Depression in Rheumatoid Arthritis: Prevalence and Effects on Disease Activity.

Background:The primary objective of this study was to estimate depression's prevalence in a cohort of rheumatoid arthritis (RA) patients, and the secondary objective was to evaluate the impact of depression on disease activity over time. Methods: We included all patients with RA presenting to our clinic from 2019 to 2020, who had three follow-up visits available. Depression prevalence was calculated using the patient's history of diagnosed depression, and disease activity was assessed using the disease activity score for 28 joints (DAS28) and its components: tender joint count (TJC), swollen joint count (SJC), pain value on a visual analog scale (VAS), and inflammatory markers. Results: A total of 400 RA patients were included, 75 of whom had diagnosed depression, generating a prevalence of 18.8%. The mean values of DAS28 and its components were higher, with statistical significance, in the depression subgroup at all three follow-ups (p < 0.001). Conclusions: Depression is prevalent in the RA population, and leads to higher disease activity in dynamic evaluations. Assessing depression could be a psychological marker for RA prognosis with an important outcome in controlling disease activity.

Comparison of Efficacy and Safety of Original and Biosimilar Adalimumab in Active Rheumatoid Arthritis in a Real-World National Cohort.

Background and Objectives: Real-world evidence should reflect the evidence obtained from controlled trials; therefore, the study aimed to compare biosimilar adalimumab (bADA) to original adalimumab (oADA) in terms of efficacy and safety in a real-life national cohort of rheumatoid arthritis (RA) patients. Materials and Methods: The following study is a prospective observational study in which we analyzed patients treated with reimbursed biologics from the Romanian Registry of Rheumatic Diseases (RRBR). RA cases must fulfill the 2010 classification criteria, as well as specific inclusion and exclusion criteria. The RRBR database was queried for all RA patients starting oADA or bADA (FKB327, GP2017, MSB11022, SB5 available) from 2 May 2019 (the first bADA initiation) until 26 March 2022 (study search date). Results: The study included 441 patients who started oADA (48.3%) or bADA (51.7%) in the same time period. At baseline, patients starting bADA had a significantly higher mean age and lower prevalence of women. After the first six months of treatment, there were no significant differences between the oADA and bADA regarding rates of Boolean (15.0% vs. 12.3%, p = 0.401), DAS28-CRP (32.4% vs. 34.2%, p = 0.686) and SDAI (16.4% vs. 14.0%, p = 0.483) remission rates. There were 107 cases of adverse events (AE): 81.3% on oADA and 18.7% on bADA. Notably, 51.4% of AE were infections. Regarding severity, 49.5% of AEs were mild, 34.6% were moderate, and 15.9% were severe. Conclusion: Biosimilar adalimumab showed similar efficacy and safety to original adalimumab after the first six months of treatment in RA patients from a national registry.

Depression in Rheumatoid Arthritis: A Narrative Review-Diagnostic Challenges, Pathogenic Mechanisms and Effects.

Depression is one of the most frequent comorbidities in rheumatoid arthritis (RA); it takes an important toll on the quality of life of these patients and also leads to a decrease in life expectancy. The current article is a narrative review on depression in RA, with the objective to emphasize and raise awareness on the high prevalence, pathogenic mechanisms, and effects that depression has on RA patients. In RA, the prevalence of depression has been shown to be 2 to 3 times higher than in the general population, with a meta-analysis reporting that 16.8% of RA patients have a major depressive disorder. Future studies are needed to determine the most accurate self-reported depression questionnaires and their ideal threshold for defining depression as compared to diagnostic interview as gold-standard for patients with RA to allow better comparisons across studies. The pathogenesis of depression remains to be fully understood, but recent specialty literature suggests that immune-mediated processes are involved and that there are similarities between the neural networks recruited in inflammation and those implicated in the pathophysiology of depression. Depression in patients with RA is associated with poor long-term outcomes. Multiple studies have shown that depression in RA is associated with increased pain, fatigue, and physical disability. It alters treatment compliance, causes more comorbidities, and leads to higher mortality, partly through increased suicide risk. Depression in RA also increases health service utilization and healthcare costs directly through hospitalization, but also indirectly through loss of work productivity. Assessing depression could be a significant psychomarker of rheumatological outcome in RA.

Lung Damage in Rheumatoid Arthritis-A Retrospective Study.

The current study aimed to evaluate rheumatoid arthritis (RA) patients with interstitial lung disease (ILD) in clinical practice and whether disease characteristics are associated with X-ray and high-resolution computed tomography (HR-CT) findings. Medical history of RA patients from a tertiary rheumatology clinic was retrieved from its electronic database starting from 1 January 2019 until the study date (8 August 2022) using International Classification of Disease version 10 codes for RA, ILD and exclusion criteria. The study included 78 RA patients (75.6% women, 15.4% active smokers), with average time from RA to ILD of 5.6 years. Regarding chest X-ray findings, men had a higher prevalence of nodules, combined fibrosis and nodules and combined bronchiectasis and nodules, rheumatoid factor (RF)-positive patients had a higher prevalence of fibrosis and anti-cyclic citrullinated peptide antibodies (ACPA)-positive patients had a higher prevalence of bronchiectasis. Regarding HR-CT findings, patients actively treated with methotrexate had a higher prevalence of nodules; a combination of fibrosis and nodules; combination of emphysema and nodules; and combination of fibrosis, emphysema and nodules. ILD develops within approximately 5 years from RA diagnosis, and ILD-associated imaging findings on chest X-rays and HR-CT are more prevalent among men with RA, among patients with positive RA serology (RF and/or ACPA) and RA patients on methotrexate.

Ankle involvement in rheumatoid arthritis - a comparison of inflammatory signs on musculoskeletal ultrasound and magnetic resonance imaging.

AIM: To evaluate the frequency of tibiotalar and subtalar joints together with extensor, flexor and peroneal tendons inflammatory lesions in rheumatoid arthritis (RA) patients by using ultrasound (US) and magnetic resonance imaging (MRI). MATERIAL AND METHODS: Fifty RA patients and 25 healthy subjects were prospectively included. All patients and controlsunderwent clinical examination (to screen for swollen and/or tender ankles) and ankle US and MRI (to screen for synovialhypertrophy - SH, tenosynovitis and power Doppler - PD signals). The imaging tests were compared using overall agreement, positive agreement, Cohen's κ, sensitivity, specificity and positive likelihood ratio. RESULTS: The subtalar joint had the highest frequency of US-detected SH (30%), as well as positive PD signals (10%). Regarding US joint effusion, the tibiotalar joint recorded the highest frequency (44%). The most frequent US tenosynovitis was detected in the tibialis posterior tendon (40%). Compared to MRI, US evaluation of tibiotalar joints had very good agreement and large effect on detection probability for both SH and effusion (kappa 0.84, positive likelihood ratio 21.1). Compared to MRI, the sensitivity and specificity for US joint involvement ranged between 72.0-88.5% and 82.4-95.8%, and for tenosynovitis were 33.3-78.6% and 85.2-100%,  respectively. Compared to asymptomatic RA patients (n=25), those with at least one symptomatic ankle (n=25) had significantly higher frequencies of both SH and effusion in all the evaluated structures. CONCLUSION: US has high sensitivity and specificity in detecting RA inflammatory lesions in the ankle and rearfoot, in very good agreement with MRI. The high frequency of ankle inflammatory lesions in RA should result in increased interest in the imaging evaluation of these structures.

A referable clinical pattern of spondyloarthritis-associated uveitis.

Objective. The aim of the study was to identify a clinical pattern of spondyloarthritis (SpA)-associated uveitis in order to facilitate proper rheumatologic referral by ophthalmologists. Methods. Demographic data were recorded and acute phase reactants were measured using standard methods between May and August 2017, for all adult patients (age > 18 years) presenting with acute uveitis (standardization of uveitis nomenclature). Afterwards, they were referred to a rheumatology clinic to be screened for the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria of SpA. SpA and non-SpA patients were then compared using appropriate statistical tests (significant if p < 0.05). All the patients offered a written informed consent and the study was approved by the local ethics committee. Results. The sample included 67 subjects, of whom 32 (47.8%) were classified with SpA, of whom 21 were known with this diagnosis (median disease duration of 13.6 years), while 11 (34.4% of the SpA subgroup) fulfilled the ASAS classification criteria for SpA without a prior diagnosis. Compared to non-SpA patients, SpA patients were more frequently male urban dwellers, they were significantly younger, they had a higher prevalence of HLA-B27 and recurrent uveitis, and they had higher median of C-reactive protein and lower median of white blood counts. Conclusions. Uveitis is an important revelatory manifestation of SpA. Young men presenting in an ophthalmology department with acute anterior uveitis and inflammatory back pain should be referred to a rheumatology unit. Abbreviations: AAU = Acute Anterior Uveitis, AS = Ankylosing Spondylitis, ASAS = Assessment Of Spondyloarthritis International Society, CRP = C-Reactive Protein, ESR = Erythrocyte Sedimentation Rate, HLA = Human Leukocyte Antigen, IBP = Inflammatory Back Pain, IBD = Inflammatory Bowel Disease, IL = Interleukin, MRI = Magnetic Resonance Imaging, Nsaids = Non-Steroidal Anti-Inflammatory Drugs, SD = Standard Deviation, Spa = Spondyloarthritis, Tnfα = Tumour Necrosis Factor Alpha, WBC = White Blood Count.