classification criteria. Forty-seven (14.7%) of the 320 patients fulfilling the 1987 criteria did not fulfill the new classification criteria. On the other hand, eighty-eight (24.4%) of the 361 patients fulfilling the 2010 ACR/EULAR classification criteria did not fulfill the 1987 ACR criteria. Thirty-six (55.4%) of the 65 patient with seronegative RA failed to meet the 2010 classification criteria. In case of seropositive RA (n=343), 85 additional patients (24.8%) could be diagnosed as RA using new classification criteria. CONCLUSION: The new 2010 ACR/EULAR classification criteria enable physicians to diagnose more patients with early RA via the help of serology. However, the sensitivity for the diagnosis of seronegative RA is projected to decrease.
Subject(s)
Female , Humans , Arthritis, Rheumatoid , Hand , Republic of Korea , Rheumatic Diseases , Tertiary Care CentersABSTRACT
It is important to identify therapeutic compounds with no adverse effects for use in the chemotherapy of patients with bone-related diseases. The aim of this study was to identify a new compound that inhibits osteoclast differentiation and bone resorption. Herein, we examined the effects of 1',2'-dihydrorotenone on osteoclast differentiation and bone resorption in vitro and in vivo. 1',2'-dihydrorotenone inhibited receptor activator of NF-kappaB ligand (RANKL)-induced osteoclast differentiation of cultured bone marrow macrophages (BMMs) in a dose-dependent manner. However, 1',2'-dihydrorotenone did not exert cytotoxic effect on BMMs. 1',2'-dihydrorotenone suppressed the expression of c-fos and NFATc1 as well as osteoclast-specific genes in BMMs treated with RANKL. Treatment with RANKL inhibited the expression of inhibitors of differentiation/DNA binding (Id)1, 2, and 3; however, in the presence of 1',2'-dihydrorotenone, RANKL did not suppress the expression of Id1, 2, and 3. Furthermore, 1',2'-dihydrorotenone inhibited bone resorption and considerably attenuated the erosion of trabecular bone induced by lipopolysaccharide treatment. Taken together, these results suggest that 1',2'-dihydrorotenone has the potential to be applied in therapies for bone-related diseases.
Subject(s)
Humans , Bone Marrow , Bone Resorption , Macrophages , Osteoclasts , Receptor Activator of Nuclear Factor-kappa B , RotenoneABSTRACT
Gout is the most common crystal-associated arthropathy. Gout is caused by deposition of monosodium urate crystals within the joints, and it is often associated with hyperuricemia. Acute gout involves the first metatarsophalangeal joint (podagra) in approximately 50% of cases and its peak incidence occurs in middle age. Although the clinical features can help with making the diagnosis of gout, many inflammatory diseases such as cellulitis, pseudogout and septic arthritis can mimic or coexist with it. The definitive diagnosis requires polarized light microscopy of the fluid aspirated from the involved joint and this shows needle-shaped, negative birefringent monosodium urate crystals. However, joint aspiration can be technically difficult, and none of the conventional imaging modalities for gout specifically identifies the chemical composition of uric acid. The advent of Dual-Energy CT (DECT) is a noninvasive method that has the potential to confirm gout and monitor the response to treatment. DECT scan can show monosodium urate deposition by using color coding. The authors performed DECT scans for detecting uric acid deposition and confirming the gout noninvasively.
Subject(s)
Humans , Middle Aged , Arthritis, Infectious , Cellulitis , Chondrocalcinosis , Clinical Coding , Gout , Hydrazines , Hyperuricemia , Incidence , Joints , Metatarsophalangeal Joint , Microscopy, Polarization , Organothiophosphorus Compounds , Uric AcidABSTRACT
Churg-Strauss syndrome is a rare systemic disorder characterized by asthma, eosionphilia and necrotizing vasculitis affecting small-to-medium-sized vessels. Although it is frequently associated with gastrointestinal mucosal lesions, recurrent bowel perforation is rare and potentially life threatening. We report a case of a 66-year-old man with Churg-Strauss syndrome, who presented with recurrent small bowel perforation. He was admitted with abdominal pain developed previous night, who had a previous small bowel perforation history treated with laparoscopic closure 5 months ago. Laboratory data showed remarkable eosinophilia. Physical examination indicated positive signs of peritoneal irritation in the entire abdomen, and abdominal computed tomography scanning showed edematous small bowel with intra-abdominal free air, suggesting intestinal perforation. He underwent laparoscopic small bowel closure and was treated with steroid.
Subject(s)
Aged , Humans , Abdomen , Abdominal Pain , Asthma , Churg-Strauss Syndrome , Eosinophilia , Intestinal Perforation , Physical Examination , VasculitisABSTRACT
Dapsone has been used for several dermatological conditions such as immunobullous disease and ulticarial vasculitis. Dapsone is very useful drug for treating the mucocutaneous manifestations of Behcet's disease. The widely recognized side effects of dapsone are headache, methemoglobinemia and hemolysis. The severer, but rarer side effect of dapsone is known as dapsone hypersensitivity syndrome, which consists of exfoliative dermatitis, hepatitis, lymphadenopathy and hemolytic anemia. When this is associated with eosinophilia, we can diagnose and treat this drug reaction with eosinophilia and systemic symptoms (DRESS). DRESS is a syndrome of fever, rash, and internal organ involvement that's secondary to administering the offending medication. We describe here a 47-year-old woman who was hospitalized with fever, skin rash, hemolytic anemia, lymphadenopathy, eosinophilia, pleural effusion and life threatening hepatitis, which could lead to hepatic failure, within three weeks of starting of dapsone therapy for controlling her oral and genital ulcers. We diagnosed the woman as suffering with DRESS syndrome and we started treatment with corticosteroid. Three weeks after starting therapy, her symptoms almost completely resolved and she was discharged.
Subject(s)
Female , Humans , Middle Aged , Anemia, Hemolytic , Behcet Syndrome , Dapsone , Dermatitis, Exfoliative , Eosinophilia , Exanthema , Fever , Headache , Hemolysis , Hepatitis , Hypersensitivity , Liver Failure , Lymphatic Diseases , Methemoglobinemia , Pleural Effusion , Stress, Psychological , Ulcer , VasculitisABSTRACT
Osteoclasts are cells of hemopoietic origin that play an critical role in bone resorption and responsible for bone diseases, including osteoporosis, periodontal disease, and rheumatoid arthritis. In this study, we examined the effect of AG490, a Jak2-specific inhibitor on osteoclast differentiation. AG490 significantly inhibited receptor activator of NF-kappaB ligand (RANKL)-mediated osteoclast differentiation in a dose-dependent manner. RANKL stimulated the phosphorylation of p38, ERK, and JNK and promoted I-kappaB degradation. However, AG490 suppressed the phosphorylation of p38 induced by RANKL treatment. AG490 suppressed the mRNA expression of TRAP, c-Fos, NFATc1, and OSCAR in bone marrow-derived macrophages (BMMs) treated with RANKL. Also, AG490 significantly inhibited the protein expression of c-Fos and NFATc1 in response to RANKL. These results suggest that AG490 inhibited osteoclast differentiation by suppressing the expression of c-Fos and NFATc1.
Subject(s)
Arthritis, Rheumatoid , Bone Diseases , Bone Resorption , Macrophages , Osteoclasts , Osteoporosis , Periodontal Diseases , Phosphorylation , Receptor Activator of Nuclear Factor-kappa B , RNA, Messenger , TyrphostinsABSTRACT
Many drugs have been known to induce lupus-like syndrome, composing approximately 10% of all SLE cases. Isoniazid-induced lupus erythematosus affects either sex equally and the most common presenting feature is arthralgia or arthritis with anemia. Fever and pleuritis occur in approximately half of the cases, and pericarditis in approximately 30% of cases. We discribe a 28-year-old woman receiving antituberculous medications including isoniazid for one month. She was hospitalized with fever, arthralgia and newly developed pleural effusion The analysis of pleural fluid and serum revealed an elevated level of antinuclear antibody. We suspected of drug induced lupus and stopped isoniazid medication. After discontinuation of isoniazid and short course of prednisolone treatment, her symptoms and pleural effusion disappeared. This case is to our knowledge, the fist report of isoniazid induced SLE in Korea.
Subject(s)
Adult , Female , Humans , Anemia , Antibodies, Antinuclear , Arthralgia , Arthritis , Fever , Isoniazid , Korea , Lupus Erythematosus, Systemic , Pericarditis , Pleural Effusion , Pleurisy , PrednisoloneABSTRACT
Sphingosine 1-phosphate (S1P) is a bioactive lipid molecule that mediates cell proliferation, differentiation, migration, and angiogenesis in vivo. However, the roles of S1P on pathogenesis of arthritis have been not completely understood. This study was designed to determine the effects of S1P modulation on collageninduced arthritis (CIA) model. DBA/1J mice were injected with collagen into the tail for induction of CIA model. S1P was administered into the peritoneal cavity every other days from day 1 to day 42 after collagen injection. To determine the degree of damage in CIA, we examined macroscopic findings of CIA. The inflammation and bone destruction of CIA mice were evaluated by histo-patholigy and radiography (CT and microradiography). The expressions of TNF-alpha, IL-6, and RANKL which have important roles in pathogenesis of rheumatoid arthritis and bone destruction were observed by immuno-histochemical staining. After injection with collagen in the DBA/1J mice, CIA was induced by swelling in the knee and ankle joint. Administration of S1P suppressed damages and incidence of arthritis elicited by collagen. In histologic and radiographic studies, S1P strongly suppressed the infiltration of inflammatory cells, the swelling of synovial membrane, erosion, and the destruction of bone on CIA mice. Injection of S1P resulted in down-regulation of the expression of the pro-inflammatory and bone destruction mediators such as TNF-alpha, IL-6, and RANKL on CIA mice. Furthermore, S1P suppressed the differentiation of bone marrow cells into osteoclasts by RANKL. In conclusion, this study suggest that S1P has protective effects on inflammation and bone destruction during pathogenesis of CIA, which indicates S1P can be a new possible therapeutic strategy for rheumatoid arthritis