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La vasculitis reumatoidea es una complicación sistémica y poco frecuente de la Artritis Reumatoidea. Si bien su incidencia ha descendido en los últimos años con el advenimiento de las nuevas terapias inmunosupresoras y biológicas, continua teniendo una alta morbimortalidad. Predomina en el sexo masculino, en pacientes seropositivos y con un largo período de la enfermedad establecida. Requiere de alta presunción diagnostica, siendo el compromiso cutáneo y nervioso periférico el más frecuente. La biopsia de nervio o piel es requerida habitualmente para su diagnóstico. El tratamiento se basa en corticoides e inmunosupresores. Presentamos tres casos clínicos y realizamos una revisión de la literatura.
Rheumatoid vasculitis is a rare systemic complication of rheumatoid arthritis. Although its incidence has decreased in recent years with the advent of new immunosuppressive and biological therapies, it continues to have a high morbidity and mortality. It predominates in males, in seropositive patients and with a long period of established disease. It requires high diagnostic presumption, with skin and peripheral nervous involvement being the most affected. Nerve or skin biopsy is usually required for diagnosis. Treatment is based on corticosteroids and immunosuppressants. We present three clinical cases and carry out a review of the literature.
A vasculite reumatóide é uma complicação sistêmica rara da artrite reumatóide. Embora sua incidência tenha diminuído nos últimos anos com o advento de novas terapias imunossupressoras e biológicas, continua apresentando elevada morbidade e mortalidade. Predomina no sexo masculino, em pacientes soropositivos e com longo período de doença estabelecida. Exige alta presunção diagnóstica, sendo o envolvimento cutâneo e nervoso periférico os mais afetados. A biópsia de nervo ou pele geralmente é necessária para o diagnóstico. O tratamento é baseado em corticosteroides e imunossupressores. Apresentamos três casos clínicos e realizamos uma revisão da literatura.
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Background: Rheumatoid arthritis (RA) is an autoimmune disorder requiring long-term combination therapy with disease- modifying antirheumatic drugs (DMARDs), non-steroidal anti-inflammatory agents (NSAIDS), low-dose steroids, proton pump inhibitors, calcium, and folic acid and these drugs cause multitude of side effects. This study on the efficacy and tolerability of drugs used in RA among South Indian patients can guide in tailoring a treatment regimen more suited for South Indian population. Aims and Objectives: The main objective of this study was to evaluate the efficacy and tolerability of drugs used in the treatment of RA among South Indian patients. Materials and Methods: In this prospective observational study, 120 newly diagnosed RA patients attending rheumatology outpatient department in a tertiary care center in South India were recruited after obtaining Institutional Ethics Committee approval and informed consent. Sociodemographic details and baseline investigations were done. Each patient was followed up for a period of 6 months wherein, response to treatment was evaluated and adverse drug reactions (ADRs) reported were collected, analyzed and appropriate treatment was instituted. Data analysis was done using SPSS software. Results: One hundred patients completed the study. There was female preponderance (85%) and 38% were rheumatoid factor positive. Efficacy of combination therapy was evidenced falling erythrocyte sedimentation rate (P < 0.001), modified health assessment questionnaire,and disease activity score 28 scorings after 1st, 3rd, and 6th month of therapy (P < 0.001) and improvement in hemoglobin count (P < 0.001). The number of swollen joints was also significantly reduced (P < 0.001). Common ADRs reported were gastritis (29%), mucosal ulcers (10%), macrocytic anemia (3%), chloroquine-related ocular toxicity (2%). Conclusion: NSAIDS and steroids helped to achieve early remission and caused most of adverse effects. Methotrexate and chloroquine had good tolerability and were preferred DMARDs in our center. Thus, we conclude that the combination therapy used in our center is efficacious and well tolerated by South Indian population.
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Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease that imposes significant challenges globally. This research seeks to contribute valuable insights that can inform the development of targeted interventions, enhancing the quality of care for RA patients and potentially mitigating the broader societal burden associated with this chronic autoimmune condition. Objectives: The main objective of the current study is to investigate the demographic, psychosocial, and clinical aspects of RA patients. Materials and Methods: The study included 93 RA patients and examined their demographic characteristics, brief- Coping Orientation to Problems Experienced (COPE) strategies, the prevalence of depression and anxiety, pain experiences (Mankoski Pain Scale), and diagnostic markers (Disease Activity Score [DAS-28], Rheumatoid Factor [RF], Anti-Cyclic Citrullinated Peptide [ACCP]). Results: The study revealed a bimodal age distribution, with a gender predominance aligning with established RA prevalence patterns. Patients exhibited a tendency toward adaptive coping strategies, notably religious coping, active coping, and positive reframing, with variability in maladaptive strategies. The prevalence of depression (14.0%) and anxiety (18.3%) among RA patients was consistent with documented mental health burdens. Pain experiences exhibited a heterogeneous spectrum, and diagnostic markers indicated elevated disease activity in a substantial proportion of patients, with varied distribution in RF and ACCP subcategories. Conclusion: This study provides nuanced insights into RA, emphasizing the importance of personalized coping and pain management strategies. The prevalence of mental health challenges and the spectrum of pain experiences underscore the multidimensional nature of RA, informing holistic approaches to care for enhanced patient outcomes.
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Background: Arthritis is a common clinical condition seen in Ayurveda clinics. Clinical trials have reported Ay- urvedic interventions to be of benefits in many arthritic conditions including Rheumatoid Arthritis (RA). No mechanistic details however are available about how such interventions on their own or as a combination of whole system Ayurveda might be working. Objective: The study aims to evaluate simultaneously the clinical outcome of Ayurveda whole system (AWS) intervention in RA patients and identifying the serum metabolic signatures which could be useful for diagnosing the disease and monitoring treatment response. Material and methods: RA patients (n = 37) simultaneously diagnosed as Amavata fulfilling the specific inclusion and exclusion criteria were recruited in the study and were given Ayurveda whole system (AWS) intervention comprised of oral medicines, local therapy and dietary recommendation for 3 months. The clinical and serum metabolic changes were investigated for pre-treatment RA patients (baseline RA group, n = 37) and post- treatment RA patients (following treatment of 6-weeks (RA_F, n = 26) and three months (RA_T, n = 36). For comparative serum metabolomics analysis, 57 normal healthy control (HC) subjects were also involved and the serum metabolic profiles were measured at high-field 800 MHz NMR spectrometer. The serum metabolic profiles were compared using multivariate statistical analysis and discriminatory metabolic features were evaluated for diagnostic potential using receiver operating characteristic (ROC) curve analysis. Results: A significant reduction in DAS-28 ESR, AAM Score, total swollen joints, total tender joints were observed following AWS intervention. The clinical outcomes were concordant with changes in metabolic profiles of RA patients as these were also shifting towards the normal levels following the intervention. Compared to healthy control (HC) subjects, the sera of baseline RA patients were characterised by increased circulatory level of succinate, lysine, mannose, creatine, and 3-Hydroxybutyrate (3-HB) and decreased levels of alanine. The present study also evaluated the serum metabolic ratios for their discriminatory and diagnostic potential and notably, six metabolic ratios (KHR, KThR, KVR, GHR, PTR and SHR) were found significantly altered (elevated) in baseline RA patients. However, in RA patients receiving AWS treatment, these metabolic changes showed marked convergence towards the metabolic signatures of healthy controls. Conclusion: This first of its kind study clearly shows the clinical efficacy of Ayurvedic Whole System (AWS) intervention in the management of Rheumatoid Arthritis (RA), as demonstrated by significant improvements in key clinical parameters. The intervention not only alleviated symptoms but also induced a profound metabolic shifting towards normalization; thus, underscoring the potential of AWS intervention to modulate cellular metabolism in a manner that facilitates a return to homeostasis in RA patients. However, future studies are imperative to confirm these preliminary observations and delineate the underlying mechanisms of action of intervention in cases of RA.
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Rheumatoid arthritis (RA) is a chronic, symmetrical, inflammatory autoimmune disease that affects small joints. RA has a population prevalence of 0.5% to 1% in the U.S. The annual cost of care for chronic treatment of RA in the United States is estimated at $12,509. Pharmaceutical companies have developed drugs to treat RA using Janus kinase (JAK) inhibitors. These drugs can have potential adverse effects. Forecasting a better output to JAK inhibitors (JAKI’s). Therapy duration of JAKI’s and Problems regarding to strategies of dose reduction or if the discontinuation of therapy takes place in case of low disease activity. The accurate pharmacological profile and interactions of other drugs with JAKI’s have to establish. Proper safety, efficacy profile of JAKI’s and when administered in combination with DMARD’s. The safety, efficacy data of JAKI’s when compared to non-anti-TNF biologics. Obtaining of experience on JAKI’s that were already existed in the market and further experimental findings on newer compounds and which may clarify many of the aspects which are to be solved in nearer future as these JAKI will have greater application in treatment of RA. Regardless of significant developments in latest years in the pharmacotherapy of RA in the use of JAK inhibitors, yet the adverse effects of JAK inhibitors are unanswered. Therefore, one of the main concerns associated with JAK inhibitor is the potential adverse effects. The challenges can be addressed by clinical pharmacist mediated interventions related to dosing of JAK inhibitors and proper management of adverse drug reactions (ADRs).
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Introducción : La artritis reumatoide (AR) es una enfermedad inflamatoria crónica, autoinmune, caracterizada por poliartritis crónica, aditiva, simétrica, que puede cursar con manifestaciones extraarticulares (MExA) asociadas a una mayor morbimortalidad. Objetivo: de describir las MExA más frecuentes en AR. Métodos: se realizó un estudio descriptivo, transversal y retrospectivo de revisión de historias clínicas de pacientes diagnosticados con AR, durante el periodo diciembre 2011-enero 2022. Resultados: Participaron 150 pacientes con AR, con una edad promedio de 53,7±12,5 años, el sexo predominante fue el femenino con 84,6%, el tiempo de evolución de la AR fue de 7,2±8,9 años; en cuanto a las características serológicas, 91,1% tenía Factor reumatoideo positivo y 76,9% tenía anticuerpos contra péptidos cíclicos citrulinados positivo. Tanto al ingreso, como en la última consulta los pacientes presentaron alguna manifestación extraarticular (MExA), 61,3% y 70%, respectivamente, siendo las más frecuentes la anemia de los trastornos crónicos (al ingreso 44,6% y en última consulta 50,6%), seguida de nódulos reumatoideos (al ingreso con 8% y en la última consulta 9,3%). Conclusiones: Las MExA se presentaron en 70% de los pacientes, siendo las más frecuentes la anemia y los nódulos reumatoideos. Estos datos muestras los cambios que han tenido la frecuencia de estas MExA en esta enfermedad a través del tiempo.
Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune disease, characterized by chronic, additive, symmetrical polyarthritis, which can present with extra-articular manifestations (ExAM), associated with greater morbidity and mortality. Objective: to describe the most frequent ExAM in RA. Methods: a descriptive, cross-sectional and retrospective study was carried out to review the medical records of patients diagnosed with RA, during the period December 2011-January 2022. Results: 150 patients with RA participated, with an average age of 53.7±12.5 years, the predominant sex was female with 84.6%, the evolution time of RA was 7.2±8.9. years; Regarding serological characteristics, 91.1% had positive Rheumatoid Factor and 76.9% had positive antibodies against cyclic citrullinated peptides. Both upon admission and at the last consultation, patients presented some extra-articular manifestation (ExAM), 61.3% and 70%, respectively, with the most frequent being chronic anemia (at admission 44.6% and at last consultation 50.6%), followed by rheumatoid nodules (at admission with 8% and at the last consultation 9.3%). Conclusions: ExAM occurred in 70% of patients, the most frequent being anemia and rheumatoid nodules. These data show the changes in the frequency of ExAM in the disease over time.
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Background : For centuries, contemplative cultures have used meditation as a practice. Its medicinal effects have just recently been investigated, but the results point to a wide range of advantages. Rheumatoid Arthritis (RA), an autoimmune condition harm the body抯 joints and cause joint pain. Apart from jeopardizing the patient physically it also affects the psychological well-being. Given the research linking mindfulness to better immune indicators, mindfulness training may lessen disease-related stress in RA patients by boosting their immune system thereby improving their perceived stress as well as Quality of Life (QoL). Aims and Objectives : To examine the effects of standardized Mindfulness-based Interventions (MBI) on psychological stress and QoL in a tertiary care hospital of eastern India. Materials and Methods : 60 patients of RA were selected by purposive random sampling and divided into cases and waitlist controls comprising 30 patients in each group. The cases received MBI over a period of 6 months. Psychological Stress was estimated by Depression, Anxiety, Stress Scale (DASS) 21 and QoL by WHO QoL-BREF among both the groups at baseline, 4 months and 6 months post-intervention. Results : Significant reduction of depression, anxiety and stress score was found in case group at 4th and 6th months. For the control group, it was not significant. The score was found to improve significantly in cases in the psychological domain of WHO QoL-BREF in the case group in 4th and 6th month. Scores in controls did not change significantly. Conclusion : MBI caused a decrease in the depression, stress, and anxiety scores; while improving the psychological well-being of RA patients.
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Rheumatoid Arthritis (RA) is a common autoimmune disease that causes chronic inflammation of the tissues around the joints, which eventually results in systemic complications and bone destruction. Macrophages are critical cells in many tissues and organs essential to an innate and adaptive immune response. It is one of the most common cell types in the synovium of rheumatoid arthritis. Various conventional and experimental therapies for RA target proteins, cytokines or their synthetic pathways, T lymphocytes, and B lymphocytes. The Fibroblast-Like Synoviocytes (FLS) and macrophages are abundantly activated in RA, and the drugs targeting the monocytes and macrophages are explored significantly less. The drugs targeting monocytes and macrophages may provide a better therapeutic strategy for RA. Proteasome inhibitors act as a potential remedy for autoimmune and inflammatory diseases. Targeting the monocytes and macrophages with proteasome inhibitors may improve the therapeutic approaches to RA. This paper reviews the types and significance of macrophages in RA, various conventional and experimental therapy approaches targeting monocytes and macrophages, and the effect of proteasome inhibitors on macrophages in RA.
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La subluxación atlantoaxial es la lesión más frecuente en la columna cervical causada por la artritis reumatoidea. Se manifiesta por rigidez de nuca, dolor cervical y déficit neurológico. El diagnóstico se realiza con tomografía computarizada e imágenes de resonancia magnética. El intervalo atlanto dental anterior mayor a 5mm indica inestabilidad atlantoaxial, el intervalo atlanto dental posterior menor a 14mm advierte riesgo neurológico. Las indicaciones más frecuentes de cirugía son: dolor cervical severo, inestabilidad y síntomas de mielopatía. Cuando existe compresión medular es necesaria la descompresión cervical alta sea por vía posterior o por vía anterior (odontoidectomía endonasal versus transoral). La línea rinopalatina nos indicará la factibilidad de una odontoidectomía endonasal endoscópica (OEE). El objetivo de la presentación del presente caso es compartir nuestra experiencia con la primera odontoidectomía endonasal endoscópica realizada en nuestro país y fomentar la utilización de la técnica. La cirugía fue realizada en un paciente con cuadriparesia espástica por subluxación atlantoaxial por artritis reumatoidea y que presentó excelente evolución pos operatoria, con recuperación casi completa. La OEE es una técnica operatoria mínimamente invasiva, ideal para pacientes con múltiples comorbilidades y que ofrece de buenos a excelentes resultados.
Atlantoaxial subluxation is the most common injury to the cervical spine caused by rheumatoid arthritis. It is manifested by neck stiffness, neck pain and neurological deficit. Diagnosis is made with computed tomography and magnetic resonance imaging. The anterior dental atlanto interval greater than 5mm indicates atlantoaxial instability, the posterior dental atlanto interval less than 14mm warns of neurological risk. The most frequent indications for surgery are: severe neck pain, instability and symptoms of myelopathy. When there is spinal cord compression, upper cervical decompression is necessary, either via a posterior or anterior approach (endonasal versus transoral odontoidectomy). The rhinopalatine line will indicate the feasibility of an endoscopic endonasal odontoidectomy (EEO). The objective of the presentation of this case is to share our experience with the first endoscopic endonasal odontoidectomy performed in our country and to promote the use of the technique. The surgery was performed on a patient with spastic quadriparesis due to atlantoaxial subluxation due to rheumatoid arthritis and who presented excellent postoperative evolution, with almost complete recovery. EEO is a minimally invasive surgical technique, ideal for patients with multiple comorbidities and offering good to excellent results.
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Background: Increase in insulin resistance predisposes to cardiovascular disease. Studies from various parts of world show increase prevalence of IR in rheumatoid arthritis (RA) but there is little data from India. Aims and Objectives: To evaluate the prevalence of IR in RA and after 6 months of treatment with disease-modifying antirheumatic drugs. Materials and Methods: This hospital-based longitudinal observational study was done between July 2018 and June 2019 in the Division of Rheumatology, Department of General Medicine, S.S. Hospital, BHU, in treatment-naive RA patients with age ?18 years. Exclusion criteria were known diabetes, preexisting dyslipidemias, or any other chronic illness. Detailed history and examination were done. Fasting glucose and fasting insulin were done to calculate the homeostatic model for assessment of IR (HOMA IR). Results: The most common age group in our study was 31–40 years (38%). The mean age of onset of disease was 39.5 years. Female-to-male ratio was 5.25:1. The mean duration of illness was 3 years with baseline mean disease activity score (DAS) 28 score 6.2698 ± 1.07437. Baseline mean cholesterol level, triglyceride, high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein were 169.40 ± 33.802 mg/dL, 164.42 ± 91.585 mg/dL, 47.66 ± 11.825 mg/dL, 99.88 ± 27.059 mg/dL, and 34.42 ± 19.186 mg/dL, respectively. Baseline fasting blood glucose levels, fasting insulin levels, and HOMA IR were 99.40 ± 20.761 mg/dL, 11.84770 ± 4.351550 m IU/L,and 2.905 ± 1.2272, respectively. After treatment of 6 months, lipid profile, fasting insulin, and HOMA IR improved significantly. However, there was no significant correlation found between IR and disease activity before and after treatment. Conclusion: The patients of RA are at higher risk of IR and dyslipidemia and early diagnosis with the initiation of treatment for RA can reverse the IR in RA patients.
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Background: Rheumatoid Arthritis (RA) is the most common autoimmune disease. RA can cause permanent deformity and loss of productivity. The primary objective of the study was to evaluate the relationship of BMI with Disease Activity Score in RA patients. The secondary objective was to evaluate the presence of comorbidities such as diabetes, thyroid, hypertension, periodontitis, and pregnancy outcomes (in the case of females) in the RA patients population presented at the tertiary healthcare centre. Method: The presented study was a cross-sectional study. 100 Patients presented to the joint clinic were recruited. RA diagnosis of patients was based on the ACR/ELULAR criteria. Their demographic and clinical data was collected through one-on-one interviews. Results: The recruited population shows that BMI has a moderate positive correlation (r=0.347, p=0.001) with disease activity scores. 51% of RA patients have one or more comorbidities. 45.2 % of female RA patients suffered one or two miscarriages during their pregnancy. It is significantly higher as compared normal female population. Conclusions: Active control of BMI may be required to prevent RA symptom aggravation. RA patients are prone to develop comorbidities and females with RA may need close monitoring during their pregnancy period.
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Osteoarthritis, also known as OA, is a type of joint degeneration characterized by changes in the morphology and biochemistry of the synovial membrane and joint capsule, as well as degradation of cartilage joint and expansion of the marginal bone. Inflammation causes the joints to deteriorate in a subtype of osteoarthritis called erosive OA. DIP (distal interphalangeal), PIP (proximal interphalangeal), CMC (carpometacarpal) and metacarpophalangeal (MCP) joints are the most often affected joints in the hand. Other joints in other body regions are extremely seldom affected. Our patient’s diagnosis report suggests erosive osteoarthritis and seronegative arthritis as negative anti-RF factors.
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Rheumatoid arthritis is a sign of progressive degradation of cartilage, subchondral bone, and small joints, as well as the persistence of synovitis and the formation of pannus. This research intends to assess the purported anti-arthritic effects of an extract from the seeds of Portulaca oleracea. Female Wistar albino rats (140–200 g) were used and assigned to five groups: Group I administrated NS (10 ml/kg), Group II received 0.2 ml of CoII-IFA, Group III received 300 mg/kg of fish oil, and Groups IV & V administrated 100 and 200 mg/kg of methanolic extract of Portulaca oleracea (MePO). During the experiment, the rats' weight, arthritic score, and footpad oedema were evaluated to determine the severity of their arthritis. Later, blood samples were collected from the animals, which were then analysed for haematological, pro-inflammatory, antioxidant, and histological parameters. A dose-dependent reduction was seen in rats treated with a methanolic extract of Portulaca seeds. Levels of haematological and pro-inflammatory cytokines were considerably reduced by treatment. Although both the standard drug and 200 mg/kg of MePO had anti-inflammatory effects, the latter's were more pronounced at this dose. When looking at the two side by side, results showed that the treatment groups of RBC, WBC, NL-ratio, and ML-ratio levels were normalised. Further histology confirmed the reduction of joint deformity, oedema, formation of pannus, and infiltration of neutrophils in the MePO groups in contrast to arthritic rats. It is hypothesised that Portulaca oleracea may reduce the arthritis and can be used as an adjuvant therapy or incorporate it into your diet with the main course of treatment.
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Chronic rheumatoid arthritis (RA) can cause irreversible joint deterioration over time. Solvent-based lipid nanoparticles (SLNs) are widely used as an efficient method to increase the oral bioavailability of poorly soluble medicines like Sulfasalazine. The present study aimed to formulate and evaluation of anti-rheumatic potential of the solid lipid nano-particles (SLNs) of Sulfasalazine. Drug loaded SLNs were formulated and coated with chitosan (CS) for sustained delivery and characterized for particle size, poly dispersity index and in vitro drug release. safety and efficacy profile of optimized batch was analyzed in animal model. Particle size of the optimized formulation was 269±2.45 nm with the PDI of 0.217±0.008 and entrapment efficiency of about 79.9±2.21. The zeta potential of particles was 35.7 mV. Particles had spherical shape with size ranging 100 nm which was determined by TEM analysis. Created formulation showed that the medication was released from the lipid matrix under regulated conditions, with 83.2±1.5% of the drug released in 24 h. Cmax for drug was higher (337±24) when administered as SLNs drug, similarly Tmax was longer when administered as lipid nanoparticles (6Hr), indicating a sustained drug release from SLNs. complete Freund's adjuvant (CFA) activity in rats administered with CS-SSZ-SLN (300mg/kg) equivalent to doses of 300mg/kg SSZ showed reduction in paw edema by day 9 (53.1 ± 1.75% (p<0.005), day 18 (68.68 ± 2.08%) (p<0.001) and 78.24 ± 2.36 % ( p<0.001) on day 21 respectively. Significant increase in the Tmax and the T1/2 values for the nanoparticles, indicates sustained release of the drugs by the SLNs. Sulfasalazine functions by decreasing inflammation, which is likely responsible for lessening the signs and symptoms of inflammatory diseases such rheumatoid arthritis and inflammatory bowel disease.
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This review provides a comprehensive overview of genetic variations influencing the effectiveness and side effects of methotrexate (MTX) treatment in rheumatoid arthritis (RA) patients. It synthesizes findings on associations between genetic polymorphisms and MTX therapy outcomes, aiming to identify potential genetic markers for enhancing treatment and personalized strategies in RA. The review highlights genetic variations associated with MTX therapy effects. Variants in genes involved in MTX transport, including reduced folate carrier 1 (RFC1) and ABC transporters, correlate with treatment response. Specific RFC1 and ABCB1 variants are linked to improved MTX efficacy. Polymorphisms in genes regulating MTX metabolism, such as thymidylate synthase (TYMS) and methylenetetrahydrofolate reductase (MTHFR), predict effectiveness and toxicity risks of MTX. Additionally, genes influencing MTX's mechanistic pathways, like the adenosine signaling cascade, impact clinical outcomes. While the evidence is preliminary, this review suggests the potential of genetic testing to guide personalized MTX therapy in RA, leading to improved effectiveness and reduced adverse events. However, further research with diverse cohorts is necessary to validate these findings and establish the utility of pharmacogenomic-based treatment approaches for RA patients receiving MTX. RA is a chronic autoimmune disease treated with MTX as the cornerstone therapy, but patient responses vary. This comprehensive review examines genetic variations influencing MTX's efficacy and toxicity in RA patients. Through a rigorous literature review using databases like PubMed and Web of Science, this study synthesizes findings from pharmacogenetic research on genetic polymorphisms and MTX outcomes.
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Objective: Evaluate and correlate data between relevant cytokines, disease progression, and handgrip and quality of life among RA patients at different stages of disease progression. Method: Thirty-three RA patients were recruited for analysis, using comparisons and correlations, between levels of circulating cytokines (IFN-γ, TNF-α, IL-4, IL-6, IL-10, IL-17, IL-1ß, and TNF receptors I and II), activity of the disease (evaluated using the DAS-28), handgrip (Hydraulic dynamometer), and quality of life (SF-36). Result: RA patients in different disease stages showed increases of IL-6 and IL-10 compared control group. Positive correlation between IL-6 with TNF-α, and IL-4 with IL-10 was found. Handgrip strength and quality of life were not related to cytokine levels. However, remission patients had better strength and quality of life indices compared to the active patients. In addition, handgrip of the non-dominant side, physical functions, role limitations physical health, pain, energy/fatigue and social functions have a negative correlation with the DAS28-PCR. Conclusion: High levels of IL-6 and IL-10 were observed in the chronic RA patients, but the values did not show correlation with disease activity, handgrip strength and quality of life. Disease activity show correlation with handgrip strength and quality of life. Furthermore, remission patients had better strength and quality of life indices compared to the active patients.
Objetivo: Avaliar e correlacionar dados entre citocinas relevantes, progressão da doença, preensão manual e qualidade de vida entre pacientes com AR em diferentes estágios de progressão da doença. Método: Trinta e três pacientes com AR foram recrutados para análise, por meio de comparações e correlações, entre níveis de citocinas circulantes (IFN-γ, TNF-α, IL-4, IL-6, IL-10, IL-17, IL-1ß e receptores de TNF-I e -II), atividade da doença (avaliada pelo DAS-28), preensão manual (dinamômetro hidráulico) e qualidade de vida (SF-36). Resultado: Pacientes com doença ativa e inativa apresentaram aumento de IL-6 e IL-10 comparados ao grupo controle. Foi encontrada correlação positiva entre IL-6 com TNF-α e IL-4 com IL-10. A força de preensão e a qualidade de vida não relacionaram aos níveis de citocinas. Entretanto, pacientes em remissão apresentaram melhores índices de força e qualidade de vida comparados aos pacientes com doença ativa. Além disso, preensão manual do lado não dominante, e quesitos dos SF-36, apresentam correlação negativa com o DAS28-PCR. Conclusão: Foram observados níveis elevados de IL-6 e IL-10 nos pacientes com AR crônica, mas os valores não mostraram correlação com DAS-28, força de preensão manual e SF-36. A atividade da doença apresenta correlação com força de preensão manual e qualidade de vida. Além disso, os pacientes em remissão apresentaram melhores índices de força e qualidade de vida em comparação aos pacientes ativos.
Subject(s)
Humans , Arthritis, Rheumatoid , Hand StrengthABSTRACT
Introduction: Rheumatoid arthritis (RA) is one of the most prevalent chronic inflammatory diseases, which primarily involves the joints and may also include extra-articular manifestations, such as nodules, pulmonary involvement, vasculitis, and systemic comorbidities. Pterostilbene (PTE) is responsible for the process of angiogenesis and contributes with its anti-inflammatory properties to the rheumatoid arthritis process. Objective: To verify whether oral Pterostilbene solution use has an effect on the acute phase of the inflammatory process in the treatment of rheumatoid arthritis. Methodology: This experimental study was composed of 45 Rattus Norvegicus rats, Wistar strain, divided into three groups corresponding to the Control Group (CG) with no lesion and no treatment; the SHAM Group (SHAM) with lesion but no treatment, and the Pterostilbene Group (PG) with lesion and treatment. The results were evaluated by histology and flow cytometry. Results: The lesions were characterized by a diffuse acute inflammatory process with mild to moderate intensity. It was observed that increasing proliferative activity of fibroblasts and angiogenesis occurred, besides the modulation of inflammatory cytokines, which corroborated the histological findings. Conclusion: It can be concluded that pterostilbene, due to its anti-inflammatory activities, can control inflammation so that there are no exacerbated symptoms and lesions, in addition to stimulating structural restoration by increasing fibroblast production and angiogenesis.
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Background: Inflammatory arthritis is associated with abnormal levels of lipoprotein. The cause is considered to be inflammation. Recently, the use of biologic drugs in the treatment of inflammatory arthritis, especially rheumatoid arthritis (RA) and seronegative spondyloarthropathy, has increased. There are different results of the effect of these drugs on fat profile. Evaluate the impact of anti-tumor necrosis factor (TNF) alpha drugs on lipid profile of patients with RA or seronegative spondyloarthritis. Methods: In this cross-sectional descriptive study, 50 patients with rheumatoid arthritis or seronegative spondyloarthritis, who were candidates for TNF alpha treatment, were included in the study. After obtaining written consent, a checklist was completed for all patients including demographic information such as age, sex, height, weight, place of residence, level of education, type of disease, and lipid profile test results including total cholesterol, triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) were recorded. Then the patients were treated and evaluated for fat profile after 3, 6, 9 months after receiving the relevant treatment regimen. The test results were recorded in checklists. After completing the study, the data were entered into the statistical package for the social sciences (SPSS) 24 software and analyzed. Results: The mean age of patients was 46.38±14.33 years. 54% of patients were female. 54% of patients had rheumatoid arthritis. 62% of patients were treated with Sinora. The results of this study showed that serum triglyceride levels increased during the study period and this increase was statistically significant but the trend of changes in serum cholesterol, HDL and LDL levels was not statistically significant. However, serum LDL levels measured in the ninth month increased significantly compared to the initial measurement. Conclusions: Results showed that there was a significant relationship between lipid profile changes and anti-TNF alpha consumption. Although decreased inflammation appears but other mechanisms may be involved in dyslipidemia.
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Non-steroidal anti-inflammatory drugs (NSAIDs) are used for alleviating pain and inflammation, particularly in the primary management of musculoskeletal disorders. Prolonged or frequent use of NSAIDs affects gastric acid levels and causes damage to the gastrointestinal (GI) system. NSAID users report GI endoscopic lesions such as petechiae, erosions, and ulcerations. Proton-pump inhibitors (PPIs) are the preferred pharmacotherapy to manage these NSAID-induced ulcers and other unfavorable GI adverse effects. PPIs offer better protection of the gastric mucosa from acid secretion and improve symptomatic indications. Rabeprazole, among all the PPIs, shows faster activation and provides beneficial action for a prolonged duration and thus exhibits a better efficacy profile. The current opinion document based on inputs from expert orthopedic professionals focuses on the NSAID-induced GI side effects, their prevalence in patients, and management using PPIs in their routine clinical practice.
ABSTRACT
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