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Presentación del caso. Se trata de una mujer de 26 años de edad, en seguimiento por la especialidad de reumatología desde los 17 años, cuando consultó con historia de un año de evolución de síndrome poliarticular de grandes y pequeñas articulaciones, aditivo, simétrico acompañado de fatiga, rigidez matutina mayor de una hora. Se reportó además factor reumatoide positivo. La radiografía de ambas manos presentó erosiones, que confirmó el diagnóstico de artritis reumatoide. Adicionalmente, la paciente tenía el antecedente de procesos sinobronquiales a repetición desde su infancia. En la evaluación médica se identificó dolor en los senos paranasales, dextrocardia y bronquiectasias, confirmados por los estudios de imágenes, que permitió concluir en el diagnóstico de síndrome de Kartagener. Intervención terapéutica. La paciente presentaba actividad clínica severa de la artritis reumatoide, se inició el tratamiento con metotrexato 10 mg vía oral un día a la semana, prednisona 5 mg al día y ácido fólico 5 mg a la semana y citas periódicas, controlando los datos de actividad y efectos adversos de los medicamentos, con pruebas hepáticas, hemograma y transaminasas. La especialidad de neumología recomendó la inclusión de la paciente en un programa de rehabilitación respiratoria, así como el uso de azitromicina 500 mg cada día por tres días en los períodos de agudización. Evolución clínica. El tratamiento logró mantener una actividad leve de la artritis reumatoide y sin exacerbación de los síntomas respiratorios
Case presentation. A 26-year-old woman, under follow-up by the rheumatology specialty since she was 17 years old, when she consulted with a history of one year of evolution of polyarticular disease of large and small joints, additive, symmetrical, accompanied by fatigue and morning stiffness for more than one hour. Positive rheumatoid factor was also reported. Additionally, the patient had a history of repeated sinobronchial processes since childhood. Medical examination revealed sinus pain in the paranasal sinuses, dextrocardia, and bronchiectasis, confirmed by imaging studies, which led to the diagnosis of Kartagener's syndrome. Treatment. The patient presented the severe clinical activity of rheumatoid arthritis. The treatment was started with methotrexate 10 mg orally one day a week, prednisone 5 mg a day, and folic acid 5 mg a week and periodic appointments, controlling the activity data and adverse effects of the drugs, with liver tests, hemogram, and transaminases. The pneumology department recommended the inclusion of the patient in a respiratory rehabilitation program as well as the use of azithromycin 500 mg every day for three days during periods of exacerbation. Outcome. The treatment was successful in maintaining a mild activity of the rheumatoid arthritis and without exacerbation of respiratory symptoms
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Humans , Female , Adult , El SalvadorABSTRACT
Purpose To assess the right atrial and right ventricular strain and right ventricular-pulmonary artery(RV-PA)coupling in rheumatoid arthritis(RA)via two-dimensional speckle tracking.Materials and Methods Sixty patients with RA in the General Hospital of Ningxia Medical University from June 2020 to June 2022 were prospectively selected,and all RA patients were divided into three groups according to pulmonary artery systolic pressure(PASP),including group A(n=20 cases)with PASP<33 mmHg,group B(n=20 cases)with PASP 33-39 mmHg as mild ePH,and group C(n=20 cases)PASP≥40 mmHg,twenty healthy individuals were selected as the control group.All subjects underwent transthoracic echocardiography,and right atrial and right ventricular systolic function was assessed by two-dimensional speckle tracking technique,and RV-PA coupling was assessed noninvasively by right ventricular free wall strain/pulmonary artery systolic pressure(RV FWS/PASP),pulmonary function was analyzed by pulmonary function instruments.Spearman's analysis was used to analyze the correlation between right heart function and RV-PA coupling to pulmonary diffusion function.Results There were statistical differences in right ventricular base diameter,right atrium diameter,tricuspid annular plane systolic excursion,inferior vena cava diameter,PASP,right ventricular global strain,RV FWS,right atrium strain-reservoi,right atrium strain-conduit(S-CD),RV FWS/PASP among the four groups(F/H=2.369-74.880,all P<0.05).Right atrium strain-reservoi[(36.0±7.9)%vs.(30.9±7.8)%],right atrium S-CD[(19.9±6.9)%vs.(15.3±4.7)%]and RV FWS/PASP(0.96±0.19 vs.0.56±0.13)in group B were significantly lower than those of group A(t=2.040,2.262,7.704,all P<0.05).There was a good correlation between diffusing capacity of the lung for carbon monoxide single-breathmethod and right ventricular global strain,RV FWS,right atrium S-CD and RV FWS/PASP in RA patients(r=0.392,0.472,0.431,0.572,all P<0.05).Conclusion The more increases of pulmonary artery pressures,the more decreases of right heart function in RA patients,and the more uncoupling in RV-PA.Right heart dysfunction and right ventricle-pulmonary artery uncoupling have developed in RA patients with PASP 33-39 mmHg,with association of pulmonary diffusion dysfunction.
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Objective:To compare the efficiency and purity of exosomes extracted from synovial fibroblasts of patients with rheumatoid arthritis by ultracentrifugation, size exclusion chromatography and modified polymer precipitation.Methods:The exosomes were extracted from human synovial fibroblasts by ultracentrifugation, size exclusion chromatography and modified polymer precipitation. Transmission electron microscopy, particle size detection and western Blot were used to identify the morphological characteristics, particle size distribution, concentration, and expression of marker proteins. One-way analysis of variance (ANOVA) was used for comparison among the three groups, and LSD- t test was used for pairwise comparison. P<0.05 was considered statistically significant. Results:Exosomes could be successfully obtained with all three extraction methods. The typical "saucer-like" structure could be observed under transmission electron microscope. The marker proteins of exosomes TSG101, Syntenin-1 and CD63 were all detectable by western blot. The peaks of main particle size were located within 30~150 nm. As for purity, the exosomes obtained by ultracentrifugation showed the highest purity, while modified polymer precipitation was the worst, with a large number of polymer particles and impurities protein. The purity of exosomes obtained by size exclusion chromatography was the moderate. For extraction efficiency, concentrations of exosomes particles obtained by the three methods were different ( F=9.61, P=0.049), and modified polymer precipitation was significantly higher than ultracentrifugation in terms of concentration of exosomes particles [(98.0±17.0)×10 10 particles/ml vs (11.6±7.7)×10 10 particles/ml, t=-4.34, P=0.023]. Conclusion:Human synovial fibroblasts derived exosomes canbe obtained by three methods. Ultracentrifugation is time-consuming, but can produce high-purity exosomes, which may be considered in the situation when high purity requirement with large volume samples are needed. Size exclusion chromatography is a good choice with high yield and purity exosomes, and suitable for small volume samples. Modified polymer precipitation is not recommended due to production of lowest purity exosomes.
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Objective:To analyze the methylation characteristics of the lymphocyte-specific protein-tyrosine kinase (LCK) promoter region in the peripheral blood circulation of rheumatoid arthritis (RA) patients and its correlation with clinical indicators.Methods:Targeted methylation sequencing was used to compare the methylation levels of 7 CpG sites in the LCK promoter region in the peripheral blood of RA patients with healthy controls (HC) and osteoarthritis (OA) patients. Correlation analysis and ROC curve construction were performed with clinical information.Results:Non-parametric tests revealed that compared with HC [0.53(0.50, 0.57)] and OA patients [0.59(0.54, 0.62), H=47.17, P<0.001], RA patients [0.63(0.59, 0.68)] exhibited an overall increase in methylation levels. Simultaneously, when compared with the HC group [0.38(0.35, 0.41), 0.59(0.55, 0.63), 0.60(0.55, 0.64), 0.59(0.55, 0.63), 0.58(0.53, 0.62), 0.45(0.43, 0.49), 0.57(0.54, 0.61)], the RA group [0.46(0.42, 0.49), 0.70(0.65, 0.75), 0.70(0.66, 0.76), 0.70(0.65, 0.75), 0.69(0.64, 0.74), 0.55(0.51, 0.59), 0.68(0.63, 0.73)] showed a significant elevation in methylation levels at CpG sites cg05350315_60, cg05350315_80, cg05350315_95, cg05350315_101, cg05350315_104, cg05350315_128, and cg05350315_142, with statistically significant differences ( Z=-5.63, -5.89, -5.91, -5.89, -5.98, -5.95, -5.95, all P<0.001). Compared with the OA group [0.65(0.59, 0.69), 0.65(0.60, 0.69), 0.64(0.58, 0.68), 0.50(0.45, 0.54), 0.63(0.58, 0.67)], the RA group [0.70(0.66, 0.76), 0.70(0.65, 0.75), 0.69(0.64, 0.74), 0.55(0.51, 0.59), 0.68(0.63, 0.73)] exhibited a significant increase in methylation levels at CpG sites cg05350315_95, cg05350315_101, cg05350315_104, cg05350315_128, and cg05350315_142, with statistically significant differences ( Z=-3.56, -3.52, -3.60, -3.67, -3.62; P=0.036, 0.042, 0.031, 0.030, 0.030). Furthermore, Pearson correlation coefficient analysis revealed a positive correlation between the overall methylation level in this region and C-reactive protein (CRP) ( r=0.19, P=0.004) and erythrocyte sedimentation rate ( r=0.14, P=0.035). The overall methylation level of the LCK promoter region in the CRP (low) group [0.63 (0.58, 0.68)] was higher than that in the CRP (high) group [0.65(0.61, 0.70)], with statistically significant differences ( Z=2.60, P=0.009). Finally, by constru-cting a ROC curve, the discriminatory efficacy of peripheral blood LCK promoter region methylation levels for identifying RA patients, especially seronegative RA patients, from HC and OA groups was validated, with an AUC value of 0.78 (95% CI: 0.63, 0.93). Conclusion:This study provides insights into the methylation status and methylation haplotype patterns of the LCK promoter region in the peripheral blood of RA patients. The overall methylation level in this region is positively correlated with the level of inflammation and can be used to differentiate seronegative RA patients from the HC and OA patients.
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Objective:To evaluate the relationship between gluten-free diet and rheumatoid arthritis (RA).Methods:Data were obtained from large-scale genome-wide association studies (GWAS), and genetic loci that are independent of gluten-free diet and RA of people of Europe2 were selected as instrumental variables. The gluten-free diet GWAS data included 64 949 individuals and 9 851 867 controls. Data were obtained from GWAS of 58 284 RA patients and 13 108 512 controls. The inverse variance weighted (IVW), MR Egger, weighted median method and weighted model were used to conduct two sample Mendelian randomization (MR) analysis. Cochran Q test and mendelian randomness pleiotropy residual sum and outlier (MR-PRESSO) were used to assess SNP heterogeneity. Applying the MR Egger intercept to test the level pleiotropy of SNP. The sensitivity analysis of the "leave one method" that evaluates whether MR studies were influenced by a single SNP. Results:After matching GFD and RA data, three SNPs were included as instrumental variables in the study. IVW showed that GFD could significantly reduce the risk of RA ( β=-60.83, s x=3.82, P<0.001). The weighted median method and weighted pattern also showed that the gluten free diet could reduce the risk of RA ( β=-57.97, s x=4.41, P<0.001; β=-55.81, s x=5.10, P=0.008). Sensitivity analysis of the correlation between GFD and RA showed that there might be heterogeneity between SNPs (Cochran Q test, Q=12.80, P=0.002). The MR-PRESSO results showed that no abnormal SNP was detected ( P=0.174). The forest map showed that SNPs was closely related to GFD and RA stability. The method comparison chart showed that the results of multiple testing methods were basically consistent. The funnel plot showed that SNPs were basically symmetrical, indicating that there was no pleiotropy in MR analysis. The MR Egger intercept test showed no horizontal pleiotropy in MR analysis (intercept value was-0.24, P=0.174). The sensitivity analysis of the "leave one method" is suggested that no single SNP had a significant impact on the overall results. Conclusion:Gluten free diet is related to the risk reduction of RA.
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Objective:Screening factors that might influence rheumatoid arthritis (RA) complicating interstitial lung diseases (ILD) by constructing and validating a model for early diagnostic.Methods:The study subjects were composed of 712 RA patients in the Department of Rheumatology and Immunology of the Second Hospital of Shanxi Medical University during December 2019 to October 2022. Fifty-two variables such as their demographic data, clinical symptoms, and laboratory indexes were collected. Patients were categorized into RA-only group and RA-ILD group with or without the occurrence of ILD disease. After data preprocessing, subjects were randomly assigned to the modeling and validation groups in a 7:3 ratio.Univariate analysis comparing baseline characteristics of the two groups of patients. Feature selection was performed using LASSO and SVM-RFE regression algorithms.Screening indicators were analyzed by logistic regression and the results were used to develop a nomograms model for the early diagnosis of RA complicating interstitial lung disease; and the modeling group was evaluated for its performance for internal assessment of the model and internal validation using data from the validation group.Results:A total of 712 subjects participated in the study, of which 498 in the modeling group and 214 in the validation group. Univariate analysis showed that the differences between the two groups were statistically significant ( P<0.05) in 18 characteristic indexes, including male, gender, age, smoking history, drinking history, number of swollen joints, number of painful joints, use of prednisone, WBC, ESR, CRP, IL-2, IL-10, IL-17, TNF-α, INF-γ, AFA family, APF, and serum albumin. The LASSO algorithm identified 13 risk variables for RA-ILD, the SVM-RFE algorithm identified 12 variables for RA-ILD, and the intersecting risk variables were male, age, history of alcohol consumption, number of painful joints, prednisone acetate, IL-2, AFA family, TNF-α, serum albumin, and IL-10. The results of multifactorial logistic regression analysis confirmed that the differences between males [ OR(95% CI)=3.61(2.11, 6.18)], gender, age [ OR(95% CI)=1.05(1.03, 1.08)], number of painful joints [ OR(95% CI)=1.03(1.01, 1.06)], IL-2 [ OR(95% CI)=0.91 (0.84, 0.99)], and TNF-α[ OR (95% CI)=1.06 (1.02, 1.10)] were statistically significant ( P<0.05) and were independently influences on ILD complicated by RA. The modeling and validation groups that were used to construct early diagnostic Nomograms had high calibration curve accuracies, and the model had a high diagnostic power, which was mainly demonstrated by the receiver operating characteristic (ROC) area under the curve (AUC) and decision curve analysis(DCA), the model modeling group had an AUC of 0.76 (95% CI=0.71, 0.81), with net benefit rates of 3%~82% and 93%~99%, whereas the model validation group had an AUC of 0.71 (95% CI=0.64, 0.79), with net benefit rates of 5%~11%, 14%~60% and 85%~89%. Conclusion:Male, gender, age, number of painful joints, IL-2, and TNF-α are independent factors for RA complicated with ILD, and the Nomogram model constructed has good performance in early diagnosis of the disease.
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Objective:The potential mechanism of cortex phellodendri chinsis in the improvement of rheumatoid arthritis (RA) through ferroptosis was analyzed based on network pharmacology.Methods:The main active components and their corresponding target proteins were screened by TCMSP database and Herb database, and the UniProt database was used to convert the corresponding target protein names into gene IDs. The targets of RA disease were obtained from GenCards, OMIM, DrugBank and DisGeNET databases. The FerrDb database was used to collect genes for Driver, Suppressors and Markers of ferroptosis. Then, Venny platform was used to obtain the intersection genes of Cortex phellodendri chinsis, RA and ferroptosis, and Cytoscape 3.9.1 software was used to plot the "active component-target-RA-ferroptosis" network diagram. Protein-protein interaction (PPI), gene ontology (GO) function, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed using String and DAVID databases. PyMOL, AutoDock Vina software and RCSB PDB database were used for molecular docking between active ingredients and key genes.Results:A total of 11 active components (Quercetin, Beta-sitosterol, Melianone, Candletoxin A, Phellochin, Palmidin A, Worenine, Hispidone, Kihadalactone A, Niloticin, Stigmasterol) and 34 intersection genes (PTGS2、AR、JUN、PRKCA、TGFB1、EGFR、CDKN1A、MAPK1、RB1、IL6、TP53、HIF1A、HSPA5、HMOX1、CAV1、IFNG、ALOX5、PTEN、NFE2L2、PARP1、PPARA、GSTM1、MTOR、PIK3CA、MDM2、MAPK8、GSK3B、SIRT1、DHODH、EZH2、AKR1C2、AKR1C1、STAT3、MAPK3) were screened. Ten possible targets of Cortex phellodendri chinsis regulating ferroptosis and anti-RA were predicted, including TP53、JUN、STAT3、HIF1A、PTEN、SIRT1、EGFR、MTOR、MAPK3、AR. Ferroptosis pathway is regulated by mediating positive regulation of gene expression, response to drugs, HIF-1, FoxO, ErbB and other signaling pathways, thus combating the occurrence and progression of RA. The docking results showed that there were molecular binding sites between the key genes and their corresponding active components.Conclusion:Cortex phellodendri chinsis may treat RA through ferroptosis effect with multiple components, multiple targets, multiple pathways and mechanisms.
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SUMMARY OBJECTIVE: Patients with rheumatic diseases have an increased risk of infections, especially tuberculosis. In this study, we aimed to recognize the positivity rate of tuberculosis skin test in patients with rheumatoid arthritis and spondyloarthritis and the characteristics of the patients with positive results. METHODS: Retrospective study of tuberculosis skin test results in patients followed from 2004 to 2021 in a single rheumatology unit. Data related to clinical and epidemiological features, along with treatment information referring to the period in which the tuberculosis skin test was performed, were collected from patients' charts. RESULTS: A total of 723 tests were identified (448 tests in 269 rheumatoid arthritis patients and 275 in 174 spondyloarthritis patients). In the rheumatoid arthritis sample, 31/275 (11.5%) individuals had positive tests, and in the spondyloarthritis, 38/174 (21.8%) had positive tests. In the rheumatoid arthritis sample, patients with positive tuberculosis skin tests used a higher dose of methotrexate than those with negative results (median of 25 mg/week versus median of 20 mg/week respectively; p=0.02). In the spondyloarthritis sample, tuberculosis skin test positivity was associated with alcohol ingestion (13.1% versus 2.9% in users and non-users respectively; p=0.02) and sulfasalazine use (15.7% of positivity in users versus 5% in non-users; p=0.01). CONCLUSION: The tuberculosis skin test-positive prevalence in rheumatoid arthritis was lower than in the spondyloarthritis sample. Patients with rheumatoid arthritis using a higher dosage of methotrexate or with spondyloarthritis using sulfasalazine had more frequency of tuberculosis skin test positivity and should be carefully followed by the attending physician in order to avoid the appearance of full-blown tuberculosis.
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ABSTRACT Connective tissue disease-associated interstitial lung disease (CTD-ILD) represents a group of systemic autoimmune disorders characterized by immune-mediated organ dysfunction. Systemic sclerosis, rheumatoid arthritis, idiopathic inflammatory myositis, and Sjögren's syndrome are the most common CTDs that present with pulmonary involvement, as well as with interstitial pneumonia with autoimmune features. The frequency of CTD-ILD varies according to the type of CTD, but the overall incidence is 15%, causing an important impact on morbidity and mortality. The decision of which CTD patient should be investigated for ILD is unclear for many CTDs. Besides that, the clinical spectrum can range from asymptomatic findings on imaging to respiratory failure and death. A significant proportion of patients will present with a more severe and progressive disease, and, for those, immunosuppression with corticosteroids and cytotoxic medications are the mainstay of pharmacological treatment. In this review, we summarized the approach to diagnosis and treatment of CTD-ILD, highlighting recent advances in therapeutics for the various forms of CTD.
RESUMO Doença pulmonar intersticial associada à doença do tecido conjuntivo (DPI-DTC) representa um grupo de distúrbios autoimunes sistêmicos caracterizados por disfunção de órgãos imunomediada. Esclerose sistêmica, artrite reumatoide, miosite inflamatória idiopática e síndrome de Sjögren são as DTC mais comuns que apresentam acometimento pulmonar, bem como pneumonia intersticial com achados autoimunes. A frequência de DPI-DTC varia de acordo com o tipo de DTC, mas a incidência total é de 15%, causando um impacto importante na morbidade e mortalidade. A decisão sobre qual paciente com DTC deve ser investigado para DPI não é clara para muitas DTC. Além disso, o espectro clínico pode variar desde achados assintomáticos em exames de imagem até insuficiência respiratória e morte. Parte significativa dos pacientes apresentará doença mais grave e progressiva, e, para esses pacientes, imunossupressão com corticosteroides e medicamentos citotóxicos são a base do tratamento farmacológico. Nesta revisão, resumimos a abordagem do diagnóstico e tratamento de DPI-DTC, destacando os recentes avanços na terapêutica para as diversas formas de DTC.
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Abstract Synovial sarcoma is a rare malignity of mesenchymal origin; the diagnostic approach usually begins by documenting a soft tissue tumor; however, it results in a challenging diagnosis when it is more profound, of small size, or primary from the bone. The present report describes a patient who presented insidious onset hip pain attributed to rheumatoid arthritis, with a fatal outcome due to baseline disease and surgery complications. The underestimation of hip pain, mainly when there is no palpable mass, may delay the diagnosis.
Resumo Sarcoma sinovial é uma rara malignidade de origem mesenquimal; a abordagem diagnóstica geralmente começa documentando um tumor de tecido mole; no entanto, resulta em um diagnóstico desafiador quando é mais profundo, de pequeno porte ou primário do osso. O presente relato descreve um paciente que apresentou dor insidiosa no quadril atribuída a artrite reumatoide, com desfecho fatal devido a doenças de base e complicações cirúrgicas. A subestimação da dor no quadril, principalmente quando não há massa palpável, pode atrasar o diagnóstico.
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Humans , Male , Aged , Pain , Arthritis, Rheumatoid , Soft Tissue Neoplasms , Sarcoma, Synovial , HipABSTRACT
Objective To explore the correlation of serum Chemerin level with disease activity and the ratio of T helper 17/regulatory T cells(Th17/Treg)in patients with rheumatoid arthritis(RA).Methods A total of 180 patients with RA who were admitted to our hospital were regarded as the observation group.According to the DAS28 score,the observation group was divided into the high activity group(60 cases),the moderate activity group(60 cases)and the low activity group(60 cases).Another 180 healthy people who underwent physical examination in our hospital during the same period were regarded as the control group.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of Chemerin,interleukin-9(IL-9),interleukin-10(IL-10)and interleukin-17(IL-17).Flow cytometry was used to detect the Th17/Treg ratio.Spearman correlation analysis was applied to analyze the correlation between serum Chemerin level and DAS28 score.Pearson correlation analysis was used to analyze the correlation between serum Chemerin level and Th17,Treg cell percentage and Th17/Treg ratio.Results The results of this study showed that the serum level of Chemerin was higher in the observation group than that in the control group(P＜0.05).The serum Chemerin level was positively correlated with DAS28 score(P＜0.05).Serum Chemerin levels and DAS28 scores decreased in turn in the high,moderate and low activity groups(P＜0.05).The percentage of Th17 cells and the ratio of Th17/Treg were higher in the observation group than those in the control group,and the percentage of Treg cells was lower in the observation group than that in the control group(P＜0.05).The level of IL-10 was lower in the observation group than that in the control group,while levels of IL-17 and IL-9 were higher in the observation group than those in the control group(P＜0.05).The results of Pearson correlation analysis showed that serum Chemerin level was positively correlated with the percentage of Th17 cells and the ratio of Th17/Treg,and negatively correlated with the percentage of Treg cells(P＜0.05).Conclusion Serum Chemerin level is elevated in patients with RA,which is closely related to disease activity and Th17/Treg ratio.
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Fundamento: la artritis reumatoidea es una enfermedad autoinmunitaria crónica que produce daño articular crónico e irreversible que conlleva al deterioro de la calidad de vida y discapacidad permanente con prevalencia mundial de entre 1,0 y 1,5 %. Objetivo: identificar las principales características clínico-epidemiológicas de pacientes con artritis reumatoidea en el Policlínico Docente Área Este de Camagüey. Métodos: se realizó un estudio descriptivo, de serie de casos, realizado en el Policlínico Docente Área Este de Camagüey. Del universo de 108 pacientes fue seleccionada una muestra de 102, una vez aplicados los criterios de elección. Se estudiaron las variables: grupo etáreo, sexo, color de la piel, años de diagnóstico, signos y síntomas clínicos, factores de riesgo; así como complicaciones presentadas. Para el procesamiento de los datos se empleó SPSS y se expresaron en valores absolutos y porcentajes. Resultados: predominó el grupo etáreo de 60 años y más (45,0 %), las mujeres (75,5 %), pacientes de color de piel blanca (66,7 %), con artritis reumatoidea de 16-20 años de evolución (22,5 %), vasculitis (25,5 %) y dolor (94,1 %) dentro de los principales signos y síntomas, mientras el consumo de café (69,6 %) y el sexo femenino se encontraron dentro los factores de riesgo modificables y no modificables. La osteoporosis fue la más notable de las complicaciones presentadas (69,6 %). Conclusiones: en la serie estudiada sobresalió el sexo femenino, la edad avanzada, el dolor como síntoma principal, así como la osteoporosis dentro de las complicaciones presentadas.
Foundation: rheumatoid arthritis is a chronic autoimmune disease that produces chronic and irreversible joint damage that leads to deterioration in quality of life and permanent disability with a worldwide prevalence of between 1.0 and 1.5 %. Objective: to identify the main clinical-epidemiological characteristics of patients with rheumatoid arthritis in the Eastern Area Teaching Polyclinic of Camagüey. Methods: a descriptive case series study was carried out at the Eastern Area Teaching Polyclinic of Camagüey. From the universe of 108 patients, a sample of 102 was selected, once the selection criteria were applied. The variables were studied: age group, sex, skin color, years of diagnosis, clinical signs and symptoms, risk factors; as well as complications presented. SPSS was used to process the data and they were expressed in absolute values and percentages. Results: the age group of 60 years and older predominated (45.0 %), women (75.5 %), patients of white skin color (66.7 %), with rheumatoid arthritis of 16-20 years of evolution (22.5 %), vasculitis (25.5 %) and pain (94.1 %) among the main signs and symptoms, while coffee consumption (69.6 %) and female sex were found among the risk factors. modifiable and non-modifiable risk. Osteoporosis was the most notable of the complications presented (69.6 %). Conclusions: in the series studied, female sex, advanced age, pain as the main symptom, as well as osteoporosis stood out among the complications presented.
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Introduction: The most important genetic association in rheumatoid arthritis (RA) is presented with some alleles from the HLA-DRB1 gene that encode the shared epitope (SE). Objectives: To apply the SE classification methods of Gregersen, de Vries, Raychaudhuri, Mattey, and Tezenas du Montcel in a group of Colombian patients with RA and determine the most common HLA-DRB1 alleles in the population. Methods: RA diagnosis, genetic study of the HLA-DRB1 region using Luminex technology in 50 RA and 50 healthy subjects. For the classification analysis, Fisher's exact test and chi-squared test were applied. Tables were created to count the RA-related alleles. We used odds ratio to determine the risk between the presence of the shared epitope (SE) and anti-cyclic citrullinated peptides (Anti-CCP). Results: Gregersen and de Vries methods were suitable for the characterization of RA in this population (p = .006). The most prevalent HLA-DRB1 alleles in the RA group were 14:02,04:04, 08:02,04:05, and 10:01. High frequencies of the 07:01, 03:01,13:02,01:02, and 12:01 HLA-DRB1 alleles were found in the healthy population. HLA-DRB1 alleles with similar distribution in both populations were 04:07, 15:01, 11:01, 16:02, and 01:01. A high frequency of SE + was observed in Anti-CCP + individuals (63.15%); however, this was not statistically significant [OR2.4 (.63-9.01); p = .19]. Conclusion: The SE classification methods of Gregersen and de Vries were adequate in characterizing RA in a Colombian population group. An equivalence of 100% was verified between the susceptibility alleles defined by de Vries and the alleles assigned as SE according to Gregersen.
Introducción: La asociación genética más importante en artritis reumatoide (AR) se presenta con algunos alelos del gen HLA DRB1 que codifican el epítope compartido (EC). Objetivos: Aplicar los métodos de clasificación de EC de Gregersen et al., de Vries et al., Raychaudhuri et al., Mattey et al., y Tezenas du Montcel et al., en un grupo de pacientes colombianos con AR, y determinar los alelos HLA DRB1 más frecuentes en esta población. Métodos: Diagnóstico para AR, estudio genético de la región HLA DRB1 por tecnología Luminex® de 50 sujetos AR y 50 sanos. Para análisis comparativos de clasificaciones EC, se aplicaron las pruebas test exacto de Fisher y Chi-cuadrado y se realizaron tablas de conteos para los alelos relacionados con AR. Se estimó la razón de odds para determinar el riesgo entre la presencia de EC y los anticuerpos antipéptidos cíclicos citrulinados (anti-PCC). Resultados: Los métodos de Gregersen et al. y de Vries et al. fueron adecuados para la caracterización de AR en esta población (p = 0,006). Los alelos HLA DRB1 más prevalentes en el grupo AR fueron 14:02, 04:04, 08:02, 04:05 y 10:01. Se encontraron altas frecuencias de los alelos HLA DRB1 07:01, 03:01,13:02, 01:02 y 12:01 en población sana. Alelos HLA DRB1 con distribución similar en ambas poblaciones fueron: 04:07, 15:01, 11:01, 16:02 y 01:01. Se observó alta frecuencia de individuos EC+ en el grupo AR anti-PCC+ (63,15%); no obstante, sin asociación estadística (OR: 2,4 [0,63-9,01]; p = 0,19). Conclusión: Los métodos de clasificación para EC de Gregersen et al. y de Vries et al. fueron adecuados caracterizando AR en un grupo de población colombiana. Se corroboró equivalencia del 100% entre los alelos de susceptibilidad definidos por de Vries y los alelos asignados como EC según Gregersen et al.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Arthritis, Rheumatoid , Biological Factors , Musculoskeletal Diseases , Joint Diseases , Epitopes , AntigensABSTRACT
La artritis reumatoide es una enfermedad progresiva, con manifestaciones clásicas y tempranas como es la afectación de las articulaciones pequeñas de las manos y los tobillos. Se realizó una revisión bibliográfica de los documentos publicados entre 2017 y 2022. Se realizó una lectura preliminar de 37 artículos que cumplían con los criterios de inclusión, y finalmente se seleccionaron 23 artículos, de los cuales se tomó el contenido de mayor importancia. La ecografía es una técnica fiable y más sensible que la exploración clínica en el estudio de la enfermedad músculo-esquelética, pues permite una exploración multiplanar y dinámica, lo que resulta en un diagnóstico más exacto. La técnica Doppler constituye un complemento útil en el seguimiento de estos pacientes. Esta enfermedad es recurrente en las consultas de Reumatología, por tanto, en su valoración inicial, la utilidad de los medios diagnósticos, especialmente la ecografía, tiene gran importancia.
Rheumatoid arthritis is a progressive disease, with classic and early manifestations such as involvement of the small joints of the hands and ankles. We conducted a bibliographic review of the documents published between 2017 and 2022. A preliminary reading of 37 articles that met the inclusion criteria was carried out, and 23 articles were finally selected, from which the most important content was taken. Ultrasound is a more sensitive and reliable technique than clinical examination for the study of musculoskeletal disease, since it allows a multiplanar and dynamic examination, which results in a more accurate diagnosis. Doppler technique is a useful complement in the follow-up of these patients. This disease is recurrent in Rheumatology consultations, that's why in its initial assessment, the usefulness of diagnostic means, especially ultrasound, is of great importance.
Subject(s)
Arthritis, Rheumatoid , Rheumatology , Echocardiography, DopplerABSTRACT
Introducción : El complejo C0-C1-C2 es responsable de la transición de la carga axial, con función biomecánica única, siendo afectada por múltiples patologías, que por lo general la literatura no las considera como un solo ítem, sino que lo desarrolla según su etiología, pero en nuestro estudio se ha considerado en 5 grupos: traumática, congénita, inflamatoria reumática, neoplásica y degenerativa. Objetivo : Determinar las características epidemiológicas, clínicas y del tratamiento en la patología cervical alta. Materiales y métodos : Se incluyeron a todos los pacientes con diagnóstico clínico radiológico de alguna patología cervical alta que hayan sido sometidos a tratamiento quirúrgico entre 2016 y 2021 en el Hospital Almenara. Se usó el test "t" de student y de chi cuadrado. Se dividió a los pacientes en alguno de los 5 grupos antes mencionados. Resultados : Se consideraron 31 pacientes, con una edad media de 51.16 años. La patología cervical alta más frecuente fue la traumática con el 35.48%. El déficit motor se presentó en el 51.61% y el déficit sensitivo se presentó en el 54.84%. La cirugía más frecuente fue la fijación cervical alta con el 43.89%. La tasa de complicaciones fue del 16.13% con una mortalidad del 0%. Conclusiones : La patología cervical alta es rara, siendo la del tipo traumática la más frecuente, pero un manejo oportuno y adecuado permite un mejor pronóstico funcional del paciente.
Introduction : The C0-C1-C2 complex is responsible of axial load transition, and its biomechanical function is unique, it is affected by multiple pathological conditions; and generally speaking, the literature does not consider these conditions as a single item, it describes them according to etiology. For our study we considered five groups: trauma-related, congenital, rheumatic-inflammatory, neoplastic, and degenerative. Objective : To determine epidemiological, clinical, and therapy-related characteristics in upper cervical pathological conditions. Materials and methods : All patients with a clinical-radiological diagnosis of any upper cervical pathological condition that had undergone surgery between 2016 and 2021 in Guillermo Almenara Hospital were included. Student's t test and chi square methods were used. patients were divided into one of the five aforementioned groups. Results : Thirty-one patients were included in the study; their mean age was 51.16 years. The most frequent upper cervical pathological condition was trauma-related, with 35.48%. Motor deficit occurred in 51.61% of all patients, and sensitive deficit occurred in 54.84%. The most frequently surgical procedure performed was upper cervical fixation, in 43.89% of all patients. Complication rate was 16.13%, and mortality was 0%. Conclusions : Upper cervical pathological conditions are rare, trauma-related conditions are most frequent, but timely and adequate management allow us to achieve better functional prognosis for these patients.
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Objective:To retrospectively analyze the correlation between blood lipoprotein levels and the risk of osteoporosis (OP) development in postmenopausal patients with RA and its influencing factors.Methods:Patients hospitalized with a definite diagnosis of RA from July 2017 to May 2020 were retrospectively collected and analyzed by bone mineral density (BMD) in subgroups, using correlation analysis, di-chotomous Logistic regression to quantify independent associations between laboratory test results and out-comes, and restrictive cubic spline (RCS) to fit the relationship of OP risk occurrence.Results:Six hundred and sixty-six eligible RA patients were included according to inclusion criteria, including 253 RA-OP and 413 RA-non-OP patients. After exclusion of relevant influencing factors by comparing demographic characteristics, a significant correlation was found between blood HDL-C ( r=-0.11, P=0.006) LDL-C ( r=0.12, P=0.003) levels and RA-OP( P<0.05), and dichotomous Logistic regression showed that as BMI ( OR(95% CI)=0.81(0.77, 0.86), P<0.001], calcium [ OR(95% CI)=0.24(0.10, 0.63), P<0.001], HDL-C[ OR(95% CI)=0.38(0.22, 0.66), P<0.001] increased, the risk of developing OP in RA patients decreased. In contrast, the risk of developing OP increased with increasing age [ OR(95% CI)=1.10(1.07, 1.21), P<0.001), disease duration [ OR(95% CI)=1.00(1.00, 1.00), P=0.020], and LDL-C[ OR(95% CI)=1.71(1.38, 2.12), P<0.001]. Conclusion:Blood HDL-C and LDL-C levels are significantly correlated with the development of RA-OP, and can be used as predictors of OP development and good indicators for disease monitoring in RA patients.
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Objective:To analyze the trend of disease burden of rheumatoid arthritis in China from 1990 to 2019, and to provide scientific basis for formulating targeted prevention and treatment strategies of rheumatoid arthritis.Methods:Based on data of the global burden of disease study 2019 (GBD 2019), according to the number of people with the disease, the prevalence, incidence, disability adjusted life year (DALY) and DALY rate of RA were used to describe the disease burden of RA in China and the world from 1990 to 2019. Joinpoint model was used to analyze the average annual percentage change (AAPC) of age-standardized prevalence rate, age-standardized incidence rate and age-standardized DALY rate of RA in China and the world from 1990 to 2019. The trend of disease burden of RA was analyzed.Results:In general, the standardized prevalence of RA in China and the world showed an upward trend from 1990 to 2019, and the age-standardized prevalence of RA in China increased by 0.18% per year on average ( t=7.34 , P=0.025). The global average annual increase was 0.27%, with a statistically significant difference ( t=6.64, P=0.013). From 1990 to 2019, the standardized incidence rate in China showed an average annual increase of 0.08%( t=7.54, P=0.032), while the standardized incidence rate in the world showed an average annual decrease of 0.37% ( t= -5.64, P=0.001). In 2019, the number of patients and prevalence of RA in China were 4.309.4 million and 302.98/100 000, respectively. The number of new cases and incidence of RA were 22.25 million and 15.64/100 000, respectively. Compared with 1990, in 2019, the number of patients and prevalence rate increased by 114.17% and 78.23%, the number of new cases and incidence rate increased by 77.90% and 48.05%, and DALY rate increased by 109.05% and 73.97%, respectively. From 1990 to 2019, the prevalence rate, incidence rate and DALY rate of women were higher than those of men. Both the prevalence rate and DALY rate showed an increasing trend with age, with the highest in the age group of 75 years old and above. Conclusion:From 1990 to 2019, the standardized incidence rate of RA in China has more increase than that in the world, and the overall incidence and prevalence of RA in China are on the rise. The prevalence, incidence and DALY of RA varies among different populations in China. Women and middle-aged and elderly people are at high risk.
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Objective:To investigate the mechanism of methotrexate in the treatment of rheumatoid arthritis (RA) by constructing a rat model of collagen-induced arthritis (CIA) and using non-targeted metabolomics.Methods:Enzyme-linked immunosorbent assay (ELISA) was used to determine the contents of TNF-α, IL-1β, IL-6, IL-4 and IL-10 in serum. HE staining and Masson staining were used to observe the histological changes of joints in each group. Non-targeted gas chromatography-mass spectrometry metabolomics technique was used to screen the expression profiles of differential metabolites in serum and cluster analysis and KEGG enrichment analysis were performed to screen the differential metabolic pathways, and real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the key enzymes in the differential metabolic pathways. All experimental data conforming to the normal distribution were compared between groups using one-way ANOVA, and P<0.05 was considered statistically significant. Results:MTX significantly improved the joint inflammatory response and arthritis score and increased the body weight of CIA rats. The results of HE and Masson staining showed that MTX could ameliorate the erosion of articular cartilage by synovial tissue in CIA rats. ELISA results showed that MTX significantly decreased the contents of TNF-α [(191.2±17.4)pg/ml, F=40.31, P<0.001], IL-1β[(28.4±1.2)pg/ml, F=10.11, P=0.012] and IL-6[(118.7±1.4)pg/ml, F=829.40, P<0.001] in the serum and increased the contents of IL-4 [(49.3±3.3)pg/ml, F=33.44, P<0.001] and IL-10 [(30.2±0.7)pg/ml, F=33.44, P<0.001] in the serum of CIA rats. Non-targeted metabolomics technique showed MTX had an effect on metabolites such as phosphocholine, palmitic acid, oleic acid, and choline in the serum of CIA rats. KEGG pathway enrichment analysis showed that MTX had an effect on glycerophospholipid metabolism( P<0.01)and sphingolipid metabolism( P<0.05)in CIA rats. qRT-PCR results showed that MTX could down-regulate the expression of the key enzymes such as Plb1 [(1.00±0.49), F=8.23, P=0.019], Gpcpd1[(1.10±0.09), F=8.19, P=0.019], Chka [(1.33±0.19), F=33.00, P<0.001], Chkb [(2.07±1.21), F=8.20, P=0.019]and Phospho1 [(1.07±0.14), F=13.58, P=0.006]in the glycerophospholipid metabolic pathway in the synovial membrane of CIA rats, and can also down-regulate the expression of the key enzymes Kdsr [(1.24±0.32), F=13.85, P=0.006], Plpp1 [(1.61±0.32), F=11.95, P=0.003) and Degs1 [(1.21±0.15, F=46.55, P<0.001]in the sphingolipid metabolic pathway. Conclusion:The biological mechanism of MTX in the treatment of rheumatoid arthritis may be related to the down-regulation of glycerophospholipid metabolism and sphingolipid metabolism pathway metabolic levels in the body.
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Objective:To identify differentially expressed genes (DEGs) associated with the progression of synovitis in RA by using bioinformatics analysis and explore the effects of DMARDs such as methotrexate, tocilizumab and rituximab on the DEGs in RA synovium.Methods:RA expression profile microarray data GSE7307、GSE12021、GSE55457、GSE55235、GSE77298、GSE89408 were acquired from the public gene chip database (GEO), including 113 synovial tissue samples from RA and 70 healthy controls (HC). At the same time, synovial expression microarrays GSE45867, GSE24742 and GSE97165 after DMARDs treatment were obtained. These data included 8 samples treated with methotrexate, 12 treated with tocilizumab, 12 treated with rituximab and 19 treated with combined tDMARDs. R software was used to screen DEGs and Venn plots using gene ontology function enrichment and Kyoto encyclopedia of genes and genomes pathway enrichment analysis. Hub genes were selected by STRING online analysis tool and Cytoscape software.Results:Compared with HC, 797 DEGs were up-regulated and 434 DEGs were down-regulated in the synovial tissue of RA. These DEGs were mainly enriched in T cell activation, immune response-activating cell surface receptor signaling pathway. Using Cytoscape and cytoHubba to obtain 5 sets of DEGs based on the STRING database model, the degree algorithm screened out 10 hub genes: LCK, SYK, PTPRC, HLA-DRA, LYN, NCAPG, TOP2A, JUN, CXCR4, CCNB1. Methotrexate treatment significantly up-regulated 20 DEGs and down-regulated 30 DEGs. Rituximab treatment up-regulated 100 DEGs and down-regulated 55 DEGs. Tocilizumab treatment up-regulated 91 DEGs and down-regulated 317 DEGs. These altered DEGs were enriched in regulating cell adhesion, leukocyte-cell adhesion, leukocyte transfer, and insulin-like growth factor receptor signaling pathways. It was worth noting that after treatment, a total of 306 high-expressing DEGs were down-regulated, and 36 low-expressing DEGs were up-regulated.Conclusion:LCK, insulin-like growth factor receptor signaling pathway, etc. are the responsible molecular mechanisms and key pivot genes for the occurrence and development of RA, and the treatment of DMARDs, which are closely related to the response of RA to the treatment of DMARDs.
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Objective:To investigate the effect of rapamycin on the proliferation and apoptosis of rheumatoid arthritis synovial fibroblasts (RA-FLS) and its mechanism.Methods:Synovial tissues were collected from patients with RA during joint replacement surgery, and primary synovial fibroblasts were extracted by trypsin digestion. The effect of rapamycin on the proliferation of RA-FLS was detected by cell counting kit (CCK-8) method. RA-FLS were divided into the control group and the rapamycin group (10 nmol/L). The effect of rapamycin on apoptosis of RA-FLS cells was detected by flow cytometry. The mRNA expres-sion levels of mammalian target of rapamycin (mTOR), serine/threonine-protein kinase AKT, B lymphocy-toma-2 (Bcl-2) associated X gene (Bax) and Bcl-2 were detected by RT-PCR. The protein expression levels of Bax, Bcl-2, mTOR, p-mTOR (2448), AKT, p-AKT and mTORC1 downstream related molecules protein S6 kinase 1(S6K1), p-S6K1, eukaryotic translation initiation factor-binding protein 1 (4EBP1) and p-4EBP1 were detected by Western blot. Differences between the two groups were compared using two independent samples t-test. Results:The results showed that the proliferation efficiency of RA-FLS treated with rapamycin was significantly weaker than that of the control group, and the drug inhibition rate of rapamycin increased with the increase of rapamycin concentration. The apoptosis rate of rapamycin group was significantly higher than that of the control group (5.31±0.59)% vs (3.49±0.40)%, t=7.83, P=0.001). The expression of Bax mRNA in rapamycin group was significantly increased (1.35±0.04 vs 1.00±0.00, t=15.60, P=0.004), while the expression of Bcl-2 mRNA (0.790±0.003 vs 1.000±0.000, t=85.50, P=0.007), mTOR mRNA (0.41±0.08 vs 1.00±0.00, t=14.37, P=0.044) and AKT mRNA (0.59±0.08 vs 1.00±0.00, t=7.54, P=0.017) were decreased, and the differences were statistically significant when compared with the control group. Compared with the control group, the protein expression of Bax in rapamycin group was significantly increased (0.75±0.10 vs 0.48±0.09, t=4.04, P=0.007), and the expression levels of Bcl-2 (0.632±0.055 vs 0.758±0.020, t=7.35, P=0.002), p-AKT/AKT(0.61±0.07 vs 0.88±0.04, t=5.61, P=0.005), p-mTOR/mTOR(0.92±0.12 vs 1.28±0.09, t=5.05, P=0.002), p-S6K1/S6K1(0.884±0.020 vs 1.023±0.058, t=4.52, P=0.004) and p-4EBP1/4EBP1 were decreased(0.86±0.05 vs 1.11±0.05, t=6.00, P=0.004). Conclusion:Rapamycin may inhibit the proliferation and induce apoptosis of RA-FLS cells by inhibiting AKT/mTORC1 pathway.