Effectiveness and safety of secukinumab in ankylosing spondylitis and psoriatic arthritis: a 52-week real-life study in an Italian cohort

Abstract Background Secukinumab has shown high efficacy in randomized controlled trials in both ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Here, we investigated its real-life effectiveness and tolerability in a cohort of AS and PsA patients. Methods We retrospectively analyzed medical records of outpatients with AS or PsA treated with secukinumab between December 2017 and December 2019. ASDAS-CRP and DAS28-CRP scores were used to measure axial and peripheral disease activity in AS and PsA, respectively. Data were collected at baseline and after 8, 24, and 52 weeks of treatment. Results Eighty-five adult patients with active disease (29 with AS and 56 with PsA; 23 males and 62 females) were treated. Overall, mean disease duration was 6.7 years and biologic-naïve patients were 85%. Significant reductions in ASDAS-CRP and DAS28-CRP were observed at all time-points. Body weight (in AS) and disease activity status at baseline (particularly in PsA) significantly affected disease activity changes. ASDAS-defined inactive disease and DAS28-defined remission were achieved in comparable proportions between AS and PsA patients, at both 24 weeks (45% and 46%) and 52 weeks (65.5% and 68%, respectively); male sex was found an independent predictor of positive response (OR 5.16, P = 0.027). After 52 weeks, achievement of at least low disease activity and drug retention were observed in 75% of patients. Secukinumab was well-tolerated and only mild injection-site reactions were recorded in 4 patients. Conclusion In a real-world setting, secukinumab confirmed great effectiveness and safety in both AS and PsA patients. The influence of gender on treatment response deserves further attention.

Efficacy and safety of different Janus kinase inhibitors combined with methotrexate for the treatment of rheumatoid arthritis: a single-center randomized trial

Abstract Objective To compare the efficacy and safety between baricitinib (BARI) and tofacitinib (TOFA) for the treatment of the rheumatoid arthritis (RA) patients receiving methotrexate (MTX) in clinical practice. Methods This retrospective study recruited 179 RA patients treated with BARI (2-4 mg/d) or TOFA (10 mg/d) at The First Affiliated Hospital of Guangxi Medical University from September 2019 to January 2022. The rate of low disease activity (LDA) was used as the primary end point. Secondary end points included the Disease Activity Scale-28 (DAS-28)-C-reactive protein (CRP); the rate of DAS28-CRP remission; visual analogue scale (VAS) for pain, swollen joint, and tender joint counts; and adverse events at the 6-month follow-up. Several factors affecting LDA achievement were also analyzed. Results Seventy-four patients were treated with BARI and 105 were treated with TOFA, including 83.24% females, with a median (IQR) age of 56.0 (53.0-56.0) years old and disease duration of 12.0 (6.0-12.0) months. There was no difference of the rate of LDA between the BARI and TOFA treatment groups. All disease indices in the two groups were significantly improved, including a significantly lower VAS in the BARI group (P < 0.05), reflecting the drug efficacy after 1 and 6 months of treatment. The incidence of adverse reactions was similar in these two groups. Conclusion The treatment efficacy and safety of BARI and TOFA in the RA patients were similar, but BARI was more effective in pain relief than TOFA. An older baseline age was more likely to achieve LDA in the BARI group, while a low baseline erythrocyte sedimentation rate (ESR) was more likely to achieve LDA in the TOFA group.

HLA-G 3’UTR polymorphisms & response to a yoga-based lifestyle intervention in rheumatoid arthritis: A randomized controlled trial

Background & objectives: Human leucocyte antigen (HLA)-G plays a vital role in immunomodulation in rheumatoid arthritis (RA). The mounting evidence suggests a link between HLA-G gene polymorphisms, disease susceptibility and methotrexate treatment response. Various environmental factors influence the onset and progression of RA and its treatment outcomes. The aim is to identify the treatment response of HLA-G 3’ untranslated region polymorphisms to yoga-based lifestyle intervention (YBLI). Methods: In this eight-week single-blinded randomized controlled trial (CTRI/2017/05/008589), patients with RA (n=140) were randomized into two groups namely, yoga group or non-yoga group. Baseline genomic DNA was isolated using salting-out method. PCR-based methods were used for genotyping. The levels of soluble (s) HLA-G and disease activity were assessed by ELISA and disease activity score-28–erythrocyte sedimentation rate (DAS28-ESR), respectively, at baseline (day 0) and after eight weeks of intervention. Results: Low-producing sHLA-G genotypes, i.e. +3142GG and 14 bp ins/ins, showed a significant increase in sHLA-G levels after YBLI. The association analysis between HLA-G polymorphisms and treatment for RA showed no considerable differential treatment remission in either of the groups (P>0.05). The percentages of improvement were higher in the yoga group as compared to the non-yoga group in both the HLA-G +3142G>C and 14 bp ins/del polymorphisms irrespective of their respective genotypes. No significant association was found between sHLA-G levels and disease activity with respect to genotypes. Interpretation & conclusions: Yoga intervention results in improvement and reduced severity of RA in patients irrespective of the HLA-G 14 bp ins/del or +3142G>C polymorphisms. YBLI may be used as an adjunct therapy in RA independent of the genotypes

Cross sectional study evaluating the correlation of thyroid dysfunction with severity of disease in rheumatoid arthritis

Background: The present study was conducted to evaluate the correlation of disease severity in RA and thyroid dysfunction.Methods: The present cross-sectional descriptive study enrolled 164 participants aged 12 years and above diagnosed as having RA. Use of drugs causing thyroid dysfunction, malignancy, diabetes mellitus, systemic hypertension, pregnancy and prior thyroidectomy were the criteria for exclusion. Data was analyzed using R and tests of significance were Chi square test and independent sample t-test and Pearson correlation. Institutional ethics committee approved the study and written informed consent was obtained from all study participants.Results: Serum TSH positively correlated with DAS 28 (r=0.2, p=0.005), ESR (r=0.2, p=0.03), CRP (r=0.2, p=0.006), RA factor (r=0.2, p=0.003), subjective assessment (r=0.3, p= 0.001) and anti TPO antibodies (r=0.7, p=0.001). Free T4 negatively correlated with DAS28 (r=-0.2, p=0.006), ESR (r=-0.2, p=0.02), CRP (r=-0.2, p=0.01). RA factor (r=-0.2, p=0.01), subjective assessment (r=-0.2, p= 0.01), anti TPO (r=-0.6, p=0.001) and Free T3 negatively correlated with DAS28 score (r=-0.2, p=0.02) , ESR (r=-0.2, p=0.03), RA factor (r=-0.3, p=0.001) and anti TPO antibodies (r=- 0.3, p=0.001).Conclusions: Hypothyroidism was significantly associated with disease severity of RA with linear positive correlation of TSH with DAS28 score, ESR, CRP, RA factor, subjective assessment and anti TPO antibodies, linear negative correlation of serum free T4 with DAS 28 score, ESR, CRP, RA factor, subjective assessment and anti TPO antibody and linear negative correlation of free T3 with DAS28 score, ESR, RA factor and anti TPO antibody was observed.

The plasma Tumor Necrosis Factor-α (TNF-α) does not have any correlation with disease activity in rheumatoid arthritis patients treated with disease modifying anti-rheumatic drugs (DMARDs)

We performed this study to measure the Tumor Necrosis Factor-alpha (TNF-α) plasma level and to survey its correlation with disease activity in the newly diagnosed Rheumatoid Arthritis (RA) patients and those who were under treatment with the combination of Disease-Modifying Anti-Rheumatic Drug (DMARD) plus Prednisolone (PSL).We enrolled 30 newly diagnosed RA patients who received no treatment regarding their disease, 30 patients under treatment with the combination of Methotrexate (MTX) + Hydroxychloroquine (HCQ) + PSL and 30 healthy subjects in this case-control study from September 2017 to December 2017. The level of plasma TNF-α was measured by enzyme-linked immunosorbent assay (ELISA) in each group. For assessment of disease severity, we used Disease Activity Score-28 (DAS-28) formula, and regarding DAS-28, we divided patients into four groups, including remission, low, moderate and high disease activity. There were no significant differences in the plasma level of TNF-α between the newly diagnosed RA patients and subjects who received MTX + HCQ + PSL, as well as healthy controls (p>0.05). There was a significant correlation between plasma levels of TNF-α and DAS-28 in the newly diagnosed patients with RA (r = 0.594, P = 0.001). Targeting TNF-α at the early stage of RA could have more beneficial effects on the amelioration of disease activity

Factors affecting carotid intimal medial thickness in patients with rheumatoid arthritis, an analytical cross-sectional study

Background: IMT assessment as a non-invasive imaging test is quite widely used especially among RA patients, the clinical applications of using such knowledge is scarce, hence study was conducted to compare the carotid artery intima-media thickness (CIMT) in patients with rheumatoid arthritis (RA) with healthy controls also to study the correlation between duration of rheumatoid arthritis, the activity of rheumatoid arthritis and other factors influencing (CIMT).Methods: In analytical cross-sectional study, of 80 participants of RA and 40 healthy controls, “DAS28” was used to assess disease activity. Carotid intima-media thickness assessed using carotid ultrasonography.Results: Mean age of the cases and controls was 43.9 and 44.38 years. Subjects with duration of disease <2 years, to 5 years and >5 years were 35%, 45% and 20%. The mean carotid intima-media thickness was 5.61mm in controls, and CIMT was 6.11mm in people below 2 years and 7.08 mm in people between 2 to 5 years and 8.00mm in people above 5 years which was statistically significant. The mean carotid intima-media thickness was 5.61mm controls and 6.86mm in people with low, 7.00mm in people with moderate and 6.95mm in people with high disease activity, which was statistically significant.Conclusions: Study findings revealed risk of increase in carotid intima-media thickness higher among RA patients in the later stages and can increase the patients’ susceptibility to cardiovascular events. The factors showing strong association with intimal medial thickness were the age and symptoms duration.

Study of Prognostic Significance of Anti Cyclic Citrullinated Peptide Antibodies in Patients with Rheumatoid Arthritis

Background: Rheumatoid arthritis is a chronic autoimmune inflammatory disease with articular and extra-articular manifestation that affects 0.5 to 1 % of total population. Aim and Objectives: To correlate Rheumatoid factor (RF) and Anti-CCP antibody in RA, to evaluate prognostic value of RF and Anti-CCP antibody in RA. Materials and methods: Retrospective study of total 50 patients admitted to our hospital from January 2018 to December 2018 was done. All patients were diagnosed as rheumatoid arthritis as per diagnostic criteria of American College of Rheumatology. All patients had symptom duration of at least one Year. Anti-CCP and lgM-RF were evaluated in all patients. Disease activity score 28 was calculated in all patients. Radiological Damage was assessed by Larsen Score. Results: Anti-CCP and RF were significantly correlated with each other and both were seen as significant independent predictors of radiological outcomes (p value 0.01 and <0.05 respectively). Combination of these two had highest risk for erosive joint damage. Conclusion: RA is more common in female. Anti-CCP antibody and RF both in combination were associated with higher probabilities of erosive disease.

Disease activity is associated with LV dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease

Abstract Objectives: The cross-sectional study aimed to assess left ventricular systolic function using global longitudinal strain (GLS) by speckle-tracking echocardiography (STE) and arterial stiffness using cardio-ankle vascular index (CAVI) in Thai adults with rheumatoid arthritis (RA) and no clinical evidence of cardiovascular disease (CVD). Methods: Confirmed RA patients were selected from a list of outpatient attendees if they were 18 years (y) without clinical, ECG and echocardiographic evidence of CVD, diabetes mellitus, chronic kidney disease, and excess alcoholic intake. Controls were matched with age and sex to a list of healthy individuals with normal echocardiograms. All underwent STE and CAVI. Results: 60 RA patients (females = 55) were analysed. Mean standard deviation of patient and control ages were 50 ± 10.2 and 51 ±9.9 y, respectively, and mean duration of RA was 9.0 ± 6.8 y. Mean DAS28-CRP and DAS28-ESR were 2.9 ± 0.9 and 3.4 ± 0.9, respectively. There was no between-group differences in left ventricular ejection fraction (LVEF), LV sizes, LVMI, LV diastolic function and CAVI were within normal limits but all GLSs values was significantly lower in patients vs. controls: 17.6 ± 3.4 vs 20.4 ± 2.2 (p = 0.03). Multivariate regression analysis demonstrated significant correlations between GLSs and RA duration (p = 0.02), and GLSs and DAS28-CRP (p = 0.041). Conclusions: Patients with RA and no clinical CV disease have reduced LV systolic function as shown by lower GLSs. It is common and associated with disease activity and RA disease duration. 2D speckle-tracking GLSs is robust in detecting this subclinical LV systolic dysfunction.

Expression and clinical significance of serum miRNAs in patients with rheumatoid arthritis / 临床检验杂志

Objective@#To investigate the expression levels and clinical significance of serum miRNAs, including miR-146a-5p, miR-155-5p and miR-124a-3p, in patients with rheumatoid arthritis (RA). @*Methods@#The clinical data, whole blood and serum samples from 39 RA patients hospitalized in our hospital during October 2016 and October 2018 were collected. Whole blood specimens were used to determine erythrocyte sedimentation rate (ESR), and serum samples were used to detect rheumatoid factor (RF), C-reaction protein (CRP) and miRNAs. The expression levels of serum miR-146a-5p, miR-155-5p and miR-124a-3p in RA patients were detected by SYBR Green real-time fluorescence quantitative PCR. @*Results@#The expression levels of serum miR-146a-5p (1.742±1.058) in RA patients before treatment were significantly higher than that in healthy controls (HC, 1.045±0.772), which were positively correlated with DAS28 scores (r=0.836 5,P=0.004 5), ESR (r=0.437 2, P=0.032 5) and RF levels (r=0.733 6,P=0.013 7). However, the expression levels of serum miR-155-5p (U=42.00,P=0.032 9) and miR-124a-3p (U=44.5,P=0.044 5) in RA patients were significantly lower than that in HC, and the expression levels of serum miR-155-5p were negatively correlated with RF levels (r=-0.445 3,P=0.031 6), and the expression levels of serum miR-124a-3p were negatively correlated with DAS28 scores (r=-0.538 7,P=0.025 8) and RF levels (r=-0.436 5,P=0.046 3). After treatment, the expression levels of serum miR-146a-5p (U= 60.00,P=0.003 8) in RA patients were significantly decreased, while the expression levels of serum miR-155-5p (U=64.00,P=0.005 9) and miR-124a-3p (U=85.00,P=0.042 2) were significantly increased. @*Conclusion@#The abnormal expression levels of serum miR-146a-5p, miR-155-5p and miR-124a-3p in RA patients have potential clinical significance for the diagnosis of RA.

Expression of regulatory B cells in rheumatoid arthritis and its correlation with disease severity / 临床检验杂志

Objective@#To investigate the IL-10+CD19+ regulatory B cells (Breg) in peripheral blood of patients with rheumatoid arthritis (RA), and analyze the correlation between the expression of IL-10+CD19+ Breg cells and disease severity. @*Methods@#A total of 40 patients with active RA and 30 healthy individuals (healthy controls, HC) were involved in this study. The peripheral blood mononuclear cells (PBMC) were isolated. The isolated PBMC were co-cultured with CpG oligodeoxynucleotide 2006 (CpG ODN 2006) and phorbol myristate acetate (PMA) in vitro. Flow cytometry was employed to analyze the expression of Breg before and after stimulation. The correlations of Breg expression with ESR, CRP and DAS28 were analyzed. @*Results@#Before stimulation in vitro, the expression of Breg in PBMC of RA group and HC group were 1.92%(1.58%, 2.56%) and 2.04%(1.73%, 2.93%) respectively. There was no significant difference between the two groups (P=0.258). After induction in vitro, the expression of Breg of RA group [13.00%(9.75%, 14.85%)] was significantly higher than that of HC group [9.12%(6.83%, 10.22%)], P＜0.001. Spearman correlation analysis showed that Breg expression was negatively correlated with DAS28 (P=0.002), but not with ESR and CRP (P＞0.05). @*Conclusion@#The expression of Breg was significantly increased after stimulation in vitro and negatively correlated with DAS28, which indicated Breg may play important regulatory roles in pathogenesis and development of RA.

Acupuncture combined with western medicine on rheumatoid arthritis and effects on blood stasis / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical efficacy of acupuncture combined with western medicine in the treatment of rheumatoid arthritis (RA) and its effect on blood stasis, and to explore ways to improve the clinical curative effect.</p><p><b>METHODS</b>A total of 56 patients of RA were randomly divided into an observation group and a control group, 28 cases in each one. ① ibuprofen sustained-release tablets, 2 times a day, each time 0.3 g; ② methotrexate tablets (MTX), once a week, each time 10 mg ③ folic acid tablets, once a week, each time 5 mg were given in the control group, 30 days as one course, a total of 3 courses were required. In the observation group, acupuncture was adopted on the basis of the treatment as the control group. The main acupoints were Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23), Hegu (LI 4), Quchi (LI 11), Zusanli (ST 36) combined with local points. The treatment was given once every day for continuous 6 days a week, the treatment for 30 days as one course, a total of 3 courses were required. The serological indexs were evaluated before and after treatment, including the rheumatoid factor (RF), hypersensitive C-reactive protein (hs-CRP), erythrocyte sedirnentation rate (ESR), platelet (PLT), fibrinogen (FBG) and D-dimer (D-D), the changes of disease activity score (DAS-28), symptom grade quantitative score, blood stasis syndrome symptom (the joint tingling, lip color, tongue, pulse, subcutaneous ecchymosis, squamous and dry skin) score were observed.</p><p><b>RESULTS</b>① The scores of RF, hs-CRP, ESR, PLT, D-D, FBG, DAS-28 and symptom grade quantitative were significantly improved in the two groups compared with those before treatment (all <0.05), and the scores of hs-CRP, ESR, DAS-28 and symptom grading in the observation group were more better than those in the control group (all <0.05). ② The total score of joint tingling, lip color, tongue, pulse, subcutaneous ecchymosis, squamous and dry skin and blood stasis syndrome in both groups were decreased after treatment (all <0.05), the joint tingling, tongue, lip color and subcutaneous ecchymosis were improved obviously in the observation group than those in the control group (all <0.05). ③ The total effective rate in the observation group was 85.7% (24/28), which was better than 75.0% (21/28) in the control group (<0.05).</p><p><b>CONCLUSION</b>Acupuncture combined with western medicine can not only improve the clinical efficacy of RA patients but also improve the blood stasis.</p>

The usefulness of osteocalcin measurements in Malaysian patients with rheumatoid arthritis

Objective: Rheumatoid arthritis (RA) is a chronic inflammatory condition that can be associated with abnormal bone turnover and hence osteoporosis. Osteocalcin (OC) levels are increased in conditions with high bone turnover, including high RA disease activity. Thus, OC levels could possibly be used as a marker to assess bone health and disease activity in RA patients. As there have been no previous studies looking at serum OC levels in Malaysian RA patients, this study was performed to examine possible correlations between OC, bone mineral density (BMD) and disease activity in this population.Methods: A cross-sectional study of 75 female RA patients and 29 healthy controls was performed. Serum OC was measured using a Quantikine® ELISA kit. Dual-energy x-ray absorptiometry (DXA) was used to assess BMD.Results: Serum OC levels were not significantly different between RA patients (median 14.44 ng/mL, interquartile range [IQR 12.99]) compared to healthy controls (median 11.04 ng/mL IQR 12.29) (p=0.198). Serum OC increased with age (Spearman’s rho r=0.230, p=0.047). There was no significant correlation between serum OC and body mass index (BMI), menopause status, BMD, DAS28, swollen or tender joint counts. Overall, there were 11 (14.7%) patients with osteoporosis and 27 (36.0%) with osteopenia. Menopause status was significantly associated with BMD at all sites (lumbar spine p=0.002, femoral neck p=0.004, total hip p=0.002). Conclusions: Serum OC were similar in RA patients compared to healthy controls. In RA patients, serum OC did not correlate with RA disease activity or BMD. Menopause status remains an important influence on BMD. Thus, measuring serum OC levels in Malaysian RA patients was not useful in identifying those at risk of low BMD.

Observations on the Efficacy of Warm Needling Moxibustion plus Medication for Rheumatoid Arthritis / 上海针灸杂志

Objective To investigate the efficacy of warm needling moxibustion plus medication for rheumatoid arthritis.Methods One hundred patients with rheumatoid arthritis were randomly allocated to two groups (treatment and control) by using random number table method, 50 cases each. The treatment group received warm needling moxibustion plus medication as combined therapy and the control group, oral administration of drugs alone. In both groups, treatment was given 10 times as a course, for a total of two courses. The DAS 28 score was recorded and rheumatoid factor (RF) was determined in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups.Results The total efficacy rate was 100％ in the treatment group and 86.0％ in the control group; there was a statistically significant difference between the two groups (P<0.05). There were no statistically significant post-treatment differences in DAS 28 score and RF between the two groups (P>0.05). There were statistically significant differences in pre-/post-treatment DAS 28 score difference value and RF difference value in the two groups (P<0.05).Conclusion Warm needling moxibustion plus medication is clinically more effective than oral administration of drugs alone in treating rheumatoid arthritis.

Observations on the Efficacy of Warm Needling Moxibustion plus Medication for Rheumatoid Arthritis / 上海针灸杂志

Objective To investigate the efficacy of warm needling moxibustion plus medication for rheumatoid arthritis.Methods One hundred patients with rheumatoid arthritis were randomly allocated to two groups (treatment and control) by using random number table method, 50 cases each. The treatment group received warm needling moxibustion plus medication as combined therapy and the control group, oral administration of drugs alone. In both groups, treatment was given 10 times as a course, for a total of two courses. The DAS 28 score was recorded and rheumatoid factor (RF) was determined in the two groups before and after treatment. The clinical therapeutic effects were compared between the two groups.Results The total efficacy rate was 100％ in the treatment group and 86.0％ in the control group; there was a statistically significant difference between the two groups (P<0.05). There were no statistically significant post-treatment differences in DAS 28 score and RF between the two groups (P>0.05). There were statistically significant differences in pre-/post-treatment DAS 28 score difference value and RF difference value in the two groups (P<0.05).Conclusion Warm needling moxibustion plus medication is clinically more effective than oral administration of drugs alone in treating rheumatoid arthritis.

Comparing Effectiveness Rituximab (Mabthera®) to Other Second-line Biologics for Rheumatoid Arthritis Treatment in Patients Refractory to or Intolerant of First-line Anti-tumor Necrosis Factor Agent: An Observational Study

OBJECTIVE: Failure of first-line anti-tumor necrosis factor (TNF) agents in in rheumatoid arthritis patients leads to decisions among second-line biologic agents. To better inform these decisions, the therapeutic effectiveness of rituximab is compared with other second-line biologic agents in this observational study. METHODS: Between November 2011 and December 2014, study subjects were observed for 12 month periods. Patients with an inadequate response to initial anti-TNF agent received either rituximab or alternative anti-TNF agents (adalimumab/etanercept/infliximab) based on the preference of patients and physicians. The efficacy end point of this study was the change in 28-joint count Disease Activity Score (DAS28) at six and 12 months from baseline. Safety data were also collected. RESULTS: Ninety patients were enrolled in the study. DAS28 at six months did not change significantly whether the patients were treated with rituximab or alternative anti-TNF agents in intention-to-treat analysis (n=34, −1.63±0.30 vs. n=31, −2.05±0.34) and standard population set analysis (n=31, −1.51±0.29 vs. n=24, −2.21±0.34). Similarly, the change in DAS28 at 12 months did not reach statistical significance (−1.82±0.35 in the rituximab vs. −2.34±0.44 in the alternative anti-TNF agents, p=0.2390). Furthermore, the incidences of adverse events were similar between two groups (23.5% for rituximab group vs. 25.8% for alternative anti-TNF agents group, p=0.7851). CONCLUSION: Despite the limitations of our study, switching to rituximab or alternative anti-TNF agents after failure of the initial TNF antagonist showed no significant therapeutic difference in DAS28 reduction.

Artritis reumatoide temprana: resultados clínicos y funcionales de una cohorte en un centro de alta complejidad, Cali-Colombia / Early rheumatoid arthritis: Clinical and functional outcomes of a cohort treated in a high complexity hospital, Cali-Colombia

La artritis reumatoide (AR) es una enfermedad crónica, inflamatoria, autoinmune y multisistémica, cuyo principal blanco es la membrana sinovial. El manejo adecuado y temprano mejora la evolución y pronóstico de la enfermedad. Objetivo: Evaluar los resultados clínicos y funcionales en pacientes con AR temprana. Metodología: Estudio observacional, con seguimiento longitudinal, de una cohorte de pacientes con AR temprana de menos de 12 meses de evolución, clasificados según los criterios de la Liga Europea Contra el Reumatismo y del Colegio Americano de Reumatología (ACR 2010). Se tuvieron en cuenta los criterios de remisión según la Escala de Actividad de la Enfermedad (DAS28-VSG) y el índice de actividad clínica de la enfermedad. Estado funcional según Cuestionario modificado de Evaluación de la Salud. Resultados: Se analizaron 99 pacientes. La edad promedio de los pacientes fue de 47,8 ± 15,5 años, el 93%(92) eran mujeres. Todos los pacientes fueron tratados con fármacos antirreumáticos modificadores de la enfermedad sintéticos. Durante el seguimiento a los 3 meses se observó una disminución significativa en los puntajes del DAS28y actividad clínica de la enfermedad respecto al valor en la visita basal (p <0,05). No se encontraron diferencias significativas en la evolución de pacientes diagnosticados antes y después de 3 meses desde el inicio de los síntomas (p>0,05). Conclusiones: Se evidencia mejoría sustancial de los pacientes con AR temprana tratados durante el primer año de inicio de los síntomas. El seguimiento continuo y periódico de la patología es una herramienta indispensable para evaluar el progreso de la enfermedad y hacer ajustes en el manejo terapéutico

Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune multisystemic disease that affects the synovial joints. An appropriate and early management improves prognosis and course of the disease. Objective: To evaluate the clinical and functional outcomes of patients with RA. Methodology: Observational study with longitudinal follow up in a cohort of patients with early RA, with less than 12 months of evolution, classified according to the European League Against Rheumatism and American College of Rheumatology (ACR 2010) criteria. Remission criteria were taking into account according to Disease Activity Scale (DAS28-VSG), clinical activity disease index, and functional status according to Modified Health Assessment Questionnaire. Results: The analysis included 99 patients with a mean age of 47.8 + 15.5 years, and of which 92 (93%) were women. All patients were treated with synthetic disease-modifying antirheumatic drugs. At 3 months of follow-up, a significant decrease was observed in DAS28 scores and clinical activity disease index compared to the value at baseline values (p<.05). No significant differences were found between patients diagnosed before and after 3 months from onset of symptoms (p>.05). Conclusions: A substantial improvement was observed in patients with early RA treated during first year from onset symptoms. Continuous and periodic monitoring of the pathology is an indispensable tool for evaluating disease progress and making adjustments in the therapeutic management

Efficacy and Safety Assessment for Treating Active Rheumatoid Arthritis Patients by Integrated Traditional Chinese and Western Medicine / 中国中医药信息杂志

Objective To evaluate the clinical efficacy and safety of integrated traditional Chinese and Western medicine in treating active rheumatoid arthritis (aRA).Methods A prospective randomized controlled study was carried out. Totally 148 aRA patients were divided into the control group and the treatment group, 74 cases in each group. Control group was treated with MTX (methotrexate) and LEF (leflunomide), while the treatment group took traditional Chinese medicine based on syndrome differentiation, on the basis of treatment with MTX and LEF. The therapeutic course for all was 3 months. Efficacy indexes, like clinical symptoms and signs, ESR, TCM syndrome integrals, DAS 28 score, and safety indexes were observed.Results This study finally completed 136 cases, including 69 cases in the treatment group and 67 cases in the control group. In the two groups, significant improvement of clinical signs and symptoms, ESR, DAS28, and TCM syndrome integrals after treatment were shown, with statistical significance (P0.05). The significant efficiency of the treatment group was 11.59% (8/69), and the control group was 5.97% (4/67), with statistical significance (P<0.05). Adverse reactions occurred fewer in the treatment group than in the control group (P<0.01).Conclusion Compared with single traditional Chinese medicine, integrated traditional Chinese and Western medicine for treating aRA can better improve DAS28 and TCM syndrome integrals, and reduce the incidence of adverse reactions.

Therapeutic Observation of Electroacupuncture in Treating Rheumatoid Arthritis Due to Liver-kidney Yin Deficiency / 上海针灸杂志

Objective To observe the clinical efficacy of electroacupuncture plus oral administration ofZeling Guanjie Xiaozhong Heji in treating rheumatoid arthritis (RA) due to liver-kidney yin deficiency.Method Totally 126 patients with active RA due to liver-kidney yin deficiency were randomized into a treatment group and a control group, 63 cases in each group. The control group was prescribed with orally taking Methotrexate tablets and Leflunomide tablets, while the treatment group was intervened by electroacupuncture plus oral administration ofZeling Guanjie Xiaozhong Heji in addition to the medications given to the control group. The Disease Activity Score 28 (DAS28) was evaluated before and after intervention, and the therapeutic efficacies were compared based on the criteria of the American College of Rheumatoid (ACR) and syndrome of traditional Chinese medicine (TCM).Result The ACR total effective rate was 87.3% in the treatment group versus 65.1% in the control group, and the difference was statistically significant (P<0.01). The total effective rate based on TCM syndrome was 87.3% in the treatment group versus 73.0% in the control group, and the difference was statistically significant (P<0.05). There was a significant difference in comparing the DAS28 score between the two groups after intervention (P<0.01).Conclusion Electroacupuncture plus oral administration of Chinese medication and western medication is an effective approach in treating RA due to liver-kidney yin deficiency, and it can significantly enhance the therapeutic efficacy based on ACR20 and TCM syndrome.

Comparison of Disease Activity Score 28 Using C-reactive Protein and Disease Activity Score 28 Using Erythrocyte Sedimentation Rate in Assessing Activity and Treatment Response in Rheumatoid Arthritis: A Meta-analysis

OBJECTIVE: We compared the Disease Activity Score 28 (DAS28) using C-reactive protein (DAS28-CRP) with DAS28 using erythrocyte sedimentation rate (DAS28-ESR) in assessing rheumatoid arthritis (RA) activity and determining European League Against Rheumatism (EULAR) response criteria. METHODS: We searched the PubMed, EMBASE, and Cochrane databases and performed a meta-analysis to examine comparisons between DAS28-CRP and DAS28-ESR by RA activity and EULAR response criteria. RESULTS: A total of ten studies were included in this meta-analysis. Significantly more patients were classified as having remission or low disease activity when using DAS28-CRP than when using DAS28-ESR (odds ratio [OR]=1.869, 95% confidence interval [CI]=1.180 to 2.959, p=0.008; OR=1.411, 95% CI=1.256 to 1.586, p=7.0×10⁻⁸), whereas fewer patients were classified as having high disease activity when using DAS28-CRP than when using DAS28-ESR (OR=0.534, 95% CI=0.388 to 0.734, p=1.1×10⁻⁴). More patients were classified as having good response with criteria were based on DAS28-CRP than with DAS28-ESR (OR=1.390, 95% CI=1.183 to 1.632, p=6.10×10⁻⁵). CONCLUSION: Our meta-analysis demonstrates that DAS28-CRP underestimates disease activity and overestimates response by the EULAR response criteria compared to DAS28-ESR.